EURAD: Europe Against Drugs ()

Part TWO

Methadone - Important to know

Methadone is a synthesised opiate replacement substance with effects which can be very similar to the opiates (opium, morphine, heroin). Methadone differs from the opiates mainly by having a very long-lasting effect in the body (24-36 hours compared to 3-4 hours for heroin). It is effective only on addiction of opiates and therefore not useful in the case of other chemical dependency states such as with alcohol or cocaine. It cannot be used against drug addiction in general.
Methadone, which is a strong drug, gives rise to dependency.
When methadone, likewise opiates, leave the body, disagreeable physical abstinence/withdrawal symptoms arise.
Methadone's long lasting effect constitutes the base on which the pharmacologist Dole developed his special methadone maintenance method for the treatment of opiate addicts.
When dosage is well assessed and adjusted, the heroin addicted who receives his daily dose of methadone finds his craving for heroin is eliminated. Large doses of methadone totally block all effects of opiates, lower doses only partially. Large adjustment is therefore very delicate.
Methadone has been utilised for the treatment of opiate addiction (primarily heroinists since the mid-1960s and so therefore a fairly well tested and well documented method. Methadone was originally intended for elder, well-motivated addicts of so called therapeutic 1 type. Using methadone to curb opiate addiction of epidemic2 nature is another matter. Contrary to original intentions, methadone programmes which are not properly administered can contribute to a deterioration of the narcotics situation by supplying methadone to the drug market.
Methadone removes the motivation of the addict to become drug free.

Therapeutic type of addiction occurring after medication with dependence-producing drugs. In some cases, the heavy medication is a consciously taken risk, sometimes it is result of overmedication or lack of medical skill.

Addicts suffering form therapeutic type of addiction are mostly older people who are not likely to spread their addiction to other. The willingness or unwillingness to spread the habit is important, differing therapeutic type of addiction from epidemic type. See Bejerot, N:Addiction and Society (Springfield, IL:Charles C. Thomas, 1970)

Epidemic type of addiction is 1.a. characterised by its spread among friends who have been close contact with each other. The spread is mostly done in the early stages of drug abuse. Bejerot (19700 named that period "honeymoon of drug abuse", since the drug taker in that stage has pleasurable effects. NO bad side effects have yet occurred.

Strict Programme

Let us look at some of the experiences of maintenance treatment with methadone in Sweden. Well-controlled Swedish studies3 show that herionists who were treated in a maintenance programme managed much better than a control group which continued with heroin in constant euphoric doses. All this sounds good, especially since many of the methadone patients can certify that the method helped them to leave their drug environments and enter into an orderly social life. It is necessary, however, to know that the Swedish model did not accept anyone for methadone treatment who

had not tried and failed at last three times in serious efforts to achieve drug-free rehabilitation and is not dependent on any intoxicating agent other than heroin.
was under 20 years of age.
had injected heroin for less than four years.

This was a strictly guided high threshold and controlled programme in which the patient daily, under supervision, drank his methadone juice. Professional social and psychological counselling were necessary parts of the programme.

What can EURAD advise about methadone?

We can advise that methadone programmes have little or no place in communities that run efficient demand restrictive policies of prevention and early intervention with brakes all the way down the slope of drug abuse.

However, failing that and when communities introduce methadone programmes, we advise that some necessary conditions learnt from the above high threshold model must be placed at the outset.

that the addict is selected according to strict criteria
that the substance is, in principle, never given to the addict to take away, but must be consumed under the supervision of experienced personnel, to counteract methadone entering the illegal drugs market
that measures (e.g. urine tests under control forms) are taken in order to counteract the temptation to manipulate and to continue with poly drug abuse
that the programme is administered by experience and competent personnel
that the possibility of reducing programme is offered as an option after a preliminary period of stabilisation
that the programme should be operated under strict and scientifically tested forms
that methadone maintenance must always be accompanied by social and other necessary support
that methadone programmes can never replace measures taken to prevent or stop drug abuse at an early stage. Methadone is a substance, directed to chronic heroinists, NOT to teenagers or others in the early stages of drug abuse. Methadone is not and easy and cheap once for all solution. It is a measure that can even deteriorate the problem.
Early intervention will decide the future size of the addict population in our societies.

