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In the mid-60s even its originators doubted whether methadone maintenance could work when everything else had failed, gnawing their nails as they waited for patients to return from the temptations outside the ward. What they saw instead was a 'miraculous' transformation.
A surprisingly small basket of randomised controlled trials (but one confirmed by other studies) supports the superiority of methadone maintenance over detoxification for patients prepared to be allocated to either option.
Though the original treatments were diametrically opposed, two long-term follow-up studies have confirmed that post-release continuity is vital to sustain the benefits of treatment in prison.
Starting methadone treatment in prison radically improves treatment uptake on release and reduces heroin and cocaine use over the following year, reports the first US randomised trial among formerly opiate dependent prisoners.
New guidance on managing pregnant women dependent on heroin and allied drugs emphasises that maintenance prescribing is the core treatment but holistic, individualised care is essential; its warnings about the dangers of detoxification are not universally accepted.
This unique randomised trial tested what would happen if detoxified opiate addicts were then maintained on a substitute drug, on an opiate-blocking medication, or simply counselled. The results led to the introduction of methadone prescribing programmes in Malaysia.
European and US studies show that methadone patients stick with therapy for hepatitis C disease and do as well as other patients, bolstering the case for drug services to encourage clients to consider diagnostic testing and therapy.
Limited access to opiate substitute prescribing in Norway opened a window on its powerful lifesaving potential, a view obscured in countries where barriers create a confounding selection effect or where everyone who needs and wants this treatment can quickly get it.
Further demonstration from a US research team that relatively intensive case management support does help welfare applicants overcome substance use problems, but in this case only those not already managed through substitute prescribing.
Two new analyses agree that despite relapse to drug use and imperfect adherence to a demanding medical regime, anti-viral therapy for hepatitis C infection in drug injectors cost-effectively prolongs and improves life.
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