Titre : | Methadone maintenance 4 decades later: thousands of lives saved but still controversial (2008) |
Auteurs : | H. D. KLEBER |
Type de document : | Article : Périodique |
Dans : | Journal of the American Medical Association (Vol.300, n°19, November 19, 2008) |
Article en page(s) : | 2303-2305 |
Note générale : | Accompagné de l'article de 1965 "A medical treatment for diacetylmorphine (heroin) addiction". |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus mots-clés HISTOIRE ; METHADONE ; TRAITEMENT DE MAINTENANCE ; EVOLUTION |
Résumé : | The effects of the article by Dole and Nyswander (JAMA, 1965) are best understood by knowing what preceded it. The current scientific consensus is that opioid dependence is a chronic and severe medical disorder, and withdrawal alone is usually followed by rapid relapse. A century ago, however, withdrawal was often considered adequate to treat narcotic addiction, with methods used often more dangerous than withdrawal. Individuals who relapsed were viewed as doing so out of choice rather than necessity. The frequency of relapse, however, led to the establishment of narcotic clinics to legally provide heroin or morphine to individuals with addiction. By 1923, all these clinics had closed, deemed failures because they did not lead to abstinence. Federal agencies interpreted the 1914 Harrison Act as prohibiting maintenance of individuals with active addiction and threatened or prosecuted physicians doing so. Between 1919 and 1935, approximately 25 000 physicians were indicted under the Harrison Act and 10% were imprisoned. Despite 1921 and 1926 Supreme Court rulings that the act did not forbid such prescribing, most physicians avoided it, ending the role of the medical profession in treating patients with addiction for 4 decades. Heroin became the street narcotic of choice. During World War II, with heroin scarce and purity as low as 1%, addiction hit a record low. By the late 1940s, the flow of smuggled heroin had resumed, but addicts were more likely younger, from a racial or ethnic minority group, and living in northern impoverished communities. Treatment was scarce, prison common, and relapse likely. (Extract of the publication) |
Domaine : | Drogues illicites / Illicit drugs |
Affiliation : | Columbia University College of Physicians and Surgeons, Division on Substance Abuse, The New York State Psychiatric Institute, New York, NY, USA |
Centre Emetteur : | 13 OFDT |
Lien : | http://dx.doi.org/10.1001/jama.2008.648 |
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