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The following conclusions were reached and reported in October, 1994, by a special "consensus conferenced" convened under the auspices of the Minister of Heath of Belgium. It has been provided to this website by Marc Reisinger, M.D., who served as co-chairman of the conference.
October 12th, 1994
Promoted by M. Jacques Santkin, Minister of Public Health
Co-Chairman of the jury : Marc Reisinger, M.D.
Methadone is an effective medication for the treatment of heroin addiction.
Methadone treatment reduces heroin consumption and injection.
Methadone treatment :
Methadone treatment is associated with an improvement in socio-professional aptitude and a reduction in delinquency.
Methadone treatment is indicated for heroin addiction, based on a diagnosis arrived at through anamnesis and clinical examination, and supported by complementary examinations if necessary (ex: urinalysis).
Except for documented exceptions reserved for specific cases and requiring special competences, the patient should be at least 18 years old, with an established history of addiction of at least one year. The term addiction includes the notion of failed attempts to stop drug use, either spontaneously or assisted.
There are no counter-indications but related psychiatric conditions (alcoholism, multiple drug abuse, depression, psychosis) require diagnosis and appropriate care.
Pregnancy is not a counter-indication.
There is no scientific reason to limit the overall number of patients admitted for methadone treatment, provided they fulfill the indicated criteria.
Methadone treatment is generally of medium duration (2-5 years) or without any set duration.
At the beginning of treatment, the recommended doses are between 30 and 40 mg of methadone per day. In general, the average stabilization dose is higher, around 60-80 mg/day. It should, however, be adapted to fit each patient's evolution.
Administration of methadone should be in appropriate oral form, so as to avoid any deviation of its use.
At the beginning of treatment and until stabilization, for the sake of caution, the patient should take his daily dose at the pharmacy or at a special center.
Occasional heroin consumption should not constitute a reason for stopping the treatment or decreasing a patient's dose.
Certain medicinal interactions require an adjustment of the dosage.
Rapidly degressive treatments [i.e., detoxification] (3 weeks-3 months) are also indicated in some cases. In general, they are associated with a change of milieu with a reduction of the patients' exposure to heroin.
Should pregnancy occur, it is not recommended to stop methadone treatment, but such a situation requires special competence.
Availability of methadone treatment should be increased to respond to the need for such treatment, including the helthcare practitioners most directly involved (General practitioners, psychiatrists, pharmacists, health centers) while respecting the requirements of responsible medical practice.
Psycho-social approach and support are essential factors for improving the therapeutic results of methadone treatment. Support should be adapted to the individual needs of patients. Patients can be treated at a multidisciplinary center, by a GP or by a specialist.
These physicians should have acquired the necessary training and should keep up-to-date for example through clinical intervision.
They should be supported by a functional relationship with a specialized center or a network for treatment of addicts, above all in order to prevent isolation, which would be detrimental to their practice.