Pharmacotherapies for the Treatment of Opioid Dependence PDF

Foreword

Pharmacotherapies for the treatment of heroin addiction matter – they matter greatly. Not only does it matter that they exist, but it also matters how they are provided. Provide the treatment well, and great public good can be achieved. Provide the treatment poorly, and some lesser level of public good may be achieved, but also opportunities will have been wasted. Fail to provide the treatment, and an opportunity to deliver individual and public good has been squandered. These observations are not obvious – there are plenty of examples where the manner of provision of treatment is not so important, provided the treatment is delivered. But in the field of pharmacotherapies for the treatment of opiate dependence, the organization of the provision of this treatment, and the quality of the treatment provided, have a great influence on the amount of individual and public good which is then achieved.

Providing treatment to individuals caught up in opioid dependence remains a controversial subject. Maintenance treatment programs are now a major component of treatment in many countries around the world, but are provided only in secret or are completely prohibited in many other countries. It is as if practitioners and policy makers have not been able to break out of the straitjacket of moral arguments and challenges about whether they do, or do not, "believe" in methadone maintenance (and similarly, but usually less passionately, with other maintenance treatments). Science needs to come to the fore, to encourage more objective consideration of the evidence, and to enable more rational planning of appropriate health care.