Taiwan's "nine-in-one" local elections are in the voting stage. In the Taipei mayoral election, drug issues have recently become a new battleground in the campaign. One of the focuses is around the characteristics and effectiveness of methadone (Methadone).
Methadone is a controlled drug that can inhibit addiction to heroin (commonly known as "white powder"), morphine and opium. It usually does not cause users to feel pleasure and has no serious side effects.
Methadone is used as an alternative drug in many regions around the world to treat people addicted to opioids. It has been recognized by organizations such as the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO). It is currently recognized as one of the most effective treatments for opioid addiction in international medicine.
Hong Kong has launched a methadone outpatient treatment program half a century ago. BBC Chinese has reviewed the history of the development of methadone treatment in Hong Kong and analyzed social myths. One scholar said, "Detoxification is defined as: minimizing the impact of drug abuse on a person. I think it (methadone) is the most cost-effective."
What is methadone?
Methadone is a synthetic analgesic developed in the 1940s and later studied as a detoxification treatment for various opiates, including heroin. A daily dose of methadone has shown to be effective, suppressing drug addiction for 24 to 36 hours.
Professor Li Ruishan, deputy director of the Ho Sin Hang Infectious Disease Research Center of the Chinese University of Hong Kong, has been in charge of AIDS (AIDS; AIDS) prevention and control work in the past. He once served as a consultant for the Special Prevention Program of the Hong Kong Department of Health and is familiar with methadone treatment plans.
"Some people say that if you give methadone to drug addicts, wouldn't you switch from one drug to a second drug? That's not the case," Li Ruishan said. "This is a misunderstanding."
He first pointed out that the average drug addict takes heroin because of psychological pressure or the need to escape from the surrounding environment and social problems. Heroin will bring a calm, serene and euphoric feeling, "as if it has solved their current problem." Some people will even use heroin through syringe injection intravenously. However, once the drug is stopped, the withdrawal reaction will be very difficult.
Li Ruishan further explained that methadone is an oral liquid with long-lasting effect and does not produce Euphoria or the pleasure commonly known as "High". There is no "abuse of methadone" in disguise, but it can relieve the uncomfortable feeling of heroin withdrawal. At the same time, it can make some people feel that they no longer need heroin. It is also a detoxification.
Hong Kong’s leading methadone outpatient program
Compared with methadone treatment programs in many regions around the world, Hong Kong is at the forefront.
As early as 1972, experimental methadone treatment clinics had been launched in Hong Kong. Dr. Robert Newman, who was in charge of the methadone clinic in New York City, USA, was invited to evaluate its effectiveness. He recommended a large-scale expansion plan to the then Hong Kong Standing Committee on Narcotics.
In 1976, the Medical and Health Department originally planned to open a clinic first. However, the supply of drugs was extremely scarce in the first half of the year and prices soared, prompting the methadone program to be accelerated. In the next year, the number increased to 21 clinics, serving nearly 10,000 people.
Li Ruishan said that in Hong Kong society in the 1960s and 1970s, many drug addicts lived in poverty and would commit crimes in order to get money to buy drugs, causing serious public security problems. "If drug addicts can be provided with good treatment, they will basically not need to commit crimes again." After the launch of the plan, the prison load was significantly reduced.
He analyzed that the way Hong Kong promoted the methadone program in the early years was "smart", but was later summarized as a "low-barrier" model - the clinic was named "treatment", "don't talk about doing anything for criminals", and charged a nominal fee of HK$1 (13 US cents; 0.85 RMB) each time. (US$4; NT$4), the price has not changed so far, and the outpatient clinics are located all over Hong Kong, Kowloon and the New Territories, making it easy for the largest audience to access services. On a daily basis, the clinic is mainly staffed by members of the voluntary Auxiliary Medical Service, with occasional part-time medical staff on duty. The place is small and only for methadone administration, and the operating costs are extremely low.
There are currently 18 methadone clinics in Hong Kong, with networks as far away as the outlying island of Cheung Chau. They are open during evening hours. Drug delivery services will also be maintained on Sundays, from typhoon signal No. 8 to black rainstorms. Users do not need to be referred or make an appointment in advance.
In principle, all drug addicts must swallow methadone in front of the dispensing staff and cannot take it away.
In the early days of Hong Kong, the orange-colored methadone liquid was commonly known as "orange juice." In the past, there were cases where users took the dose in their mouths and took it away, causing discomfort or even death by others. Later, the solution was changed to green.
How effective was the plan?
To evaluate the effectiveness of the methadone program, Li Ruishan said it depends on the goals set and the definition of "drug detoxification."
The methadone clinic provides two types of treatment. The substitution plan means that users take an appropriate dose of methadone every day when needed, with no time limit on the course of treatment. Those participating in the detoxification program gradually reduce their dose over a period of time until they no longer need to take it.
