METHADONE-MAINTENANCE IN AUSTRALIA

The history of methadone treatment in Australia has been and continues to be marked by conflict between two competing aims: harm minimisation and abstinence. The two approaches tend to be associated with high dose-long term and low dose-short term treatment, respectively. Most programmes fail to provide adequate ancillary services, often to the detriment of patient outcome. Despite chronic under-funding, a relative lack of staff training and, in some states, the absence of a system of clinical accountability, Australian methadone services have grown significantly in the last decade. Factors influencing the growth of programmes have been described using the New South Wales programme as the example as it represents the largest and most complex programme in the country. Current problems and the impact of the Human Immunodeficiency Virus on policy development are highlighted.