Methadone and heroin prescription: babies and bath water

Criticism of methadone treatment abounds in all countries where this intervention is available. Although such criticism is often justified, it is critical to recognize that methadone is the most effective, safe, and cost-effective intervention available, is supported by innumerable studies, and provides considerable benefit to drug users, their families and communities. The major causes of the pervasive deficiencies of methadone treatment is the severe and consistent under-funding and hostile environment, both inevitable by-products of the global commitment over recent decades to an expensive, ineffective, and often counter-productive drug policy overly reliant on supply reduction. Methadone treatment is often criticized by drug war supporters not because of its limitations, but because its very effectiveness highlights the meagre benefits of supply reduction. The compelling arguments to expand pharmacotherapies for heroin dependence by rigorously evaluating prescription heroin treatment should not be based on the real or perceived deficiencies of methadone treatment. Rather, these arguments should be based on the need to provide evidence-based treatment for drug users which has the capacity, range of options, and quality expected in other health care services. The paramount aim should be to improve the current deplorable rates of death, disease, crime, and severe distress now evident in an increasing number of countries.