Negative Effects From "Zero Tolerance" in Swedish Methadone Programs

"Some Swedish maintenance treatment programmes have 'zero tolerance' against lateral use, which means that a patient can be discharged from treatment after a single positive urine test (Heilig & Gunne, 2008). In the study 'Involuntary discharge from medication-assisted treatment for people with a heroin addiction – patient’s experiences and interpretations' (Svensson B, 2011) the effects for involuntary discharged participants in a maintenance treatment programme in Malmö were studied by qualitative methodology. A deteriorating physical and mental health status were described by the participants generally. The serious medical risks of discharge were confirmed in a study by Fugelstad (2007) in which mortality in a group of patients expelled from a programme was 20 times higher than in treated patients.
"Recent Swedish research has shown good results in clinical trials with highly structured treatment based on positive reinforcement of desired behaviours (Kakko, 2011). In an evaluation of a drug-assisted programme for female prostitutes in Malmö, two success factors are mentioned: effective liaison with social services and mental health care and a reasonable programme size. Small-scale programmes create an organizational vulnerability while large-scale programmes increase the risk of neighbourhood problems and therapeutically unfavourable patient compositions (Laanemets, 2007)."