By Julie Robotham Medical Editor

First published December 3, 2005 (SMH)

PEOPLE who use the heroin substitute methadone will be encouraged to kick their drug addiction completely using a treatment that sends them into immediate withdrawal, under an option being considered by the federal health department.

The Health Minister, Tony Abbott, confirmed he wanted to expand access to rapid detoxification services using the drug naltrexone, which fights addiction by neutralising the body's response to opioids such as heroin and methadone.

The plan, which ups the ante in the Government's abstinence-based Tough on Drugs strategy, comes in response to the growing number of people in long-term treatment with methadone.

In NSW the number of people treated with methadone or an alternative, buprenorphine, has doubled over a decade, and stood at 15,523 last year. Based on an estimate from the National Drug and Alcohol Research Centre that methadone costs on average $9.63 daily per patient, that is a total of more than $50 million annually in NSW alone.

"Methadone is an important part of our response to the drug problem, but in the end it's just a substitution of a legal for an illegal product," Mr Abbott said.

"It doesn't stop people being addicts … This Government would like to see people off drugs. One accepts that naltrexone treatment in this country is not always regarded as mainstream … but I think it shows great promise. It has this great benefit that it controls the craving."

Mr Abbott said he had asked the department to advise on ways of making the treatment more widely accessible. At present there is no Medicare funding for the detox procedure - performed under sedation in doctors' rooms.

Naltrexone is subsidised through the Pharmaceutical Benefits Scheme for alcohol addiction but not for drug use.

Mr Abbott last month made a $50,000 special grant to the Sydney-based Psych n Soul clinic, which offers rapid detoxification, slow-release naltrexone implants to help people remain drug-free, and intensive counselling. A West Australian clinic has also received a $100,000 grant.

Ross Colquhoun, Psych n Soul's director, said he would use the money to reduce the $4000 price of the program for people who could not otherwise afford it.

Methadone was "a form of social control", Mr Colquhoun said. "There's no exit strategy."

Mr Colquhoun said one in three of his clients were users of methadone rather than heroin.

But David McGrath, the acting director of NSW Health's Drug and Alcohol and Mental Health programs, defended the number of people on methadone. "In terms of a starting point for best health outcomes and social outcomes, methadone's clearly the best place to start," he said.

The longer people remained on methadone, the relatively healthier they were.

Research had indicated people found it hard to stick with naltrexone, and those who began using opiates again after a rapid detox were at increased risk of overdosing because their bodies were no longer tolerant to the drug, Mr McGrath said.

NSW already provided detoxification services for people on methadone, based on phasing down the drug dose over a month of in-patient care, and would soon open an additional seven beds.