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A preventive ethics approach to methadone maintenance programmes.

P L Townshend1, J D Sellman, J H Coverdale

  • 1PO Box 4028 Nelson South, Nelson, New Zealand. phil.townshend@xtra.co.nz

New Zealand Bioethics Journal
|December 14, 2004
PubMed
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Methadone Maintenance Programmes in New Zealand face conflicts due to provider paternalism. Unjustifiable paternalism in these opioid substitution programs can be reduced by examining and redesigning program structures.

Area of Science:

  • Addiction Medicine
  • Public Health
  • Ethics in Healthcare

Background:

  • Opioid users in New Zealand primarily access drugs through codeine products, prescribed medication, and poppies due to the high cost and limited availability of street heroin.
  • Hospital-run methadone programs dominate opioid substitution therapy, resulting in high client retention and potential conflicts between clients and providers.
  • Paternalism, where providers act in perceived client best interests, is a key issue in methadone programs, particularly concerning client autonomy and program aims.

Purpose of the Study:

  • To explore the conflict between clients and providers in New Zealand's methadone programs.
  • To critically examine the justification of paternalism within Methadone Maintenance Programmes (MMPs).
  • To suggest program design strategies for eliminating unjustifiable paternalism in MMPs.
Keywords:
Health Care and Public Health

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Main Methods:

  • Analysis of the characteristics of Methadone Maintenance Programmes (MMPs) in New Zealand.
  • Examination of the concept of paternalism in the context of client autonomy and treatment risks.
  • Review of program structures and aims to identify potential instances of paternalism.

Main Results:

  • Paternalism in MMPs may arise from confusion regarding program aims, assumptions about client autonomy, and the application of harm reduction principles.
  • Inflexibility and social invasiveness of some MMPs contribute to the perception and reality of paternalism.
  • While some initial impairment of autonomy may exist for clients entering MMPs, the temporary nature and unpredictable risks make paternalism unjustifiable.

Conclusions:

  • Unjustifiable paternalism in Methadone Maintenance Programmes can lead to client-provider conflict.
  • Preventative ethics, focusing on examining and eliminating problematic program structures, is crucial.
  • Revising MMP design can help eliminate paternalism and improve client treatment outcomes.