Clinical and social aspects of heroin addicts enrolled in an ambulatory methadone program

textabstractIn 1969 the GGD (Municipal Health Department) Rotterdam developed the first program for drug abusers. In 1972 the first central outpatient methadone program was established shortly after the introduction of cheap heroin in the Netherlands. In 1974 there was a total case load of 240. The methadone was distributed in the GGD building and the patients received medical, social and psychological guidance from the C.A.D. (Consultation Bureau for Alcohol and Drugs), a state-financed agency (Van Eepen, 1978). In 1976 the caseload was distributed over three agencies and the GGD program was reduced to 100 patients. As the number of methadone patients was steadily growing, diversification and specialization of offices took place. The GGD program remained basically a "low threshold" methadone maintenance program, requiring only a few basic demands from the clients such as no violence, coming regularly, no selling of the methadone and occasional urine analyses. The number of patients, however, decreased steadily to an average of 80 at the end of 1982. At that time another financing structure came into operation and all methadone patients were referred to the Consultation Bureau for Alcohol and Drugs. During the period of the data collection of this study {1977-1981), most of the patients were on maintenance although there always existed a regular turnover. Most of the patients received their methadone three times a week and had periodical contacts with the staff. Urine testing was carried out regularly. It was clear that additional use of heroin occurred frequently. The aim of the methadone program was reduction and abstinence, but the practice was fluctuating maintenance doses. The population of the program can be described as "hard core" and non-motivated toward abstinence. A later study has been carried out to evaluate the methadone programmes in Rotterdam between June 1982 and June 1984. New admissions to the programs are for 70% former clients asking for readmission. About one-third of the clients revolves between two or more methadone programs. On the basis of the outcome of this study it becomes clear that the mixed methadone reduction and methadone maintenance programs where highly identical to the real maintenance programs. In this view it can be seen that the GGD program did basically function as a maintenance program. Methadone to all programs was provided by the Municipal Pharmacy. However a minimum of methadone patients received treatment by general practitioners (Bernaert, 1985). This later study was restricted to the use of methadone and did not further evaluate the psychosocial functioning of the city's methadone clients. It may be assumed that the results of the study presented in this volume are still valid with, perhaps, the intensification of the psychopathological profiles brought about by the increase of a polydrug pattern of use and cocaine in the population (lntraval, 1989)