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Home > Effectiveness Bank Bulletin [Methadone maintenance and staff attitudes]

Drug and Alcohol Findings. (2013) Effectiveness Bank Bulletin [Methadone maintenance and staff attitudes]. Effectiveness Bank Bulletin, 25 Feb, .

PDF (1. Alternatives to non-clinical regulation: training doctors to deliver methadone maintenance treatment) - Published Version
PDF (2. Changing attitudes and beliefs of staff working in methadone maintenance programs) - Published Version

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1. Alternatives to non-clinical regulation: training doctors to deliver methadone maintenance treatment.
Bell J. Addiction Research: 1996, 3(4), p. 315–322.
Seminal study of how to train out socially derived attitudes to methadone maintenance as a policy solution to a social problem and train in attitudes which place it within mainstream medical practice as a treatment of individuals which does not 'fix' their problems but offers the opportunity for positive change.

This account is based on the description of the study in the chapter by the same author 'Training health professionals to deliver methadone treatment' in the book 'Methadone maintenance treatment and other opioid replacement therapies' (1998). In the Australian state of New South Wales training for medical practitioners in the delivery of methadone maintenance treatment has comprised a written manual, an interactive workshop, and a supervised clinical placement. The training has been evaluated and progressively modified in the light of feedback from participants and observers.

2. Changing attitudes and beliefs of staff working in methadone maintenance programs.
Caplehorn J.R.M., Lumley T.S., Irwig L. et al. Australian and New Zealand Journal of Public Health: 1998, 22(4), p. 505–508.
In Sydney in Australia an official campaign and educational efforts had the desired effect of shifting staff attitudes in methadone maintenance clinics away from achieving abstinence and withdrawal and towards long-term treatment aimed at reducing harm.

The featured study sought to establish whether staff attitudes in methadone maintenance clinics in New South Wales in Australia changed as a result of an official campaign to reorient these programmes from aiming primarily for abstinence to aiming primarily to reduce harm. The data sources were two staff surveys either side of the campaign.

At the time of the first survey in 1989 health service policy on methadone maintenance was strongly abstinence-oriented: "The methadone program will have a drug-free outcome as its basic objective. Doctors and counsellors will be asked to actively pursue the withdrawal from methadone of patients whenever this can be achieved." In the second half of 1989, around the time the first survey was completed, a new policy was circulated stating that: "The principal aim of methadone treatment programs is to assist opioid-dependent persons to improve their health and social functioning and alleviate the adverse social consequences of their drug use by reducing and eliminating their illicit drug use ... Methadone treatment is also intended to complement strategies to minimise the risks of transmission of [HIV] amongst intravenous opioid users and from them to other members of the community."

To herald the change in policy, in mid-1989 a special HIV-focused issue of the health department's educational magazine for alcohol and drug treatment staff was produced. The first Australian National Methadone Conference was held in Sydney in New South Wales in 1991 and staff at public methadone units were paid to attend. Several hundred heard presentations on harm minimisation and the importance of methadone dose for retention of patients in maintenance. Staff training seminars conducted by the health department featured speakers from the conference.

To assess the results 90 staff were surveyed at the 10 public methadone units in Sydney in 1989 and 92 at 11 of the 12 clinics operating in 1992. The surveys assessed their orientation to abstinence/withdrawal versus maintenance as goals of methadone treatment ( panel), their disapproval of drug use, and their knowledge of the risks and benefits of maintenance treatment.

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