Drug Replacement and Maintenance Therapy

Methadone is the most widely-used maintenance treatment. Used properly, methadone reduces drug use and related crime, death, and disease among heroin users. But methadone has been handicapped by restrictive government regulations, by misinformation - among treatment providers and drug users alike - and by prejudice against methadone treatment. Methadone is the most tightly restricted drug in the U.S. Doctors in general medical practice can't prescribe methadone, and regular pharmacies don't distribute it. Buprenorphine is a newer medication that has also been shown to be effective and it can be prescribed by physicians who have gone through special training. The Drug Policy Alliance advocates for making both methadone and buprenorphine more accessible, through changing attitudes, laws, regulations, and health insurance policies. Funding must be increased for access to methadone and buprenorphine through the public health system for those who cannot afford it otherwise.
For drug users who have not found success with methadone, the most dramatic developments in drug substitution therapies have been in the field of Heroin-Assisted Treatment (HAT). HAT programs, as part of comprehensive treatment strategies, provide substantial benefits to long-term heroin users who have not been responsive to other treatment. Studies have shown that those enrolled in HAT demonstrate a reduction in drug use and an improvement in overall physical and mental health. Additionally, several studies have found that individuals who participated in these programs significantly reduced their involvement in criminal activities, generating large cost savings. Heroin maintenance may be a feasible, effective and cost-effective strategy for reducing drug use and drug-related harm among long-term heroin users for whom other treatment programs have failed.