Distortion 5: Methadone Treatment

Methadone programs around the world have been found to be effective measures both in reducing harms arising from opiate use and in helping people stop using opiates.

It is true that in 1996 The South China Morning Post reported on discussion of a report on Hong Kong’s methadone program by the Research and Library Services Division of the Hong Kong Legislative Council.

The report was prepared during the run-up to Chinese take-over of the Hong Kong colony, and the methadone maintenance program was a holdover from British rule and as such was not regarded highly by the incoming Chinese government. The report, while critical of the Hong Kong methadone program, noted the success of methadone programs in the US and Australia.

[Langendam, Miranda W., PhD, et al., "The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users," American Journal of Public Health, Vol. 91,

No. 5; "Effective Opiate Addiction Treatment - NIH Consensus Conference," Journal of the American Medical Association, Vol. 280, No. 22, Dec. 9, 1998, pp. 1936-1943).]

South China Morning Post, "Landmark experiment a sign authorities are willing to tackle growing mainland epidemic," November 17, 2001, from scmp.com.

The American Journal of Public Health reported in May 2001 (Langendam, Miranda W., PhD, et al., "The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users," American Journal of Public Health, May 2001, Vol. 91, No. 5) that:

"Our results support the hypothesis that harm-reduction-based methadone maintenance treatment decreases the risk of natural-cause and overdose mortality. Furthermore, our data suggest that in harm-reduction-based methadone programs, being in methadone treatment is important in itself, independent of the pharmacologic effect of methadone dosage. To decrease mortality among drug users, prevention measures should be expanded for those who dropout of treatment." (p. 779)

The Journal of the American Medical Association reported the NIH Consensus Statement on opiate addiction treatment in December 1998 ("Effective Opiate Addiction Treatment - NIH Consensus Conference," Journal of the American Medical Association, Vol. 280, No. 22, Dec. 9, 1998, pp. 1936-1943), which calls for expansion of methadone services. According to it:

"Conclusions.-Opiate dependence is a brain-related medical disorder that can be effectively treated with significant benefits for the patient and society, and society must make a commitment to offer effective treatment for opiate dependence to all who need it. All persons dependent on opiates should have access to methadone hydrochloride maintenance therapy under legal supervision, and the US Office of National Drug Control Policy and the US Department of Justice should take the necessary steps to implement this recommendation. There is a need for improved training for physicians and other health care professionals. Training to determine diagnosis and treatment of opiate dependence should also be improved in medical schools. The unnecessary regulations of methadone maintenance therapy and other long-acting opiate agonist treatment programs should be reduced, and coverage for these programs should be a required benefit in public and private insurance programs." (p. 1936)

It is true that in 1996 The South China Morning Post reported on discussion of a report on Hong Kong’s methadone program by the Research and Library Services Division of the Hong Kong Legislative Council. The report by the Research and Library Services Division of the Hong Kong Legislative Council, "Methadone Treatment Programmes in Hong Kong and Selected Countries," is available online att
http://www.legco.gov.hk/yr97-98/english/sec/library/956rp12.pdf

The report was prepared during the run-up to Chinese take-over of the Hong Kong colony, and the methadone maintenance program was a holdover from British rule and as such was not regarded highly by the incoming Chinese government. Methadone programs around the world have been found to be effective measures both for reducing the harm from opiate use as well as for helping people stop using opiates. According to the report in question:

"52. In the past five years, the number of registered methadone patients as at the end of each year maintained at about 9,000-11,000. Almost all of them received maintenance instead of detoxification treatment." (p. 9)

The programs themselves have a high dropout rate, and a low attendance rate:

"53. Patients who fail to attend the programme for twenty-eight consecutive days are considered as drop out. If they choose to join the programme again, they have to undergo the readmission process. In each of the past five years, about 9,000 drug addicts dropped out and over 80% of the registered patients were readmitted drug addicts, indicating large mobility of patients. (Appendix 5)

54. Each registered patient is allowed to receive methadone treatment once per day. The average daily attendance had decreased from 8,035 in 1991 to 6,401 in 1994. However, such figure bounced back to 7,002 in 1995, representing 71% of the average effective registered patients in that year. (Appendix 5)" (p. 9)

The programs are cost-effective in a sense, but since they are intended for maintenance, the report notes, they have a low graduation rate:

"60. Since there is no information on the duration of a methadone patient staying in the programme, it is difficult to estimate the total cost spent on each methadone patient in order to keep them away from drugs. As the average attendance is about 70%, the cost to maintain each patient in the programme is estimated to be HK$4,000 per year. As methadone programme in Hong Kong is chiefly for maintenance purpose, the number of patients successfully detoxified since the introduction of the programme was only 227." (p. 10)

