Methadone in the Treatment of Narcotic Addiction. Forward and Table of Contents

A Note to the Reader

While every care has been taken to ensure that the content of this book is accurate, the author and publisher do not accept legal liability for any problems arising from the implementation of the various treatment strategies outlined therein. The mortality amongst street drug users is such that deaths are occasionally encountered in this type of practice. The aim of this work is to assist physicians and others working in the field to ease the suffering of those affected by heroin addiction and to reduce this mortality as far as possible.

Dedicated to my many patients who have educated me about addiction, and especially to those who have suffered from HIV, overdose and other complications which may have been avoided had methadone treatment been more widely available.

Thanks are due to Dr Alex Wodak of Sydney who first kindled my interest in this field and to Dr Robert G. Newman of New York for encouraging my first foray into research. My gratitude also to the many people from both private and public practice who made helpful suggestions during the book's genesis. Anne Love and Allan Gill also deserve special thanks for their tireless work on the manuscript.

Forward

This book is intended for the practising physician wishing to prescribe methadone in the treatment of heroin addiction. It contains the lessons learned by a general practitioner during ten years of practice in this field. Far from being the last word on treatment, it merely represents one physician's approach to a complex problem.

While many doctors have ambivalent views of methadone treatment, most are aware of some patients who have functioned normally in society for extended periods while taking the drug. Rather than being exceptions, such patients may represent the majority. The conspicuous few who continue to use illicit drugs create a slanted impression of this treatment. With society's consequent prejudice, those who are leading normal lives are unlikely to advertise the fact that they take methadone.

It has been well documented that much methadone treatment provided is still inadequate and difficult to access. One patient found it more convenient to fly from Boston to New York every two weeks to collect her methadone doses, rather than suffer the rigours of the local treatment program. It has also been shown that improvements in the delivery of methadone are associated with improvements in outcomes. Professor Dole now states that by providing good quality methadone treatment, complete abstinence from heroin can be achieved by 95% of patients. The HIV epidemic has made this goal even more relevant.

Undergraduate teaching still has inadequate drug and alcohol content, and this 'primer' is intended to help bridge that gap. Although methadone has often been provided in large clinics, its use has always been based on the ethical and legal framework of other medical treatments. Many authorities now believe that this form of treatment is not fundamentally different from other areas of medical practice, where accurate diagnosis, advice and judicious prescribing with appropriate supportive measures are associated with predictably favourable outcomes.

There are some reports of general practitioners treating numbers of such patients without disrupting the smooth running of their medical practices (1,2,3). Two Australian States, Victoria and South Australia have recently permitted methadone prescription from private doctors offices. Belgium, France and Germany have also recently introduced this form of treatment after many years of virtual prohibition.

The challenging field of drug and alcohol medicine can be as rewarding as any medical endeavour. The use of methadone should be taken up by general physicians who are best placed to optimise its use. Indeed, it is intrinsic to the Hippocratic philosophy to utilise every available modality in our patients' interests.

TABLE OF CONTENTS

A New Treatment Theories

Behind Methadone Treatment

Commencement of Treatment

Routine Methadone Maintenance Problems

After the 'Honeymoon'

'I Want Out'

Patients with Other Medical Conditions

Life After Methadone

Dispensing Methadone

People Issues

Case Histories

Appendices

Selected Reading

References

ABOUT THE AUTHOR

Andrew Byrne is a third generation medical practitioner from Sydney. Following six years working in inner city hospitals, he went into general practice where he first treated drug addicts in 1984. He was the first general practitioner in New South Wales approved to prescribe methadone for addiction and has treated up to 120 patients at a time over a ten year period. Having studied methadone treatment facilities in Brighton (England), Hong Kong, New York and San Francisco, he has developed a successful rehabilitation strategy based on the medical model originally proposed by Dole in 1965. The general practice setting has allowed observation of long-term outcomes in patients who have completed methadone treatment. Dr Byrne presented his practice profile to the National Methadone Conference in Sydney in November 1994. He has been published widely in Australian medical journals on various drug and alcohol issues including the use of nicotine patches, benzodiazepine addiction as well as politically viable alternatives to the prohibition of drugs.