An independent panel convened for a National Institutes of Health (NIH) Consensus Development Conference came out firmly in favor of methadone treatment for all heroin addicts who might benefit from it. The panel on "Effective Treatment of Opiate Addiction" met in November 1997 and its report is published in full in this week's Journal of the American Medical Association. The panel's consensus is that methadone maintenance therapy (MMT) has clear medical and economic benefits for both the individual and for society.
Specific recommendations of the panel include:
- All opiate-dependent persons under legal supervision should have access to methadone
- Unnecessary Federal and State regulations of methadone should be reduced
- Methadone maintenance therapy should be a required benefit in public and private insurance programs
The panel also called for improved training for physicians and other healthcare professionals in the diagnosis and treatment of opiate dependence.
"The primary conclusion of the panel, and the premise for our recommendations, is that opiate addictions are brain and medical disorders that, indeed, can be treated effectively," said Dr. Lewis L. Judd, Chairman of the Department of Psychiatry, University of California, San Diego, School of Medicine, who served as Chair of the 12-member NIH panel.
Dr. Alan I. Leshner, Director of the National Institute on Drug Abuse (NIDA), said, "It is a step forward that opiate addiction is being recognized as a treatable disease. A major problem is that fewer than 20 percent of the nation's 600,000 diagnosed heroin addicts are receiving MMT. We hope that this report will wake people up to the enormous benefits of methadone treatment and will help dispel myths that have prevented its more widespread use."
The report enumerates the advantages of MMT, including: reduced drug use, not only of opiates, but also of other drugs of abuse; higher survival rates (the death rate for persons receiving MMT treatment is one-third of that of untreated opiate-dependent persons); markedly reduced rates of criminal activity; lower health care costs; enhanced earning capacity (opiate-dependent persons in MMT earn more than twice as much annually as those not in treatment); and better pregnancy outcomes (HIV+ pregnant women receiving MMT are more likely to be treated with zidovudine, thus reducing by two-thirds the rate of HIV transmission to their babies).
The NIH consensus panel did not claim that MMT is a panacea, but rather that it is an important element in a treatment regimen that should also include substance abuse counseling, psychosocial therapies, and other supportive services.
The panel, representing the public and the fields of psychology, psychiatry, behavioral medicine, family medicine, drug abuse, and epidemiology, was convened as part of the NIH process of developing consensus on issues of vital public health importance and interest. The report was initially developed and presented at a conference held November 17-19, 1997. The conference was sponsored by the NIH Office of Medical Applications of Research and NIDA, and was cosponsored by the NIH Office of Research on Women's Health. A copy of the full report is available from the NIH Consensus Development Program website, at http://consensus.nih.gov.