Opiate substitution treatment

There are various terms for prescribing a pharmaceutical equivalent for people who have a drug problem involving opiate street drugs. An internet search suggests OST, standing for Opiate Substitution Therapy is the term most commonly used in Scotland.

In the UK, this practice links all the way back to, at least, the establishment of the British system (see british system) that emerged from the report of the Rolleston committee in 1926. The evidence for prescribing methadone goes back to the early 1960s and is extensive; methadone being one of the most widely researched medicines and OST one of the most widely researched treatments in medical history. OST with either methadone or buprenorphine is the World Health Organisation’s (WHO) recommended treatment for opiate dependence and methadone is on the WHO List of Essential Medicines.

All of this has not prevented OST and methadone prescribing being the subject of a controversy in Scotland which is now entering its fifth decade. Much of this controversy is unnecessary in that it involves assertions for which there is little or no evidence or the generalisation of particulars which are not accurate or typical (see parked on methadone). Sometimes this controversy is based in misunderstanding on the role of treatment (see treatment). For some, the controversy is rooted in fundamentally ideological and moral positions on the respective roles of the individual, the family, community, wider society and the state in the causes and means to address problem drug use.

This controversy has impacted on Scotland’s ability and capacity to prevent and address problem drug use and on the quality of treatment and support services. For these reasons, the fact that there is a controversy, rather than the detail of that controversy, is an issue in itself. It is an issue which has stigmatised the best evidenced clinical intervention to support people with an opiate-based drug problem i.e. OST and methadone specifically (see stigma). It is an issue which results in human suffering and preventable deaths.