There is a very powerful case for the immediate phasing out of publicly funded methadone treatment. There is now no doubt that methadone is a deadly drug that kills many young people every year.
The latest research shows that methadone is four to six times more dangerous and leads to more overdoses and deaths than does buprenorphine, the other agonist medication often used as a treatment. Both are highly addictive drugs that tend to prolong drug use and addiction. And both can be lethal.
Choice of poisons
In some jurisdictions methadone is responsible for more deaths than heroin. In Scotland between 2011 and 2013, methadone was found to be implicated in 663 deaths, while heroin and morphine were implicated in 538 drug deaths. In England and Wales between 2007 and 2012 methadone contributed to some 2300 deaths.
In Australia it is a major contributing cause of 200 to 300 deaths each year. Based on statistics relating to the lethality of different drugs it has been found that methadone is more toxic than heroin.
Moreover, the longer people use these drugs the more likely it is that they will continue to inject drugs and to die. Health outcomes on methadone and buprenorphine are arguably worse than for someone who just uses heroin or prescription narcotics.
Claims are made that since methadone prevents HIV transmission and kills fewer people than heroin, then a few deaths, mainly of people who are sold or given methadone, are acceptable. The facts are that methadone has yet to be shown to have prevented a single case of HIV infection or that it is less lethal than heroin.
The conclusion from a review of all the controlled studies (Cochrane Reviews, 2004 and 2009) is that methadone is no better than no treatment when it comes to mortality and criminality, and that there is no convincing evidence to support the idea that it prevents HIV infections.
Yet this distortion of the evidence justifies the deaths that it causes and the millions of dollars spent each year to provide it to those who are hopelessly addicted to it. On any single day in Australia, some 48,000 addicts use methadone or buprenorphine. Many cycle on and off these drugs and many others buy them on the street, so the total numbers who use them to sustain their addiction is unknown.
Statements that methadone has been highly useful in the fight to contain HIV transmission are not based on any evidence. No controlled studies have been done, despite the industry’s use of HIV scare tactics to persuade governments to invest millions of dollars in providing methadone.
Moreover, the statistics relating to HIV transmission due to injecting drugs are unconvincing. First, only 3 to 4 per cent of HIV transmission is believed to be due to sharing injecting equipment. Among the most at risk groups the drugs injected are mostly amphetamines, not opiates. Methadone is not a substitute treatment for amphetamines.
Second, methadone, although it reduces injecting, retains people on the drug for longer and injecting continues for longer, albeit at reduced rates. It has played, at best, a negligible role in HIV prevention. Risky behaviour is common to both drug use and HIV transmission. It does not mean that one causes the other.
Moreover, studies show that methadone users tend to stay addicted much longer than does the average heroin addict. I suggest this is why people are at greater risk on methadone (quite apart from those who are not in treatment and who die using diverted methadone). When you add the risk posed by black-market methadone, it is even harder to justify its continued funding.
Claims that methadone reduces mortality and criminality are misleading. Cochrane Reviews of the research – the gold standard – say otherwise.
Over many years academics have defended the use of this deadly drug that prolongs and entrenches addiction. The number of people dosed daily has grown, although their average age is rising. Many on this drug have been trapped in “liquid handcuffs” for 30 or 40 years. In other words, very few manage to beat their addiction while on methadone. And these people die younger and suffer from more chronic disease than those who are not subject to this “treatment”.
An urgent review is needed to determine the real effect of keeping people addicted to this drug for so many years. Not just the health consequences but the ability of these people to play a useful role in society. The pharmaceutical companies that claim such wonderful outcomes and that profit from these drugs should be required to do the controlled studies to prove that their words are not mere rhetoric.
Dr Ross Colquhoun is an executive member of Drug Free Australia and research fellow, and a member of the Drug Advisory Council of Australia (daca.org.au).