Against the background of a declining number of reported heroin users, the Director of Audit concludes that methadone clinics should give way to programmes on soft drugs ('New focus urged on treating abusers', April 10). I see three grounds for this claim, in 'audit' terms.
First, the methadone clinic programme costs HK$30 million a year. This money enables 20 clinics to serve several thousand patients a day. It has become less cost-effective in the eyes of auditors when the same money helped 7,000 heroin users in the past but only 6,000 today - a difference of a little more than HK$1 per day per person. But I know of no humbler model in Hong Kong's medical service.
Second, there is a perpetuating myth that methadone treatment does not bring more people to detoxification. This is another misconception about key objectives of methadone treatment. By putting heroin users on methadone maintenance (which is the primary approach, not detoxification) we are reducing harm to individuals and society, a fact borne out by the declining crime rates and prison occupancy since the clinics were established in the 1970s, but which appears to have been forgotten. Hong Kong's HIV prevalence among heroin users continues to be one of the lowest in the world, because of the methadone programme. Despite this, the auditors are calling for a shake up, without regard to the need for maintaining broad population-level coverage of the service.
Third, a comparison has been drawn between the cost of treatment programmes for methadone and soft drugs. But is this a valid comparison? Nobody disagrees with efforts to curb soft-drug abuse, but these should not be at the expense of a humble service that has served public health so well.
It is not the money that counts in drug treatment, but rather having a coherent approach, professional support, and effective strategy. These qualities are not measured by the Audit Commission. At a time when Malaysia, the mainland, Vietnam, Indonesia and others are modelling their own methadone programmes on ours, this report provides them a good lesson on what should not be done.
S. S. Lee, professor of infectious diseases, Chinese University