Please read this preface before reading the rest of the book as there are some important notes about things that are missing, should be changed, or are not covered to the extent to which they would be if I was writing the book today.
The methadone briefing was written some time ago now, between 1994 and 1996, while I was working as a CPN for a community drug team in West Dorset. I began writing with the aim of developing my understanding of the history and pharmacology of, and the research into, methadone prescribing in order to develop my practice. I figured if having all that information in one place would be useful for me, then it would probably be useful for everyone else. An assumption that turned out to be true with 12,000 copies of the book sold in the UK, an adaptation for New Zealand, and translations into several Eastern European languages, including Russian.
At the time there weren't really any other books that attempted to pull together the theory, research and the day-to-day practical realities of treatment. This gap has now been addressed by a number of authors and editors, in particular the work of Ward, Mattick and Hall who have produced a number of authoritative literature reviews, including 'key issues in Methadone Maintenance treatment' which systematically address the major clinical issues in prescribing to people who are opiate dependent. Also of great value are books like 'community treatment of drug misuse: more than methadone' by Nick Seivewright.
I am grateful to the other authors who collaborated on the book and reviewed the manuscript - without them the book wouldn't have been anything like as authoritative or influential as it was.
As time has passed I haven't been able to find the time nor the funding to produce a second edition of the methadone briefing, and in early 2003 the last copies were sold by DrugScope, and the book went out of print.
It would not be right to simply reprint it when things have changed so much since publication - National Treatment Outcome Research Study (NTORS), supervised consumption, buprenorphine prescribing, clinical guidelines, DTTO's and Models of Care are just a few of the important developments that have had to be absorbed by the field since the first publication of the methadone briefing.
Also in need of greater emphasis than is given in the book, is the importance of:
- adequate dose (increases to between 60mg and 120mg should be the norm for those who do not stop using heroin on top of their prescription);
- retention in treatment and the inadvisability of compulsory detox, or detox for 'non-compliance' in people on sub-therapeutic doses;
- the inadvisability of long drawn out detoxes (for more on this, click here); and
- the fact that not everyone metabolises methadone in the way described, and that some people require larger doses and/or more frequent dosing to remain stable on methadone.
These shortcomings made charging people to buy a copy of a straight reprint untennable, but offering it free on the website, with the above qualifications will hopefully be useful to both practitioners and drug users as the underlying principles of the book of harm reduction and humane practice remain the same.
The book has been available online for sometime on drugtext, but there were some problems with the formatting and navigation and with the book now out of print we have decided to overhaul the formatting and navigation.
If you spot any mistakes or problems or have suggestions for improvements/changes that need to be made to the online or any possible second edition, please
to send me an email.