Overall, the report was quite critical of HK's methadone maintenance program:

"72. According to the information provided by the Narcotics Division, only 227 methadone patients had been successfully detoxified since the implementation of the programme. A one-day survey conducted in July 1995 by the Department of Health also indicates that almost 50% of methadone patients had stayed in the programme for more than fifteen years. While it is noted that the present programme is basically for maintenance instead of detoxification purpose, the large number of drop-out cases and readmissions suggests that the patients are not maintained in the programme in a stable manner." (p. 13)

"74. The present methadone treatment programme cannot help drug addicts to achieve a drug-free state. It is also not known to what extent opiate dependence is reduced through participation in this programme. To evaluate the effectiveness of the programme in this respect, results of the urine tests taken on methadone patients by the Department of Health would be extremely useful. It is regrettable that such data are not published nor provided to the researcher." (p. 14)

On the other hand, the report notes there are pragmatic reasons why HK's methadone program can be seen as useful and effective:

"75. It can be noted from the analysis in paragraphs 64-74 that methadone treatment programme is not particularly helpful to drug addicts themselves in improving their employment status, reducing the use of needles and abstaining from drugs. However, as there is a strong correlation between the price of heroin and programme attendance, there appears to be a need for the availability of an easily accessible means of substitute in case of an upsurge in heroin price.

76. As the unemployment rate among drug abusers is high, and over $200 on drugs per day is spent by each drug addict, some addicts may be driven to committing crime if methadone is not available. There will be a marked deterioration in the crime situation even if a small proportion of methadone patients engage in crime, as indicated by the comparison of the number of quick-cash crime and registered methadone patients below." (p. 14)

The report also notes that other countries have had better results with their methadone programs. For example, the US:

"79. Research conducted on the US programmes indicates that the effectiveness of methadone treatment varies greatly with the dose prescribed and the competence of the counselling services. It is found that the longer the patients remain in treatment, the lower the use of heroin, HIV seroprevalence and criminal behaviour. There is also marked improvement in the general health and nutritional status of the patients. Since criminality and risk of HIV/AIDS exposure has reduced, methadone treatment effectively reduces economic and social burdens." (p. 15)

and Australia:

"80. In Australia, it is estimated that 30,000-50,000 individuals regularly and 60,000 individuals occasionally abuse heroin. The number of methadone patients was about 1,000 in the early 1980s, but had increased to over 7,000 in 1990. The increase is due to the fact that methadone is now perceived as an effective intervention to prevent the spread of HIV infection among drug abusers. As a result, there has been a remarkable increase in methadone maintenance services and additional funding has been allocated to improve staff training for methadone programmes. Although methadone is the main drug approved for the management of heroin dependence, on occasions, other drugs such as codeine, dextramoramide, buprenorphine or oxycodone may also be prescribed." (p. 15)

More Current Information on Methadone:

Again, this report and the negative press occurred in 1996. Contrast this attitude with a recent report in the South China Morning Post on November 17, 2001: "Landmark experiment a sign authorities are willing to tackle growing mainland epidemic," abstract from scmp.com: "China is to launch its first project using methadone to help drug-users beat their addictions, state media reported yesterday, in a further sign the mainland is taking its Aids crisis more seriously."

A report in the South China Morning Post from July 24, 2000, indicates that buprenorphine may replace methadone as a preferred treatment (on the web at http://www.mapinc.org/newscsdp/v00/n1042/a04.html, "Study Finds Near Perfect Drug Addiction Remedy"). Note particularly that the success rate for methadone treatment in Hong Kong is given here as 70%, though with a caveat.

"A medicine used as a painkiller has a near total success rate in helping heroin addicts quit and could become a replacement for methadone, researchers have reported.

Dr Dominic Lee Tak-shing, an associate professor at the Chinese University's department of psychiatry, co-ordinated the study, which found that buprenorphine worked on 109 out of 110 addicts. The trial involved patients at the new Caritas Wong Yiu Nam Drug Abusers' Rehabilitation Centre, which opened in April.

The success rate of methadone treatment in Hong Kong is about 70 per cent, but the figures do not take into account those who relapse over a period of time after treatment.

Dr Lee said the subjects were free of addiction after three days of treatment, which costs $100 per patient, and showed milder degrees of withdrawal symptoms such as vomiting, pain in the bones and tiredness. The methadone treatment takes three weeks."

Another article in the South China Morning Post, from June 20, 2000, "Amnesty for Addicts to Register," available at:
http://www.mapinc.org/newscsdp/v00/n842/a10.html

notes that China now admits that it has a huge and growing drug use problem:

"China’s chief anti-drug official reported in March that China had 681,000 drug addicts last year, a 14 per cent increase over the previous year."