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standards, they were given relatively large doses of methadone to stabilize their “habits” before beginning the reduction. ( And then something completely unexpected happened. A few days after the subjects had been switched to methadone, and before the “detox” had begun, they began to exhibit very different behavior. Whereas for weeks they had spent their days either feeling the effects of the narcotics or complaining of their need for more narcotics, suddenly the focus of their days turned away from drugs. One subject asked the researchers for supplies so that he might resume his long neglected hobby of painting. Another inquired after the possibility of continuing his interrupted education. In short, the addicts- who when admitted to

the hospital had looked and behaved very much alike -now began to differentiate. They began to manifest the potential that each had obscured during years of chasing street narcotics. ( Brecher describes the nineteenth century America as a “dope fiend’s paradise.” explaining “Opium was on legal sale conveniently and at low prices throughout the century, morphine came into common use during and after the Civil War, and heroin was marketed toward the end of the century.” (Brecher 1972) Methadone is the most effective treatment for heroin addiction. Compared to the other major drug treatment modalities?drug-free outpatient treatment, therapeutic communities, and chemical dependency treatment?methadone is the most rigorously studied and

has yielded the best results. Methadone is effective HIV/AIDS prevention. (Ward J, Mattick R, Hall W. Key Issues in Methadone Maintenance Treatment. New South Wales, Australia: New South Wales University Press; 1992:46-61) MMT reduces the frequency of injecting and of needle sharing. Methadone treatment is also an important point of contact with service providers and supplies an opportunity to teach drug users harm reduction techniques such as how to prevent HIV/AIDS, hepatitis, and other health problems that endanger drug users. Methadone treatment reduces criminal behavior. (Drug Abuse Treatment Evaluation: Strategies, Progress, and Prospects. NIDA Research Monograph 51. Rockville, MD: U.S. Department of Health and Human Services; 1984:42-68.)Drug-offense arrests decline

because MMT patients reduce or stop buying and using illegal drugs. Arrests for predatory crimes decline because MMT patients no longer need to finance a costly heroin addiction, and because treatment allows many patients to stabilize their lives and obtain legitimate employment. Methadone drastically reduces, and often eliminates, heroin use among addicts. (Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995:22.)The Treatment Outcome Prospective Study (TOPS)?the largest contemporary controlled study of drug treatment?found that patients drastically reduced their heroin use while in treatment, with less than 10% using heroin weekly or daily after just three months in treatment.(Ball JC, Ross A. The Effectiveness of

Methadone Maintenance Treatment. New York: Springer-Verlag; 1991:160-175) After two or more years, heroin use among MMT patients declines, on average, to 15% of pretreatment levels. (Fairbank A, Dunteman GH, Condelli WS. Do methadone patients substitute other drugs for heroin? Predicting substance use at 1-year follow-up. American Journal of Drug and Alcohol Abuse. 1993;19:465-474.) Often, use of other drugs?including cocaine, sedatives, and even alcohol ? also declines when an opiate addict enters methadone treatment, even though methadone has no direct pharmacological effect on non-opiate drug craving. (Institute of Medicine. Treating Drug Problems, vol. 1: A Study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems) Methadone is cost

effective. MMT, which costs on average about $4,000 per patient per year, reduces the criminal behavior associated with illegal drug use, promotes health, and improves social productivity, all of which serve to reduce the societal costs of drug addiction. Cost benefit analyses indicate savings of $4 to $5 in health and social costs for every dollar spent on MMT. Incarceration costs $20,000 to $40,000 per year.( Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995:162) Residential drug treatment programs are significantly more expensive than MMT, at a cost of $13,000 to $20,000 per year, though it should be noted that treatment stays are typically no more than one year in these programs. (Yancovitz SR, Des Jarlais DC,