The first methadone clinic in Beijing

Abstract

In December 2004 one of the authors (R.H.) had the opportunity to spend a day with Professor Zhao Chengzheng from the National Institute of Drug Dependence and her colleagues at the Ankang Hospital methadone clinic in Beijing—the first methadone clinic to be approved in the area. The visit was part of a review of their site, which is part of the WHO study on Substitution Treatment of Opioid Dependence and HIV/AIDS being co-ordinated by the WHO Collaborating Centre in Adelaide, in conjunction with the Zurich team led by Ambros Uchtenhagen. The study is being conducted in China, Indonesia and Thailand as well as Eastern Europe (Lithuania, Ukraine, the Czech Republic and Iran). Ankang Hospital had received approval from the Chinese government to dispense methadone for therapeutic maintenance purposes only a few weeks prior to the visit. In the 2 or so years prior to this time, methadone had been approved for research purposes only to investigate its long-term maintenance properties. However, methadone has been available in China since the early 1990s and approved by the government for short-term detoxification from opioids such as opium and heroin. In these instances, methadone is administered in tapered doses for up to 3 weeks and has been shown to be effective for detoxification [1]. Initially methadone was approved for use only in the southern provinces of China where opioid use was a greater problem, due to the closer proximity to south east Asia where opioids are more freely available. As opioid use spread to other regions of China, so did the approval to use methadone as a detoxification medication. The modern opium trade has historical roots dating back approximately 200 years to the Qing dynasty (1636 – 1909) when western colonialists brought opium into the country. The impact of colonialism on China, which involved Portugal and Britain among other countries, resulted in two major Opium Wars arising from Chinese opposition to the trade. At the end of the second Opium War in 1858 the Chinese legalized the opium trade while regulating domestic trade and maintaining control of the customs duty. This resulted in considerable growth in opium production in China itself, with southern areas of China becoming the provinces where production was highest. The southern provinces exported opium to south-east Asia and the rest of China, resulting in high rates of dependence in the general population of China. Following the founding of the Peoples Republic of China by Mao Zedong in October 1949, a nation-wide anti-drugs campaign was executed along with the many other anticampaigns initiated by the new communist government. During the 3-year campaign, people involved with production or trafficking of opioids were punished according to the new laws. Accordingly, opium availability decreased rapidly and it was reported that 20 million opioid-dependent people became drug free again [2]. The next 30 years of the history of China were reported to be relatively drug-free until the 1980s, when the political tide of China slowly began to change with new market reforms and increased openness and trade with the rest of the world. Slowly drugs, particularly opium, were reintroduced to China, initially near the borders of south-west China and rural areas in the north-west, but spread quickly throughout other parts of the country. Opioid use has increased markedly from 1990 until the current time. The re-