GOOD “PILOTS” OR BAD:

Depends on where they’re heading. The Xinhua News Agency Mar 26 reports that a “methadone pilot” is being launched in Vietnam. Sounds good – until one looks at the details. First, it targets 700 patients – in a nation that estimates over 160,000 opiate dependent people. Second, the “pilot” is to last almost two years – until Dec. 2008; the premise seems to be that it will take that long before data are in hand on which the government will rely to determine the future role of methadone in Vietnam. And finally, the report describes the project” as “…giving oral methadone to patients instead of heroin and eventually weaning them off methadone.”

Comment: over 40 years of experience with methadone maintenance around the world – including Asia – have demonstrated the efficacy of this treatment of addiction; the very concept of a “pilot” for such a proven therapeutic regimen is impossible to justify.

The corollary of “700 patients” to be enrolled in the project is that over 99.5% (sic!) of those who might be helped by methadone treatment will be abandoned – presumably for the next two years or so.

And perhaps most damning of all, the “pilot” embraces and implicitly endorses the unequivocally incorrect assumption that persistent abstinence following discontinuation of methadone maintenance is an appropriate and realistic program objective.

While USAID and its British counterpart surely have the very best intentions, one has to wonder if this particular effort will not be decidedly harmful to vast numbers of people who desperately want and need help - people for whom we know, unequivocally, help could be provided promptly and effectively without any “pilots.”