Illicit use of methadone in heroin addicts in Rome.

Although in several countries heroin addicts have been found to engage in illicit use of methadone, no studies have been addressed to this behavior in Italy. The present study gives evidence that methadone dispensed by public health services in Rome is paralleled by a black market in this drug. Of sixty-five heroin addicts hospitalized for medical or surgical problems, the majority (89.2%) referred to the existence of an illicit methadone market in Rome, and 38% used it. When asked why they bought illicit methadone the addicts stated that the daily dose obtainable from public health services was inadequate. However this statement is in contrast with the evidence that the heroin addicts using illicit methadone had highest daily doses similar to those of heroin addicts not referring to the illicit methadone market. We wonder whether illicit use of methadone is influenced by the therapeutic benefit that addicts expect to obtain from methadone. These "expectations" may lead heroin addicts to extend consumption of methadone to alleviate problems altogether unrelated to the withdrawal syndrome. If so, the illicit market in methadone may be sustained not by the drug's addictive properties but by its therapeutic effects.