Sir, - As a family doctor who has been deeply involved in caring for patients addicted to heroin and for their families in Dublin over the past 10 years, I have always welcomed your newspaper's enlightened approach to the problem of drug addiction. This approach is in general to address the fundamental causes of drug addiction and to explore appropriate management strategies.
Breda O' Brien's article entitled "Moving beyond maintenance in drug addiction" (Opinion, June 24th) was one such excellent article, which once again drew our attention to the root causes of drug addiction in Irish society. While I am reluctant to criticise this article, which advocates strongly on behalf of people caught in the trap of heroin addiction, as a doctor involved in the treatment of many such patients I must take issue with two assumptions made.
The first is that "methadone means that a person copes with life by being partially stoned all the time." Methadone is the most widely researched drug used in the management of heroin addiction, and the published evidence is that when methadone is taken in therapeutic dosage on a longterm basis, it does not impair intellectual function nor does it alter mood. In these circumstances the only side-effects are constipation and increased sweating. While methadone has been shown to be highly effective in enabling patients to abstain from heroin, it has not been shown to be effective in enabling patients to abstain from benzodiazepines or alcohol, and it is the misuse of these drugs which may cause some patients to appear to be "stoned".
The second (implied) assumption is that heroin addiction is largely a psychological one and that if the original psychological precipitating causes are removed (following a period of "methadone detoxification"), then cure may result. Unfortunately the overwhelming scientific evidence does not support this proposition but rather concludes that once opiate addiction is established, permanent and irreversible neuro-physiological damage occurs which renders the patient vulnerable to relapse indefinitely, in a similar fashion to alcohol addiction. Fortunately, there is widespread international evidence that methadone can safely and effectively reduce this vulnerability to relapse.
It is undoubtedly true that the most effective means of preventing heroin addiction is to redress social injustice in our society. It is also likely that a more just society would reduce the vulnerability of heroin addicts, thereby enabling a greater number to safely discontinue their methadone medication. Doctors and other workers in this field must in the meantime offer their patients the safest and most effective form of treatment available, while at the same time advocating on their behalf and engaging in "the debate about the nature of the emptiness which afflicts so many people's lives". - Yours, etc.,
Kieran Harkin MRCPI, MRCGP, General Practitioner, Inchicore Medical Centre; Medical Officer, Rialto Community Drug Team.