Sir, - In his response to Breda O'Brien's excellent article on "Moving beyond maintenance" (Opinion, June 24th), Dr Kieran Harkin (June 29th) makes a number of surprising claims.
He states that, once opiate addiction is established, permanent and irreversible neuro-physiological damage occurs, rendering the person prone to relapse indefinitely. He doesn't add how this damage is assessed or who reaches this conclusion while, presumably, the addicted young person is still abusing drugs. We can presume that he means a doctor, who subscribes to this theory, makes this devastating diagnosis.
The doctor then prescribes the highly addictive full-strength opiate, methadone, which over time will inflict brain damage to the point where the person cannot do without it, and cannot attempt a life free of drugs. Street heroin is a very dilute substance compared with methadone. It is certainly clear that an addicted person availing of health services will not be encouraged to seek detoxification.
Do the doctors in the health service who think as Dr Harkin does inform the client of their diagnosis? Do they warn the patient that the drug being prescribed for him can damage his brain? Do they tell him he is being put on the opiate methadone for life? Clients have a right to know, as we the citizens have a right to know the basis on which our drugs service is operating.
Contrary to this medical stance, drug addiction is a psycho-social problem and unless we get away from the inappropriate medical/public health model our addiction crisis will continue to get worse, particularly if this thinking is applied to the rest of the country which is still not too heavily infested with heroin and methadone.
Currently, there are 5,000 young people on methadone with little likelihood of them achieving a drug-free healthy state. At the same time, residential drug-free recovery programmes have been starved of investment. In the Dublin area there are 50 people on methadone for every one place in drug-free residential recovery.
We should thank Dr Harkin for alerting us to the medical thinking which, it would appear, is part of Department of Health policy. The Minister for Health needs to clarify his policy as the consequences for young people are so shocking - and unacceptable.
Happily not all psychiatrists and doctors share this no-escape view of addiction and continue to believe in the capability of human beings to recover. Substituting one addictive opiate for another opiate traps people in addiction. - Yours, etc.,
Jim Cumberton, Chairman, Drug Prevention Alliance, Oaklands Park, Dublin 4.