Lowering the Threshold

Sixty-five countries now offer the medications buprenorphine and methadone to treat opiate addiction. Deemed “essential medicines” by the World Health Organization, methadone and buprenorphine treatment help reduce drug injection and drug-related crime and improve public order, family satisfaction, return to employment, and adherence to HIV treatment.

Unfortunately, even when methadone or buprenorphine are available, treatment fails to reach many of those who could benefit. One reason for this is the many requirements—including admission restrictions, limited hours of operation, waiting lists, and cumbersome prescription and storage requirements—that make it difficult for patients to enter treatment programs.

This report documents low-threshold methadone and buprenorphine programs—that is, programs that seek, in the spirit of harm reduction, to meet patients “where they’re at” and minimize bureaucratic requirements.

Lowering the Threshold includes the following topics:

  • Methadone on Demand: The Hong Kong Model
  • Treatment by Prescription in France
  • Slovenia: High Coverage, Low HIV Prevalence
  • Widespread and Uncontroversial: Methadone and Buprenorphine in Croatia
  • Methadone by Bus in Amsterdam
  • Vancouver: Integrated Low-threshold Models of Care