A COST/BENEFIT ANALYSIS OF METHADONE MAINTENANCE
THERAPY IN CANADIAN FEDERAL PRISONS

Lori L. Mills
The John Howard Society of Alberta

INTRODUCTION

In dealing with drug-related issues, harm reduction is a public health approach that places first priority on reducing the negative consequences of drug use, rather than on ensuring abstinence (CCSA 1996). As there is currently no agreed upon definition of harm reduction among practitioners and the addictions literature, the following definition is suggested: “A policy or program directed towards decreasing the adverse health, social, and economic consequences of drug use without requiring abstinence from drug use“ (CCSA 1996:9). That harm reduction is now the official basis of Canada’s Drug Strategy is evidence both of its proven effectiveness as well as its increasing authoritative acceptance (Single 2001). In particular, harm reduction is credited with developing a wide variety of new and innovative approaches to the problems of injection drug users (IDU’s), such as methadone maintenance treatment (MMT) for those addicted to heroin and other opiates.

The purpose of this research is to explore the cost/benefit ratio of expanding existing MMT programs in federal prisons in Canada. It is not intended to promote the use of incarceration as a method of dealing with heroin addiction. On the contrary, given that many heroin addicts come into contact with the criminal justice system and often find themselves imprisoned, the following discussion is intended to promote the expansion of existing MMT programs in federal institutions, so as to assist heroin addicted individuals who end up in that environment. This article begins with a summary of the history of methadone as a treatment for heroin addicted individuals, with specific attention paid to the current statutory obligations of the Correctional Service of Canada (CSC) and its implementation and ongoing operation of its National MMT Program. The balance of this article will provide a cost/benefit analysis of MMT in Canadian federal prisons as a specific strategy in Canadian drug policy. In particular, this article will consider the impact that MMT has on inmates with HIV, AIDS and/or Hepatitis C, as well as their future criminality and ongoing drug use. Relevant studies and literature reviews will be comparatively assessed. Finally, this article will provide a series of recommendations and conclusions in support of the development and implementation of a policy to expand existing MMT programs in Canadian federal prisons.

BACKGROUND

Developed in a lab, methadone is a long lasting narcotic that was first used in the mid-1960’s by Dr. Vincent Dole and Dr. Marie Nyswander of Rockefeller University as a maintenance treatment for opiate addiction (Institute of Medicine 1995). As methadone is made in accordance with strict manufacturing guidelines, its exact potency is known (CCSA 2001). Notwithstanding the fact that its use has been constantly challenged since its discovery, methadone maintenance treatment remains the most effective, safe and successful means of treating opiate addiction. To illuminate how MMT achieves its success, “[t]he tolerance mechanism that blocks the narcotic effect of heroin also blocks the narcotic effect of methadone itself” (NIDA 1999:5). Methadone is effective because it provides relief from the effects of opiate withdrawal without inducing the “high” associated with opiate derived drugs like heroin and morphine.