Methadone isn’t a one-size-fits-all treatment

But the one the know-it-alls always have the strongest views on is the use of methadone for heroin addicts. Try mentioning it over dinner tonight and see what happens. Many people thoroughly disapprove, think methadone is a waste of resources and that addicts should be left to fester in their own self-induced hell.

I write about it because the government body responsible for treatment strategy, the National Treatment Agency for Substance Misuse, is proposing strict limits on how long heroin addicts should be allowed to stay on methadone.

This is a politically motivated decision, of course. Methadone use is ever on the increase, implying that the number of people using and becoming addicted to heroin is rising, and that the Government's stated ambitions for its drugs policies are therefore not being realised.

But while I agree that wherever possible we should try to get people off their addictions, and that weaning them off methadone is absolutely desirable, we also now know that for many people opiate dependency is a lifelong problem requiring long-term treatment. The negative connotations that methadone has are disappointing, because the drug can prevent death, stabilise lifestyles and improve social functioning. Those who work on the front line providing it comment on how remarkable the improvements are when people start this therapy.

So I never understand why these sorts of debates are only ever allowed to have an either/or answer to them. What's wrong with having a range of options that would include various maintenance prescribing and abstinence regimes, with decisions made on which is most appropriate to a given individual by the relevant clinical expert?

Leaving people languishing on methadone for years is not ideal for some, and residential rehab doesn't work for others (nor is it always financially available), so why can't we offer all options? It seems we are having a nasty case of "call-centre operator syndrome" — being able to see only in maddening black and white, and not the more suitable shades of grey.

People too often make the error of equating abstinence with recovery. Abstinence is a condition, and often only a temporary one, while recovery is a process.

It's great that we are changing our view of methadone being a one-way road only from which there is no recovery and starting to realise that we need our drug treatment services to set their sights a good deal higher than prescribing life-long methadone. But we now need to start working out how to differentiate between those patients for whom improvement to the point of abstinence is an impossible ideal, and those for whom it is highly achievable. Once we do that, ongoing methadone use will seem more justified.

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