Methadone can cut crime levels and give life back to heroin addicts

Methadone can cut crime levels and give life back to heroin addicts


This is a letter written by a doctor in reference to a letter by a psychiatrist who opposes methadone treatment. I will share both letters for the sake of disclosure. They were posted in the Irish Medical Times and the link is

http://www.imt.ie/opinion/2010/10/15978.html

Here was the first letter:

Detox is still the best option for addicts

it is worrying to think of the small towns mentioned that will dispense methadone because of the rising heroin epidemic.

The numbers of methadone addicts are set to increase by between 15,000 and 20,000. According to the Irish Examiner there are at least 500 heroin addicts in Limerick alone, where none existed five years ago.

If the present costs of providing the methadone scheme are €20 million for one year, why not spend the money wisely to commence a detox rehab programme to try and rehabilitate these young people, who will still be on methadone when they are grandfathers?

In England, only 3-4 per cent are given the chance to detox from heroin. This addiction problem is no different from alcohol addiction – and would you substitute vodka with Heineken? Also, further to my earlier letters to IMT over recent months, I am still receiving complaints from people who wish to have their family members ‘dried out’.

Ireland has a major alcohol problem and the Government is concerned. Yet there are no detox units in Ireland. Detox is to be commenced by general practitioners, but some individuals do need hospitalisation. Yet the psychiatric hospitals will not admit them; neither will the general hospitals. The private hospitals, however, will admit.

To enter a residential addiction treatment programme, one must be alcohol free and detoxed.

Thus, if one cannot be detoxed, the alcoholism rate will continue to rise and the physical complications will increase.

A new alcohol detox policy is what is needed in Ireland.

Dr M. Bhamjee
Consultant Psychiatrist,
Ennis

Here is the response from the doctor supporting MMT.

Can a consultant psychiatrist really be so naïve with regard to the scourge of heroin addiction and its management? I refer to Dr M Bhamjee and his recent letter to the Irish Medical Times

Heroin per se is not the whole problem. Rather, it is its illegality and the consequential associated lifestyle that goes with it that destroys lives.

Heroin requires ingestion/injection several times daily and a 24-hour commitment to access funds to feed the habit. This lifestyle incorporates criminality, risk of infection, disease and overdose, with little or no capacity to maintain a normal life, hold down a job, rear a family, et cetera.

Methadone, on the other hand, requires once-daily ingestion taken orally and, of course, is given free of charge. Crime is no longer necessary and the risk of infection/disease is eliminated. But the really crucial issue for the patient is that they are given their life back, once the lifestyle required to maintain a heroin addiction is no longer necessary.

To compare substituting methadone for heroin with exchanging two forms of alcohol is an insult to this newspapers reader’s intelligence. Dr Bhamjee makes much of the fact that patients on methadone maintenance may be taking methadone all their lives and indeed into old age. I know many patients well approaching the golden years who are prescribed slow-release opiate analgesia for chronic intractable pain. What is the difference? Perhaps it is, Dr Bhamjee, that the former heroin addicts reach old age ‘because’ of methadone treatment and not in spite of it.

In an ideal world, all patients would rush for detoxification, be offered a place and successfully detox. In practice, patients generally request, and are most suitable for, methadone maintenance. They do not request detoxification until they are mentally ready to do so, and it is this scenario that offers the best chance of success, whether as an inpatient or outpatient.

Whatever the circumstance, the detoxification failure rate is very high. You cannot force a patient to detox any more than you can force an alcoholic to give up drinking.
Get real, embrace methadone maintenance and do your community a favour.

Dr John O’Grady MICGP,
Addiction services,
Aisling Clinic,
Ballyfermot, Dublin.