NDARC Technical Report No. 45 (1997)
Summary of conclusions
Methadone is a long-acting opioid analgesic with well-understood pharmacological characteristics which make it suitable for stabilising opioid dependent patients in a maintenance treatment approach.
Methadone maintenance treatment is one of the best researched treatment option for opioid-dependent individuals, being demonstrated to be more effective than either no-treatment, drug-free counselling and rehabilitation, placebo medication, and detoxification/withdrawal in randomised controlled trials. The research fromdiffering countries shows consistent benefits in terms of reduced illicit opioid use, reduced criminal behaviour and improved social functioning.
The evidence shows that methadone maintenance therapy is associated with a lower risk of death compared to that associated with no treatment, drug free treatment or detoxification/withdrawal. Methadone maintenance treatment protects users from death due to over-dosage of opiates, particularly heroin, and thus achieves an important health outcome.
Methadone maintenance treatment has been repeatedly shown to be associated with lowered rates of HIV infection. Observational study and natural experiment findings converge to show a consistent protective effect against this infectious disease of being in methadone maintenance treatment. The ability of methadone maintenance therapy to protect against hepatitis B and C infection is less well established.
Methadone maintenance treatment repays $4-$5 to the community in terms of reduced health care costs, reduced crime and other benefits for every $1 spent on it.
Almost all clients attending Queen’s Court Clinic live in Wentworth or Western Sydney Area Health Services. Notably, of clients who live in Wentworth but receive methadone elsewhere, 65% access clinics in Western Sydney. Wentworth AHS catchment area data are similar showing 54% methadone clients living in and attending home AHS and 42% residing outside Wentworth region (Drug and Alcohol Directorate, NSW Health). Therefore clients are crossing into the neighbouring Area Health Services to receive methadone. Results do not indicate that Queen’s Court Clinic is attracting new residents to Wentworth AHS and those clients living in Wentworth AHS have been for sometime (average number of years 8). Furthermore, clients reported visiting St. Mary’s shopping area in the context of clinic appointments and then leaving the area.Methadone therapy was associated with improvements in client’s quality of life as indicated by better health, family and social life and employment as well as decreased heroin use and involvement in illegal activities. Urine analysis data substantiate self reports of decreased heroin use since attending the clinic.