Dear Editor,
Dr Moosajee Bhamjee (IMT, July 9, page 11, ‘Swapping one illegal drug for another legal one’; see www.imt.ie/opinion/letters/2010/07/swapping-one-illegal-drug-for-another-legal-one.html) is grossly inaccurate in stating that “methadone was to be prescribed for only a minority (10 per cent) of heroin addicts who had failed to abstain”.
The treatment of choice for heroin addiction is opioid-agonist treatment and is supported by numerous studies stretching over 40 years. It needs to be stressed that the outcomes for detoxification from opioids are poor.
As Dr Cathal Ó Súilliobháin highlighted in his original response (IMT, June 11, ‘Resources must target proven treatments’; see www.imt.ie/opinion/letters/2010/06/resources-must-target-proven-treatments.html), there is the added risk of fatal overdose due to loss of opioid tolerance.
This is a serious consideration and forcing patients to come off methadone is increasing their risk of death.
There is no evidence to support the contention that increasing the number of inpatient detox units improves outcomes. In fact, the opposite is likely to be true, as more patients are likely to take the detox option.
It puzzles me why heroin addiction, recognised by the WHO as a chronic relapsing condition, seems in the eyes of many to be less deserving of long-term medication. No one, for example, would insist that type I diabetics stop their insulin or that those with high blood-pressure stop anti-hypertensive therapy.
Why? Because these medications are protective against adverse outcomes. Heroin addiction is not that different. Methadone maintenance treatment saves lives and improves mental, physical and social health. Whilst patients are entitled to detox, it should be their choice, and their choice only, and they should be informed of the risks.
Dr Garrett McGovern,
GP Specialising in Substance Abuse,
Sandyford, Dublin 18.
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Sadly, in the UK only 2-3 per cent of those desperately seeking help are given the opportunity of becoming drug free, being diverted in their vulnerable state to a drug which is more addictive than heroin, harder to withdraw from, increasingly damages their cognitive functions so that they cannot make the decision to recover – and is the second-greatest killer after heroin. I refer to the substitute medication methadone, which patients can be on for literally decades and three generations of a family.
People who wish to come off drugs must be given that chance, not demotivated with scripts.
There is a role for substitute drugs in detoxing and engaging clients, even stabilising them. But do not confuse that with true treatment which leads to lives independent of drugs, indepdendent of prescribers, independent of state benefits – lives free of drugs which reassure their families allowing them to build healthy relationships, and so much more.
Get people off drugs, when they want, via rehabs, quasi-residential rehabs, daycare programmes. The overwhelming body of research shows that these work best when linked with 12 step programmes for long-term free support.
Deirdre Boyd
CEO – Addiction Recovery Founation
charity no 328133
193 Victoria Street, London SW1
“Addiction is not a consequence of taking drugs and drinking. Rather, it arises from the way in which these and other compelling activities fit into people’s lives and meanings.”
Stanton Peele, Ph. D., J.D
http://www.peele.net/about/cv.html