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by Dr Michael Farrell
Methadone prescribing
remains a highly controversial and contentious activity. Despite reasonable
evidence of its benefits there remains a deep suspicion and antipathy
among drug users, drug services, professionals and the broader community
to methadone and other substitute prescribing.
The generality of
this negative attitude makes the long-term viability of such services
uncertain and very vulnerable to hostile criticism. Much of the discussion
and criticism are based on belief systems, be these treatment, religious
or philosophical. Some such criticism may not be amenable to change in
the light of empirical evidence on the effectiveness of substitute treatment.
This book provides
a comprehensive background on the history, research, pharmacology and
legal aspects of methadone prescribing. It focuses on this single substance
in practical aspects of assessment, treatment aims, dosages and detoxification
and should be a valuable reference for workers in the field.
In looking at substitute
prescribing there are three dimensions of consideration:
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The type of drug
prescribed and its properties, the administration system which includes
whether the drug is taken on or off site and whether it is consumed
with or without supervision
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What other sorts
of rules and contingencies are associated with the administration
of the drug, and
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The types of psycho-social
interventions associated with the first two, including vocational
training, education, counselling, psychotherapy, physical health care,
and welfare and legal rights information.
It is clear that methadone
prescribing can be well done or badly done, and badly delivered methadone
treatment may be substantially worse than badly delivered treatments that
do not involve prescribing. The principle of 'do no harm' needs to be
carefully observed in the context of substitute prescribing.
Andrew Preston has
performed a monumental and scholarly task in pulling all this information
together.
The section on the
history of methadone should put some well worn myths to rest: in particular
the text points out that the name 'Dolophine' - which was reputed to be
derived from Adolf Hitler - was not in fact created as a trade name until
after the war, by the Eli-Lilly pharmaceutical company, and was probably
derived from the French words 'dolor' (pain) and 'fin' (end).
Finally as the area
of substitute prescribing becomes more textured, issues such as the balance
between short-term maintenance and long-term maintenance and oral and
injectable prescribing is well argued and will provide the basis for further
discussion on these subjects.
I am certain that
this text will be a valuable guide for those embarking on the challenging
but rewarding task of working with drug users to help them achieve greater
control over their lives.
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