Methadone treatment for opiate addicts

When properly regulated, still a valuable outpatient treatment

Thirty years have passed since the first report of the effectiveness of methadone maintenance.1 At the time the approach was viewed as close to miraculous, because it was the first outpatient treatment that heroin addicts would attend reliably. Since the early studies hundreds more have shown that maintenance treatment with methadone reduces (though it does not eliminate) the use of opiates and criminal behaviour. However, papers in this issue of the BMJ highlight the need for adequate supervision of methadone treatment.

A recent review in the European Archives of Psychiatry and Clinical Neuroscience confirmed that maintenance treatment using methadone not only reduces illicit use of opiates and criminal actions but also lowers the risk of HIV infection and its associated mortality and improves social rehabilitation.2 The same enthusiasm for methadone is apparent in the United States, where the Institute of Medicine recently published a review that endorsed the effectiveness of this type of maintenance treatment3—a verdict in line with other …