Intravenous Methadone Maintenance: A British Response to Persistent Opiate Injectors

Abstract

In drug abuse, the mode of administration of a drug and the associated cues and rituals are often as important as its pharmacology. Many tobacco smokers who found nicotine chewing-gum an unacceptable alternative to cigarettes will readily confirm this. Intravenous injection is evidently a highly addictive behaviour and those who are strongly addicted to it often find conventional oral methadone maintenance and reduction programmes unhelpful, even if the dosage is generous. Intravenous methadone maintenance appears to make treatment acceptable to at least a proportion of injectors who would not otherwise come forward. This paper discusses some of the experiences and practices of one of the largest injectable methadone programmes in Britain including demographic data, assessment, dosage, safeguards, problems, bureaucratic requirements and monitoring. It also touches on certain historical and medico-political factors. Preliminary results from a pilot study of hair-analysis for illicit drugs indicate a surprisingly low incidence and level of continuing heroin and cocaine use in our patients. Methadone doses up to 1100mg daily can be compatible with regular, skilled employment. Both hair analysis and intravenous medication assist the ‘therapeutic bargaining’ which is an intrinsic and very useful feature (though often a neglected or undervalued one) of methadone programmes.