Who should receive methadone maintenance?

The aim of this study was to evaluate the assessment policies of a regional unit established to process requests for entry to several long-term methadone maintenance programmes. The factors which led staff to reject an applicants request for methadone maintenance were retrospectively analysed from assessment records. Analysis indicated that the decision to reject applicants had been based on the judgement that they were not physically dependent on opioids; other factors favouring rejection included less involvement in crime, youth, and short duration of drug use. Eighty-four applicants who had either been rejected (n = 58) or failed to complete the assessment (n = 26) were followed. At follow-up, more than half of the subjects had entered methadone programmes, usually after a long delay. Four subjects had achieved a degree of stable abstinence. The remainder were continuing to use illicit drugs, or were in treatment or prison. Four subjects had died. We conclude that: (1) our criteria for excluding people from treatment were based on the perceived need to keep non-addicted people from maintenance treatment; and (2) such a policy in practice served to prolong the applicants' illicit drug use and delay their entry to treatment.