Methadone Against AIDS. The Swedish Experience
After a period of 15 years as a local experiment in Uppsala, followed by 5 years of closed admission to the program, Methadone Assisted Rehabilitation is now an accepted, regular treatment for heavy heroin addiction in Sweden. More than 600 patients have been or belong to the 423 who are still in treatment. Some have successfully left treatment. Some 150 have been involuntary detoxified and most of those have relapsed into heroin addiction; some are back in treatment again. Others are still abusing, a few have become drug free and some have died.
Over all, when using comparatively strict inclusion criteria and when keeping strict criteria for staying in treatment, the MAR model gives a dramatical effect on survival and rehabilitation compared to drug free treatment or no treatment. Results from other models of methadone treatment, such as low threshold or harm reduction programmes do rarely produce such clear results. This can be explained by many factors. One is a tendency to under medicate (prescribe an insufficient dose) in these programmes. Others have to do with patients expectancy and motivation and treatment resources. If the program goal is to reduce the harm of addiction to the individual, but not to rehabilitate back to society, one should not expect any other results.
In Sweden, we have chosen a high ambition for our treatment, which gives high outcome measures. But we may loose patients on the way, who might have survived in a harm reduction program in Holland or Liverpool.
KeywordsMethadone Treatment Harm Reduction Methadone Maintenance Treatment Drug Addict Heroin Addict
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