Chapter 10
Out-patient Methadone Detoxification and Methadone Maintenance
A milestone in Hong Kong's development of drug addiction treatment facilities In 1976 Hong Kong passed another milestone in the development of its drug addiction treatment facilities when it launched a massive methadone detoxification programme, offering a completely new mode of treatment for local drug abusers. (See illustration on p. 62.)
2 The addition of the methadone detoxification scheme to the existing treat- ment programmes was another major effort by the Government to develop a multiplicity of treatment methods, each employing different techniques. This multi- modality approach is necessary as one mode of treatment suitable for some addicts may not be equally suitable for others, because of differences in age, personal background, employment, history of addiction and other characteristics. In the case of the new methadone detoxification programme, it is designed to cater for addicts who, generally speaking, have a motivation to get off drugs but are not prepared to stay in a residential treatment centre for a relatively long period for various reasons, such as employment and family problems.
3
Methadone detoxification in Hong Kong was started on the recommendation of Dr. Robert Newman of New York, who visited Hong Kong in early 1975 as a consultant to the Medical and Health Department. He recommended that a detoxification programme with substantial capacity to provide short-term with- drawal treatment on an out-patient basis should be introduced, in addition to the existing methadone maintenance programme. Unlike methadone maintenance, in which a patient is maintained indefinitely on methadone as a "substitute" for heroin or opium, methadone detoxification is aimed at weaning a patient off drugs by gradually reducing the dosage of methadone over six to eight weeks. 4 Given the internationally recognized difficulty of "one-shot" cures in drug addiction treatment, it was expected that there would be a substantial drop-out rate in an out-patient methadone detoxification programme. However, bearing in mind the large number of addicts that the programme can potentially cater for, it is worth-while even if many of them are only able to achieve short-term abstinence from "hard" drugs before relapsing; it is hoped, however, that such cases will return for treatment, that the intervals between relapses will get progressively longer, and that, eventually, the patient will be able to terminate his habit.
The methadone detoxification centres
5 Dr. Newman's proposal was endorsed by the Action Committee Against Narcotics. The original plan called for the Medical and Health Department to start with only one experimental methadone detoxification centre and thereafter progressively open more centres in various parts of Hong Kong at staggered intervals. In the event, however, a serious shortage of drugs on the illicit market in the first half of 1976 and an unprecedented upsurge in their prices (see Chapter 8) provided immediately impelling reasons to launch methadone detoxi- fication on a much larger scale. The first methadone detoxification centre was
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opened at the Violet Peel Polyclinic in Wan Chai on 1st June 1976 and about three weeks later, 11 more were opened simultaneously in various parts of Hong Kong Island, Kowloon and the New Territories. By 11th October 1976, the total numbe these centres had grown to 16.
6 Al Methadone detoxification centres are at present housed in the buildings of existing Government out-patient clinics. Of the 16, 14 open from 6 to 10 p.m. in the evening. This is because experience gained in the methadone maintenance programme shows that most patients prefer to come for their daily dose of methadone in the evening, presumably after work. The remaining two detoxi- fication centres open from 9 a.m. to 5 p.m.
7
Each detoxification centre is manned by a doctor, a social worker, and three members of the Auxiliary Medical Service. The role of the social worker is to encourage patients to complete their treatment and to provide counselling, if necessary, in solving their personal and family problems.
8
The detoxification centres accept patients, male or female, who are over 18 years of age and have been addicted to drugs for two years or more. (Those under 18, and with an addiction record of less than two years are referred to the residential treatment centres of the Society for the Aid and Rehabilitation of Drug Addicts.) As in methadone maintenance, addicts undergoing methadone detoxification are required to visit the centre daily and take their methadone on the spot. This is designed to prevent abuse or misuse of methadone, which may occur if the drug is allowed to be taken away. The charge per visit is one dollar, a nominal fee which may be waived if a patient is in financial difficulties.
Encouraging response
9 When the methadone detoxification programme was first launched, intensive publicity was mounted to encourage drug addicts to come forward and make use of this new treatment facility. (Details are given in paragraph 13 of Chapter 13.) The results were very encouraging. During the seven months from the opening of the first detoxification centre to the end of the year, a total of 6,677 addicts, including 425 women, registered for treatment at the 16 centres. 10 As stated in paragraph 4 of this Chapter, it was not unexpected that the drop-out rate at the methadone detoxification centres would be high. Up to the end of the year, however, 1,798 addicts were still actively undergoing treatment at the centres, excluding 91 who had already completed their treatment. In addition, 368 elected to be transferred to methadone maintenance centres. 11 Although it is recognized that methadone maintenance and methadone detoxi- fication are types of treatment with different objectives, experience in Hong Kong has indicated considerable advantage in maintaining flexibility in the operation of the programmes. The Medical and Health Department has therefore adopted a pragmatic approach, and has permitted some patients to continue attendance at the centres long after the normal period allowed for detoxification has passed, whilst, similarly, detoxifying patients attending maintenance centres, at their request. There are, in addition, formal transfers between each type of centre. The over-riding aim is, of course, to encourage the addict to continue treatment for as long as his individual circumstances indicate to be necessary.
12 The methadone detoxification programme in Hong Kong is still in its infancy and the Medical and Health Department and other government departments concerned are keeping the programme under constant review. However, it can be reasonably claimed at this stage that out-patient methadone detoxification has
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