Bejerot calls "psycho-social contagion" really means that a drug taker who likes the effects of the drug and sees no ill effects, wants his friend to share this experience. Therefore, he willingly "advertises" his drug and declare its advantages. The novice, who is curious and trusts his friend, is tempted to try. If there are many friends using the drug, the peer pressure can be considerable. Jesus worded clearly this phenomenon of "advertising good or bad feelings" almost 2000 years ago: "The mouth speaks that the heart is full of".

Needle / syringe distribution

The discussion about distribution of free needles has much in common with the discussion of methadone. Naturally, EURAD does not doubt the good intentions behind the demand for free needles and syringes. But good intentions are not always the same as good actions and good results.
Exactly as with methadone, many find it difficult to imagine that a theoretically attractive model, which may have certain beneficial effects in individual cases, can have the directly opposite effect when put into large-scale use.

Different methods of needle distribution are a newer phenomenon than the distribution of methadone. The measure is primarily intended to be a preventive measure against the spread of HIV/AIDS.

There are, however, different opinions about the value of free needles. It is almost impossible to prove in a short-term scientific study whether such programmes have an effect on the HIV/AIDS-epidemic or not. Scientific reports on the subject do not give any clear-cut picture of the value of these programmes. The contradictory reports from the various syringe exchange programmes should be cause for consideration.

Important to know about drug users and needles/syringes

Intoxicated and confused addicts are likely to be careless with needles.
Drug users cannot be expected to act responsible under the influence of their drugs.
Drug users become impatient for the next injection of drugs and will not necessarily wait for a clean needle.
Some drug users refuse to stop the common ritual of sharing the needles.
The intravenous drug addict is threatened by death from many angles and not only by AIDS: overdose, accidents, intoxicated violence, etc.
Heroinists are sexually low-active, cocaine and amphetamine users in many cases are high active. While methadone is directed only to opiate addicts, needle distribution affects also abusers of stimulants.
HIV/AIDS is spread more by sex that by sharing needles.

Objections

The objections which are usually directed against needle/syringe distribution programmes are:

A ). The programmes reduce the threshold against intravenous drug abuse and thus encourage injecting among those who still take drugs orally or by sniffing.

B ). Society is stimulating a destructive and dangerous practice

C ). Syringe exchange programmes often claim that they get a majority of the syringes in return. Even if that is the case, that means discarded needles/syringes left lying around in parks, beaches or other public places. They pose a health risk to the completely innocent children playing there and to the general public in all.

D ). Discard needles/syringes become desirable articles of trade for addicts outside the distribution programmes.

E ). Focusing on needles/syringes might make society forget that HIV/AIDS is spread to a greater extent by sex than by the sharing of needles/syringes. Drug taking impairs judgement, and heterosexual contacts between addicts and non-addicts is proving to be a major route for the spread of HIV/AIDS in the future. Addicts, in many cases, are only mildly interested in using free condoms. The intoxicating effects of the drugs might also simply make them forget to use condoms.

F ). A syringe exchange programme in Malmö/Lund, Sweden has shown some discouraging results. An example is that the spreading of hepatitis B (a blood borne virus) continued undiminished despite access to clean syringes. This indicates that free syringes by no means is guarantee for HIV/AIDS-free drug taking. It cannot be scientifically proven that this programme has had any effect on suppressing the HIV-epidemic.

What can EURAD advise about needles/syringes?

In view of the above, we maintain and emphasise that needle/syringe distribution programmes, as well as poorly controlled methadone programmes, have no place in communities that run efficient demand restrictive policies of early intervention what brakes all the way down the slope of drug abuse.

However, having failed that and faced with communities like Merseyside (England) who did not listen to the pleas of parents not to introduce needle distribution programmes in the first place, we hope that communities invest more resources into education and prevention leading through to drug free treatment. We understand it is unrealistic to abolish these needle programmes overnight but we do not advise any community to start up new programmes.

We also advise communities to remember that needle/syringe programmes promote a dangerous behaviour and life style which might increase the risk of spreading HIV/AIDS.

It is possible for communities to reduce the grave practice of drug abuse. It has been done in many different countries at different times- and it can be done again.

EURAD wishes to state clearly that it is drug abuse which is the source of the drugs epidemic.

The main question is how we can force drug abuse into retreat-not how we can make it safer. Free syringes to addicts can increase drug abuse by giving the impression that under these conditions abuse is safe.
What in the short-term appears to be "harm reduction" may in the long-term prove to be "harm production"

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