The clinic also provides HIV and hepatitis screening, provides various vaccinations, and provides social worker counseling. It will also refer patients to appropriate drug treatment institutions according to the situation. The government has also proposed a "harm reduction" strategy, which takes public health interests as the premise and aims to mitigate the harm caused by drugs to individuals and society, rather than focusing on a single level.
According to Li Ruishan's understanding, when joining a methadone program for the first time, the doctor will decide the direction of treatment together with the user. Young drug addicts may be more inclined to target drug rehabilitation, but they also have the right to choose a substitution model. He has met people who stopped taking methadone after 5 or 10 years. There are also cases where people still need to take low doses for more than 20 years. The person said, "It's good to come to the methadone clinic and chat with people." In his eyes, both are considered drug addicts.
Li Ruishan used the metaphor of treating heart disease to ask: "What is your goal of treatment? You want to make the heart look exactly like it was before the disease. I don't think that is right. His heart is healthy and no new problems will occur. This is the most important thing."
"Drug addicts have many other problems. If they do not occur, they are already healthy. For example, the person can go back to work." Li Ruishan said, "I think it will be much better if drug addicts are allowed to use methadone therapy with the goal of no longer being exposed to illegal drugs, or only need to take low-dose methadone to live."
In the official narrative, the methadone program was highly effective.
A commemorative special issue on anti-drug work published by the Narcotics Division of the Security Bureau of the SAR Government in 2000 pointed out that the methadone program had largely contributed to the decline in the number of drug-dependent prisoners, and the government closed two drug treatment centers and two prisons in 1979.
The author of the special issue is Peter Lee, who served as the anti-narcotics commissioner of the British Hong Kong government in the 1970s. He pointed out that methadone does not require drug addicts to be hospitalized, making it easier for drug addicts to return to work or reintegrate into society. In the past, Hong Kong government officials have pointed out that methadone is the only alternative treatment that can take care of the needs of drug abusers who are unsuitable or unwilling to receive hospitalization or other treatment methods.
As for criticism from time to time about whether methadone is addictive or whether drug addicts can eventually stop using it, Li Shangzhi cited an article saying that compared with diabetics who stop taking insulin preparations and rheumatoid arthritis patients who stop taking steroids, patients who suddenly stop taking methadone will have much milder withdrawal symptoms. However, no one derogates other long-term drugs as "easily addictive" drugs, emphasizing that if drug addiction relapses after drug addiction, crime, law enforcement and health care costs will increase significantly.
Stop the spread of AIDS
Professor Li Ruishan, who is mainly engaged in AIDS prevention and treatment, also pointed out that drug users have the opportunity to contract AIDS through syringe injection. However, Hong Kong had established methadone services long before the spread of AIDS, which greatly reduced the incidence of syringe transmission, and was later followed by other Asian regions.
"I can boldly say that the percentage of drug addicts among people infected with HIV (Human Immunodeficiency Virus, which without treatment can lead to AIDS) in Hong Kong is the lowest in the world. It's so low that I don't even believe it."
According to statistics from the Department of Health, from 1984 to June 2026, less than 3% of cases were infected with HIV or AIDS due to injection drug use. A report from the United Nations Program on HIV/AIDS (UNAIDS) states that in 2022, 8% of new HIV infections globally will be among injecting drug users.
Li Ruishan said: "If you define drug detoxification as minimizing the impact of drug abuse on a person, I think it (methadone) is the most cost-effective."
"If it is defined as a person never taking drugs again, methadone clinics really cannot bring you this immediate effect."
Unfinished social controversy
Hong Kong’s experience in implementing methadone for more than half a century has attracted more than 150 study tour groups from more than 20 international organizations or neighboring regions to Hong Kong for exchanges.
Li Ruishan admitted that after the spread of AIDS, methadone programs were launched in many places around the world. Mainland China, Taiwan, Macau and even Southeast Asian countries also followed Hong Kong's approach, but there were slight differences in each place. For example, mainland China has a vast territory and it is difficult to build multiple outpatient clinics, so larger clinics will be built in a single location. Macau is smaller and does not need the same number of outpatient clinics.
China and Taiwan introduced methadone treatment in 2004 and 2006 respectively.
However, looking back at Hong Kong, even though the methadone program has been implemented for many years, it still faces doubts.
The authorities described the program as "effective" and will continue to do so, citing plans by the United Nations Office on Drugs and Crime and the World Health Organization that estimate that for every US$1 spent on methadone treatment or other similar therapies, society can save US$6 in security, medical and social welfare expenditures.
The drug problem is no longer concentrated on heroin, but has shifted to ketamine (ketamine), methamphetamine, and in recent years, fentanyl, etomidate, etc.
