"Methadone Maintenance: It Ain't What it Used to Be":
That was the title of a presentation made in April 1974 (and published 2 years later), lamenting the overwhelming focus on providing the lowest dose of methadone and discontinuing it altogether as soon as possible (or sooner!). Alas, the preoccupation of politicians, the public at large and - tragically - even most providers is at least as great today as it was 36 years ago, in America and throughout the world. Source: Newman RG, Br J Addict 1976, 71:183-186.
posted by RGNewman, MD @ 10:21 AM
9 comments
9 Comments:
The problem with Methadone maintenance is that the dosages are going up with time just like with heroin. Besides that, the withdrawal syndrome of methadone is worse than with heroin.
Methadone maintenance treatment does not in anyway solve the opiate addiction, since in very short time methadone addiction developes.The withdrawal of methadone is ten times worse that opiate.
Dr.Hermon Mihranian
I was addicted to opiates until I found methadone. For the last 10 years I've been on monthly takehomes as I've been clean of all other drugs and am able to get a month's supply in pill form. I have a good job, supportive family, and I look at it no different than my dad who is a diabetic and takes insulin. For those who need it, there's nothing wrong (as long as you stay clean of other drugs) in staying on methadone maintenance for as long as necessary, even for life. It should be available to anyone from a private physician for addiction, not just for pain. We need OBOT (office based opioid treatment) for methadone or buprenorphine, methadone being the much cheaper drug, even for those limited or no health coverage.
Maria and Hermon, your beliefs, though common, illustrate your misunderstanding of how methadone treatment works and what opioid addiction involves.
Firstly, methadone works well for maintenance precisely because it is a long acting drug. It maintains a stable state in the bloodstream, instead of the constant up and down swing of short acting opiates, so the patient feels normal, not swinging back and forth between euphoria and illness. This also means that it takes a longer time to taper off the medication, yes--but that does not make it "more addictive". In fact, the addictiveness of a drug is not measured by how long it takes to taper off, but by how reinforcing the use of the drug is--i.e., the "rush" it provides and the intensity of the desire to repeat the use of the drug. In this sense, methadone is far LESS addictive--it does not provide this rush due to the very slow crossing of the blood-brain barrier. And if you will note, people who leave MMT and go back out and relapse do not relapse on methadone--they relapse on heroin or another short acting opiate. If methadone were so much more "addictive" they would seek it out instead--but they do not.
Also, the goal of MMT is NOT to be "drug free"--it is to be free of drug ABUSE and to return to a productive, functional life. Therefore, the length of time it may take to taper off the medication is not of utmost importance. Those who leave MMT relapse at a rate of 90% in the first year--however for those who remain IN treatment, 65% to 90% remain illicit drug free--a much higher rate than with ANY other treatment.
Additionally, the definition of addiction and of physical dependence is not the same. Addiction includes not just physical dependence, but a series of behaviors that are not present in stable MMT patients--therefore, they do not meet the medical criteria for being "addicted" to methadone, though they ARE physically dependent. It is then untrue to state that "in a very short time methadone addiction develops".
Active addiction results in negative outcomes--the patient usually experiences a variety of consequences such as being LESS able to function in society, LESS able to work, LESS connected to friends and family, etc--whereas a patient properly treated with appropriate medication is MORE able to work, care for family, etc and experiences the change as "life saving". This, then, is obviously NOT just "trading addictions".
Methadone absolutely for sure doesn't "solve" addiction, just as NO medication "solves" any chronic medical condition, be it diabetes or epilepsy or hypertension or ... What methadone does is save lives, restore health and allow normal functioning. Not every patient responds as well as one would like, but this too is a reality that methadone for addiciton shares with all other medications for any disease.
Isn't it better to be free of physical addiction to any substance?
There are methods which can help the patient achieve this goal...
off-course it would be better to be free of any addiction to any substance but unfortunatly some people find them-selfs in these situations(sometimes through no fault of there own). I would like to add, the comments about methadone being less addictive than heroine is correct, this drug does save lifes and saying methadone is 10 times more adictive than heroine is complete nonsence and such comments could be very harmful. Methadone gives people a chance to start leading a better life without having to break the law etc to get money to fund there addiction. If only people researched there information perhaps such utter rubbish would not have to be displayed on these sites
such a helpful comment - i don't think......sometime's the expresion - if u cant say something sensable its better to say nothing at all comes to mind !! these small minded ppl get sooo boring
I have been on methadone for 8 years. I also go and pick up take homes every 28 days and don't use anyother drugs .I never even drank a beer before I was in a car crash that left me addicted to oxycontin . I see Doctors posting on here saying how bad methadone is and this and that but even the stats show that they are the cause of most opiate addiction now. So is that what the problem is with a lot of doctors ? Are they getting less appointments now that there are more methadone clinics. I know that sounds crazy but so are the number of oxycontin prescriptions being wrote daily in the U.S.!
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