Introduction

Methadone occupies a position of huge prominence in drug misuse treatment. As a synthetic opioid drug, it not only provides direct and effective relief of opiate withdrawal symptoms, but it is accepted as a long-term treatment option in those with a significant history of opiate dependence. Its selection as the main treatment drug in these indications is largely based on three properties, as shown in Table 1.1.

The first two properties are fundamental to the use of methadone, ideally allowing a heroin user, for instance, to switch from injecting a drug in a rapid cycle of relieving withdrawal symptoms, to taking a medication by mouth which will keep him or her well all day. The noneuphoriant property is relative, and we will see in further discussions on response to methadone, rationales for alternative medications and safety of treatment, that this is the least straightforward of the benefits of methadone. Overall, however, the effect of methadone is to enable an opiate misuser to ‘just feel normal’, and in individuals who accept this, the treatment routinely produces excellent results, in reducing other drug use and in a wide range of health and social outcomes (Farrell et al. 1994, Bertschy 1995, Marsch 1998). The effectiveness of maintenance treatment makes up for the big relapse rates after detoxification from drugs, and is a major factor in the selective presentation of opiate users to drug services.