The introduction of a methadone prescribing programme to a drug-free treatment service: implications for harm reduction.

In 1990, a National Health drug treatment service with a non-opiate prescribing policy introduced an oral methadone treatment programme for problem opiate users, in addition to existing counselling services. The present study aimed to evaluate the implications of this policy change by comparing two client groups in terms of defined harm reduction variables. The groups consisted of 39 clients presenting to the service prior to methadone prescribing (pre-methadone group), and 41 clients who attended for treatment after methadone prescribing had commenced (post-methadone group). Data analysis revealed that 83% of the post-methadone group remained in treatment for longer than 6 months, in comparison with 13% of clients in the pre-methadone group (p < 0.00001). Other significant differences were noted in treatment outcome, where findings indicated that clients in the post-methadone group were more likely to report cessation of injecting behaviour and continued illicit drug use. Detected crime in the post-methadone group was reduced, and greater positive change in terms of personal relationships was reported. The study concludes that the introduction of a methadone treatment programme appears to have improved treatment outcome significantly for problem opiate users presenting in the service.