October 1, 2017
Methadone is one of the best-studied and most effective medication-assisted treatments for heroin dependence. Individuals and communities have found that methadone treatment not only reduces the use of opiates and the prevalence of overdose, but it also improves adherence to other medical regimens, increases employment, and improves family function. The systems that deliver methadone treatment programs, the conditions for their creation, expansion, and therapeutic success are just as important to understand as the treatment itself. Globally Informed, Locally Responsive: Hong Kong's Common-Sense Approach to Expanding Methadone Treatment presents a model for how localities can review best practices from other treatment delivery contexts and then adapt these recommendations to their local needs, resource availability, political realities, and community expectations. It captures how Hong Kong sourced ideas from New York and other locales to construct a methadone program that serves the individuals and communities who are most in need.Started in 1975, in response to a growing health and social crisis with an increasing number of opiate-dependent, heroin-injecting residents, the Hong Kong methadone program aims to make drug treatment accessible to all who need and want it through its 20 clinics around the territory. The program's success hinges on a number of features, including convenient hours and locations, robust staffing, and an understanding that abstinence should not be the only goal when supporting people with drug dependency.The approach deployed in Hong Kong is pragmatic and flexible. Hong Kong conducted research and scaled up at the same time, prioritized making treatment widely available, and expedited enrollment. This approach has worked for decades to control heroin dependence and its negative consequences, such as HIV and Hepatitis C infection and crime, which have been common in other communities with heroin use.Globally Informed, Locally Responsive offers an important insight for the design and provision of treatment services for people who use illicit drugs: the most effective systems are responsive to the needs of patients, not the other way around.