Sir, – Irene Crawley, director of the Hope project, based in Dublin, states long-term methadone use is a form of State-sponsored social control (Home News, October 21st). Presumably the same could be said about any form of public health service, as well as welfare payments, governmental support of education, etc. However, the specific criticism of methadone treatment attributed Ms Crawley is difficult to reconcile with the evidence – or with pragmatism.
To start with the latter, one can only wonder what alternative hope (or Hope!) she would offer to the almost 9,000 current recipients of methadone maintenance in Ireland, and the thousands more who want it, need it, and may well die without it. As for evidence, it’s unequivocal: opiate addiction is a chronic condition which, to date, we can treat but simply do not know how to cure (the same is true of alcoholism). It’s also a condition where relapse is the rule rather than the exception when treatment – any treatment – ends.
It is not dissimilar from illnesses such as diabetes, hypertension and obesity. And yet few would criticise the management of these diseases because the vast majority of patients are unwilling or unable to become “drug-free” through behavioral change, such as rigid adherence to a prescribed diet and exercise regimen. For sure, supporters should express their pride and admiration of Hope, and applaud its contribution to the well-being of its successful clients. Denigrating other types of care, however, discredits their advocacy. – Yours, etc,
ROBERT NEWMAN, MD,
MPH,
East 82nd Street,
New York, US.