The use of methadone or naltrexone for treatment of opiate dependence: An ethical approach (2012)

The policy of Harm Reduction was adapted and implemented by the Australian health establishment in response to a rising epidemic of opiate use, dependency and death from overdose and fears of the spread of AIDs and Hepatitis C throughout the intravenous drug-using population in the 1980s. The Harm Reduction movement provided funding for the methadone treatment program, needle exchanges, education about safe use of drugs, a harm reduction approach by police, a safe injecting room in Sydney and the call for drug trials of heroin for maintenance purposes. This is despite the lack of evidence that these measures result in disease prevention, reductions in drug use and/or criminality, or that health is significantly improved. On the other hand, naltrexone has been shown to be non-toxic, safe with no significant side-effects, highly effective in providing high rates of detoxification, and helpful in improving long term drug free status. Being drug free significantly reduces all risks associated with drug addiction. In Australia, since the year 2000, recent major reductions in the numbers of individuals using opiates and dying of overdose indicate that the enforcement of legal penalties and reduction in supply, has resulted in a reduction in demand and a greatly reduced rate of mortality. It seems these policies need to be part of a broad-based and coherent policy on preventing harm from drug use. This also applies to abstinence-based treatment approaches. Opiate dependent people have a right to the best form of treatment available and the right to choose to be drug-free and that includes naltrexone treatment incorporating those components which maximise effectiveness and safety.