An Evaluation of Methadone Substitution Therapy in the Context of Nigeria: Cultural Considerations and Clinical Effectiveness

Abstract

Background: Methadone Substitution Therapy (MST) is employed to manage opioid addiction and has generated extensive discourse. While widely embraced in the West, its applicability in Nigeria, considering its unique cultural, infrastructural, and societal nuances, remains debated.

Methods: A critical literature review methodology was utilized, focusing on English-language studies from databases such as PubMed and Google Scholar. The review centered on MST in Nigeria or similar cultural contexts, examining its pharmacological properties, clinical effectiveness, ethical considerations, health economic implications, and cultural perceptions.

Results: Methadone, introduced in the 1960s, reduces cravings and withdrawal symptoms but raises concerns about cognitive impairment and potential exacerbation of cravings. While some studies show its effectiveness in decreasing criminal behaviors, others suggest prolonged use may hinder genuine recovery from opioid dependence. Within Nigeria's resource-limited setting, MST raises concerns about resource allocation, cost implications, and long-term cost-effectiveness. Additionally, the behavioral economics of MST suggests potential pitfalls in addressing the core behaviors leading to addiction. In addition, MST's utility is potentially limited by its marginal contribution to Quality Adjusted Life Years (QALYs) and concerns about patient autonomy and societal benefits. Further, the sociocultural fabric of Nigeria plays a significant role in MST's acceptance. Despite MST's evident challenges, cultural perceptions surrounding addiction and medication are pivotal.

Conclusion: While MST offers a potential intervention for opioid addiction, its challenges are evident, especially in the Nigerian context. Economic, cultural, and clinical implications necessitate a nuanced, context-specific approach.

Keywords: Methadone Substitution Therapy, Nigeria, Cultural Perception, Health Economics, Opioid Addiction.