Heroin dependency | |
Methadone maintenance treatment and other opioid replacement therapies. Jeff Ward, Richard P. Mattick and Wayne Hall, editors. Amsterdam: Harwood Academic Publishers 1998 (vii + 471 pp., $38.00 [softcover]). ISBN: 90 5702 238 9. |
Management of opioid dependency is a matter of heated public debate because of disagreement about whether the problem should be handled as a moral and legal issue or as a public health issue. There is no disagreement that heroin dependency is associated with an enormous international illicit trade. The cost to society in terms of crime, corruption, spread of viral disease and deaths due to drug overdose is huge and is mounting, as is production of opium worldwide. This publication, the successor to a 1992 publication by the same authors, Key issues in methadone maintenance treatment, reviews extensive literature relating to options in the treatment of opioid dependency. It provides a valuable resource for all those concerned with public policy or the management of drug problems in the clinic or on the street. The publication comes from the National Drug and Alcohol Research Centre in Sydney, and its authors are among the most experienced in the field in Australia, and have high standing internationally. Its review of objective trials, comparing methadone therapy with outcomes of treatment in therapeutic communities or with outpatient counselling, provides a challenge to strongly held views based on existing custom and practice. Of particular value are the reviews of methadone, l-alpha-acetylmethadol (LAAM), buprenorphine, naltrexone and the previous trials of maintenance with heroin by prescription. A chapter on cost-effectiveness compares the cost of different management regimens with the cost to society of individuals continuing to use illicit heroin. It provides a basis for a more active and rational approach than is currently seen in many countries. Other chapters cover training of professionals to deliver methadone treatment, provision of methadone within prisons, maintenance therapy during pregnancy, and psychiatric disorders among those with opioid dependency. The chapter dealing with detoxification from methadone maintenance treatment discusses the doubtful benefit of clonidine, but no discussion of the usefulness of naltrexone, buprenorphine or other drugs. Another minor irritation is that the discussion of the use of urinalysis during opioid replacement therapy is restricted to the context of prisons or clinics, and no discussion of new methods of testing is attempted. Overall, however, this book is highly recommended. David G Penington
|
New books | All books | Search | Information | Write to us | eMJA Home
© 1999 Medical Journal of Australia