Materia Medica Malaysiana

How methadone works for addicts

"THEY are patients, not addicts," says Professor Dr Hussain Habil, of people who are addicted to narcotics such as heroin.

According to the head of University Malaya's psychological medicine department, drug addiction was considered a moral issue in the past.

"It is only of late that it is understood to be a brain disease, a biological phenomena.

"Now, we hope that drugs such as methadone can help deal with addiction problems." This form of drug substitution therapy is founded on the premise that some people are susceptible to drug addiction because of a biological imbalance in the brain. A prescription-only drug, methadone is a kind of narcotic analgesic taken in either syrup or tablet form.

It is a synthetic opiate that overcomes the withdrawal symptoms. The cravings may take years to go away but with proper counselling and support, most patients should be able to rise to the challenge of beating the addiction.

Based on the many patients he has seen and counselled over the years, Hussain says there is a need for greater availability of treatment and specific medications to treat, for instance, withdrawal and relapse.

"We can't just pack them off to the Serenti centres and expect them to be okay." Almost 80 per cent of former Serenti inmates fall back into their habits of addiction upon release. One of the most crucial elements missing from the "Serenti approach" is family support. The methadone programme, however, allows the patient to remain at home, and only visit the physician for the prescribed dose. In the long run, this also may reduce the cost for the government. The preliminary results of a research group study at the University of Malaya Medical Centre revealed that after one month, almost 70 per cent tested negative for heroin. By the second month, 100 per cent tested negative. The study, which involved prescribing methadone to confirmed heroin users who had someone to consistently care for them, will undoubtedly give hope to many users who have tried various means to kick the habit.

Relationships got better for some and many displayed a marked improvement in work performance. None lost their jobs. In fact, two patients actually found jobs because of their improved condition.

There was no crime involvement and neither did they indulge in high-risk behaviour such as unprotected sex. Physically, several reported minor side-effects, such as itching on the face, but this was resolved by splitting the dose.

There have been long-term effects reported by other patients, such as loss of sexual desire, increased perspiration and constipation but most disappear with time, dose adjustment, dietary changes and general improvement in lifestyle. According to former drug users who are in the programme now, the cravings are still there although methadone has taken away much of the withdrawal symptoms. They say the drug has done wonders for them. Families have been reunited. Many have friends.

Hussain, however, stresses that while the turnaround in their lives is fantastic, the success does not just lie in the drug alone. "There must be adequate supervision, counselling and necessary lifestyle changes too." The experts also say there is a need for guidelines to monitor the use of methadone to ensure no abuse takes place and to prevent a spillover to the black market. The Government plans to overhaul the conventional drug rehabilitation system using methadone. A study involving 50 former Pusat Serenti inmates will soon be conducted by the National Drug Agency, UMMC, Universiti Sains Malaysia and Duopharma (M) Sdn Bhd, the drug manufacturer and sponsor.

The results of the study will determine whether the drug therapy will be adopted in its Pusat Serenti rehabilitation programmes, thus heading in the direction of community-based treatment as opposed to institutionalised therapy