Methadone in OAT

Methadone in Opioid Agonist Therapy
Methadone was developed in Germany in 1941 as a synthetic opioid agonist. It was in 1961 that Dole and Nyswander suggested it could be used as opioid agonist therapy in the treatment of heroin addiction.

Methadone is an extensively investigated treatment in opioid agonist therapy. A 30 year observational study by Grella and his colleagues in 2011 found that 25% of patients on Methadone decreased their heroin use quite rapidly and stopped using heroin in 10-20 years, 15% achieved a modest decrease in their heroin usage but also subsequently stopped using heroin in the next 10-20 years and another 25% decreased their heroin usage.

Methadone has also been found to reduce the frequency of injecting and the sharing of injecting equipment thus also decreasing the risks of transmission of blood borne viruses.

Methadone maintenance treatment improves health, reduces illicit heroin usage, reduces infectious diseases transmission and overdose death. However it's effectiveness is compromised if low maintenance doses of Methadone are used. Studies have shown that those receiving greater than or equal to 60mg daily doses of Methadone are 70% more likely to remain in treatment than those on doses less than 60mg daily. Degenhardt and his colleagues in 2009 found that Methadone decreases mortality by 29% in this cohort of patients.

Thus in summary Methadone is of vital importance in the optimal treatment of patients in opioid agonist therapy.

Author: Dr Thileepan Naren
MBBS FACRRM FRACGP
Thileepan is an Addiction Medicine Advanced Trainee and experienced general practitioner with a demonstrated history of working with disadvantaged and marginalized groups.