Understanding drug treatment for heroin addiction

Drug treatment for heroin addiction involves prescribing either heroin itself or a substitute substance that mimics its effects in a controlled way. A key reason for continued heroin use is to avoid withdrawal symptoms, which exemplifies negative reinforcement. Drug treatment is the primary method for addressing heroin dependence.

How methadone works as a heroin substitute

Methadone is a synthetic opioid that acts by replacing heroin at the synapse, which removes withdrawal symptoms. The idea is that methadone is enough to take away painful withdrawal symptoms, helping the individual to give up the drug. Without these withdrawal symptoms, giving up the drug is more likely.

Key features of methadone

• Methadone has been in use since 1964 and is prescribed through official medical channels as part of a maintenance programme.
• Methadone does not impair normal functioning, so users are not in a 'drugged' state and can maintain daily activities.
• Methadone blocks the euphoric effects of heroin at the synapse, meaning that if heroin is taken alongside methadone, it will not produce the desired high.

Administration and supervision of methadone

Methadone is administered orally, which makes it safer than heroin injection. It has a longer-lasting effect, persisting for about 24 hours, which helps avoid the rapid cycles of euphoria followed by withdrawal that occur with heroin.

Key features of methadone administration

• Daily dosing - Addicts are assessed and prescribed a daily dose of methadone.
• Initial supervision - Initially, the dose must be consumed under the supervision of a pharmacist.
• Progression to self-administration - When considered trustworthy, individuals are allowed to take some doses home for self-administration.

The treatment process: Stabilisation and detoxification

Once the treatment has stabilised, detoxification can commence.

Steps in the detoxification process

1. Dose reduction - The amount of methadone is slowly decreased over time.
2. Regular monitoring - Medical checks are conducted regularly to monitor the dosage.
3. Urine testing - Tests are performed to check that no other drugs are being taken.