<B>Doctor at the Idris Goomany centre</B>

<B> What is methadone and how does it work? </B>

Methadone is a synthetic narcotic similar to morphine. It is sometimes used as an analgesic and to suppress the cough reflex. In the brains of addicts, methadone prevents heroin or morphine from interacting with receptors for natural painkillers called endorphins, blocking the effects of addictive drugs and reducing physical cravings. In controlled doses, it creates its own effects of mild euphoria and drowsiness much longer and does not create the sometimes fatal respiratory depression that opiates do. Its continued use as a heroin substitute eventually restores sexual, immune and adrenal functions.

<B>Is it specific for treating substance abusers? </B>

In the 60s, two doctors promoted methadone as therapy to rehabilitate narcotic addicts. The drug is now used in maintenance programs in a few countries. Methadone is mostly dispensed orally under supervision; counselling and medical care makes it more effective.

<B>What are the treatment goals? </B>

Methadone treatment relieves the patient?s narcotic craving, suppresses the abstinence syndrome and blocks the euphoria associated with heroin. The overall goal is to improve the patient?s health and quality of life. Intermediate objectives include improving patients? access to health care, teaching them to reduce risks of infectious diseases such as HIV and hepatitis, and helping them build healthy relationships and re-enter the workforce or school. In recent years, a gathering consensus has endorsed methadone maintenance as a potentially lifelong treatment. It harmonizes with recent emphasis on the chronic, episodic nature of heroin addiction.

<B>Does it include side effects? </B>

Methadone maintenance treatment shows few side effects and substantial health improvements. Around three-quarters of people respond well. However, for various reasons, methadone does not suit all people with opioid dependence. Some require several treatment episodes before progress is achieved.

<B>What are the risks of such medicines? </B>

Critics counter that methadone patients are still addicts and that the therapy does not help their personality problems. In many cases, multiple drug use and strong psychological dependence undermine the gains made. Some cases of overdose have also been reported.

<B>How to avoid such risks? </B>

Such risks may be avoided by strict monitoring. Methadone must be prescribed in a ?controlled? environment with emphasis on other treatment components like counselling, random urine testing and group therapy. The treatment should be restricted to specialised centres with the appropriate setup.