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Methadone replacement therapy: tried, tested, effective?
1Muirhouse Medical Group and Clinical Reader, University of Edinburgh, Scotland, UK.
Abstract:
Methadone prescription is a controversial topic. While many believe that it is an effective treatment for opiate dependency, others argue that it is not successful in reducing either the addiction or even injecting behaviour. In this debate, Dr Robertson makes the case that methadone has been well tested, is cheap and acceptable to the patient and results in visible improvement. Dr Daniels argues that methadone treatment is philosophically ill-conceived, ethically dubious, and costly. He also highlights evidence that the treatment is potentially harmful to both patients and those in contact with them.
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The mechanism of methylation unfolds in two stages. The first stage sees a methyltransferase enzyme facilitating the transfer of a methyl group from S-adenosylmethionine (SAM) to the substrate, forming S-adenosylhomocysteine (SAH). The second stage involves further metabolism of SAH into homocysteine, which can be recycled...