Academic journal article Bulletin of the World Health Organization

The Methadone Fix: There Is No Miracle Solution to the Addictive Grip of Opioid Drugs Such as Heroin, Writes Patralekha Chatterjee. New WHO Guidelines Confirm That, Even after 40 Years, Substitution Therapies Such as Methadone Are Still the Most Promising Method of Reducing Drug Dependence, but Getting Access to Treatment Is a Global Problem

Academic journal article Bulletin of the World Health Organization

The Methadone Fix: There Is No Miracle Solution to the Addictive Grip of Opioid Drugs Such as Heroin, Writes Patralekha Chatterjee. New WHO Guidelines Confirm That, Even after 40 Years, Substitution Therapies Such as Methadone Are Still the Most Promising Method of Reducing Drug Dependence, but Getting Access to Treatment Is a Global Problem

Article excerpt

In the global battle against illicit drugs, stemming the crisis of opioid dependence poses a grave challenge.

The World Health Organization (WHO) is issuing guidelines to help countries treat dependence on opioids and prevent the transmission of HIV and other blood-borne infections.

The United Nations Economic and Social Council (ECOSOC) and the Commission on Narcotic Drugs invited WHO in collaboration with the United Nations Office of Drugs and Crime (UNODC) to develop the guidelines--to be published in the coming months.

"These constitute the first attempt to compare different approaches to the management of opioid dependence in a systematic way," says Dr Nicolas Clark, Medical Officer in WHO's Mental Health and Substance Abuse Department.

Globally, there are around 16 million illicit opioid users; 0.4% of the total population in the 15 to 64 age group. Of those, 11 million people abuse heroin, according to the 2007 Worm drug report. Opioids are naturally occurring opiates and synthetic and semi-synthetic drugs that act on opioid receptors in the brain and can cause dependance due to their euphoric effects. Heroin is an opioid. Other examples are morphine, methadone and buprenorphine, widely used as pain-killers.

The battle against opioid dependence is at its grimmest in the countries in and around Afghanistan, which accounted for nearly 93% of the global opium production in 2007. "Opiate addiction is increasing in the countries neighbouring Afghanistan, including India, the Islamic Republic of Iran and countries in central Asia, and along the east coast of Africa. In contrast, the situation is largely stable or even declining in most of Europe, North America, and several parts of east and south-east Asia," says Dr Thomas Pietschmann, of UNODC's Policy Analysis and Research Branch.

Perhaps one of the most surprising findings of the new WHO guidelines is that methadone maintenance treatment--a treatment that has been around for over 40 years--is still regarded as the most effective.

But one of the key global issues is access to treatment. Less than 650 000 people are thought to be receiving substitution treatment globally for opioid dependence, less than 10% of those in need of treatment. Opioid substitution therapy is the medically supervised administration of a psychoactive substance that is similar to the one producing dependence.

In countries where opioid substitution is widely available, 40-50% of drug users receive treatment. Most of the unmet need for treatment is in Asia and eastern Europe, particularly in China, India and the Russian Federation.

The two most common agents used for substitution therapy are methadone and buprenorphine. Used in this way, these substances have a stable non-intoxicating effect, while diminishing the effects of any additional opioid use.

This long-standing treatment was endorsed in 2004 by WHO, UNODC and UNAIDS (Joint United Nations Programme on HIV/AIDS) in a joint position paper. The three agencies argued that there was consistent evidence to link substitution therapy for opioid dependence with substantial reductions in illicit use, criminal activity, deaths due to overdose, and behaviour that leads to a high risk of HIV transmission.

But various political, social and cultural factors impede the expansion of methadone (or buprenorphine) treatment for opioid addicts.

In many countries, methadone and/or buprenorphine maintenance treatment is unavailable or illegal. For example, though the Russian Federation has one of the highest rates of opiate use in the world, "substitution therapy by methadone and buprenorphine is forbidden by law. All treatment for drug abuse in the Russian Federation is abstinence oriented," says Dr Evgeny Krupitsky, Psychiatrist, Leningrad Regional Dispensary of Narcology.

Access to methadone depends on how strictly governments apply control measures to this narcotic. …

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