Justifying drug substitution therapies: The case of methadone maintenance treatment Jeff Ward School of Psychology Australian National University Canberra ACT 0200, Australia Email:
[email protected] Paper presented at 2nd Annual Conference of the Addiction Research Centre, Trinity College, Dublin, Ireland, 26 September 2002 1 Introduction Some time ago, I was told the story of a meeting that took place in a local community, the purpose of which was to decide whether a methadone clinic should be established there. At this meeting, members of the relevant government health authority and medical practitioners wanting to establish the clinic tried to alleviate community concerns about the clinic by talking about the evidence in favour of methadone maintenance and responding to concerns raised during the meeting. Concerns were raised about the possibility of the clinic attracting more heroin users to the area, the effects on local business, the risks associated with discarded needle and syringes, and so on. After long discussion, it appeared that the majority of the audience were convinced that methadone maintenance was an effective treatment for heroin dependence and their fears were assuaged by the arguments that they had heard. Just as the meeting was drawing to a close, one member of the audience raised her hand and wanted to know if methadone was a drug just like heroin. When it was answered, somewhat reluctantly by my informant that, yes, methadone was a drug that acted in ways similar to heroin, the mood of the meeting immediately changed, and, within a short period of time, it became clear that if methadone was a drug just like heroin, then people didn’t want a methadone clinic in their community.