Comments on the new legislation concerning Methadone Treatment in Denmark

by Marc Reisinger

Through several conversations I had with the persons responsible for public health in Denmark, I came to understand that the reform of methadone treatment was the result of a more relaxed way of prescribing methadone by general practitioners. The increase of drug deaths was cited as an indication of this insufficiently controlled way of methadone prescription.

 

The article by Dr. Lundstedt seems to be written from the same perspective, even though he warns that "the number of drug-related deaths decreased marginally" since the new legislation and "it is not possible to deduce a definite tendency from these figures".

 

All the same, it is interesting to examine the figures of drug related deaths a little more objectively. The mortality may have decreased marginally after the reform of methadone treatment in 1996, but it should be noted that this mortality seems to have been stabilised

even before the reform, since the number of deaths are as follows:

1993: 210

1994: 271

1995: 274

1996: 266

(Source: Ministry of Health, Denmark)

 

The strong increase of mortality from 1993 to 1994 is also not related to an increase in methadone prescriptions, since methadone consumption actually decreased from 1993

(105 kg/year) to 1994 (93 kg/year). Moreover, we should not forget that the mortality figures include different causes of death and deaths by intoxication are chiefly attributed

to heroin overdoses (1).

 

The reform of methadone treatment no doubt includes some positive aspects, such as the increase of capacity in Copenhagen. However, the fact that the patients are forced to transfer to public services and that they are generally unsatisfied, constitutes an essential ethical problem, especially when this coercion only has a marginal influence on mortality and the amount of seizures of illegal methadone. Patient satisfaction seems to me an essential evaluation element in every public health policy.

 

(1) Kringsholm et al. Deaths among drug addicts in Denmark in 1987-1991,

Forensic Science International 67 (1994) 185-195.

 

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