Methadone As Normal Medicine

European Methadone Association
27 rue de la Vanne
1050 Brussels,
Belgium
Tel + Fax : 322 640 46 28
[email protected]

SUMMARY

Methadone prescribing increased tenfold in the last four years
in Belgium. This has been made possible through involvment of general
practitioners in methadone treatment. Drug overdoses, crime and even presence of
methadone on the black market have decreased at the same time.

Introduction

During the last four years, methadone consumption in Belgium increased
tenfold (From 6 kg/year in 1990 to 58 kg/year in 1994). This fact may seem
insignificant because it concerns a country with a population no higher than
that of New York City and whose precise geographic location may not be known to
everyone. However the Belgian experience might demonstrate that it is possible
to overcome certain limitations of methadone treatment as it is generally
practiced.

Legal confrontation

Methadone has been available with a prescription in
pharmacies since the 1970’s. But physicians who began to prescribe it to addicts
at the beginning of the 1980’s, when the heroin epidemic was worsening, were
often subjected to disciplinary sanctions by the Belgian Medical Association and
sentenced by courts of justice.

At the beginning of the 1990’s a group of physicians, including myself,
requested that the Supreme Court revoke the Medical Association’s regulations
permitting the indictmemt of physicians prescribing methadone and other
substitution treatments. This request was granted. Subsequently, the regional
authorities of the French speaking part of Belgium began to encourage physicians
to treat opiate addicts with methadone. The authorities became aware of drug
addiction’s impact on criminality and on the AIDS epidemic. They knew that it
would be impossible to extend rapidly the number of methadone clinics and they
also wanted to avoid stigmatizing heroin addicts. To encourage the treatment of
addicts in normal settings, they allocated funds for training sessions for
general practicioners on treatment of drug addiction.

Consensus Conference

Another measure which permited a rapid expansion of
methadone treatment was the organisation of a Consensus Conference on Methadone
Treatment by our Minister of Health. The conclusions of the Consensus Conference
were sent to every doctor in the country, as new guidelines for methadone
treatment. They stated the following points :

• Methadone is an effective medication for the treatment of heroin
  addiction.
• Methadone reduces heroin consumption and injection, reduces mortality
  related to heroin addiction, reduces the risk of infection with HIV as well as
  hepatitis B and C, improves therapeutic compliance of HIV-positive drug
  addicts, facilitates detection of illness and health education strategies and
  is associated with an improvement in socio- professional aptitude and a
  reduction in delinquency.
• Prolonged treatment with proper doses of methadone is medically safe.
  At present, methadone has not been shown to be toxic for any organ.
• There is no scientific reason to limit the overall number of heroin
  addicts admitted for methadone treatment.
• Availability of methadone treatment should be increased to respond to
  the need for such treatment, including by private practitioners.
• Psycho-social support is not compulsory and should be adapted to the
  individual needs of patients.

These conclusions are in no way
revolutionary on the scientific level, but as official guidelines for methadone
treatment, they represent a significant innovation, compared to what happens in
a lot of countries. Methadone is now dealt with as an ordinary medication. Its
effectiveness is recognized without ambiguity. No longer is it considered an
experimental treatment, accessible only to a limited number of patients and
subject to rigid controls. No longer are patients required to have attempted
previous withdrawal treatments. Addiction can be ascertained by spontaneous
withdrawal attempts recounted during patients history. Urinalysis is done only
following doctor’s decision.

It is specified in our new guidelines that dosage and duration of treatment
should not be limited, but adapted to each patient by the physician. It is
acknowledged that short-term methadone treatment are appropriate only in certain
very particular cases. Daily administration of methadone is not compulsory, but
recommended at the beginning of treatment and will generally take place in a
pharmacy chosen by the patient. The physician is free to prescribe larger
quantities of methadone at less frequent intervals, depending on how the patient
evolves.

Conclusion

The number of heroin addicts undergoing methadone treatment
is increasing and now reaches 5.000, out of an estimated total number of heroin
users of 20.000 to 30.000. More than 80% of these patients are being treated by
general practitioners. Hundred of general practitioners are currently involved
in methadone treatment. Most patients receive methadone provision for one or two
weeks, but the presence of methadone on the black market has decreased, since
less addicts are seeking methadone on the streets. Drug overdoses and
criminality have decreased. Thus the very flexible method of prescribing
methadone used today in Belgium seems to have resolved some problems and does
not seem to have created any.

Thank you.

Marc REISINGER
27 rue de la Vanne
1050 Bruxelles

Belgium
Tel + Fax : (322)640 46 28

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