7 Things You Need to Know About Methadone Treatment

7 Things You Need to Know About Methadone Treatment

By Jeremy Galloway 04/18/17

The research and statistics are irrefutable: methadone treatment is successful at improving almost every quality of life measurement for patients and creates safer, healthier conditions for families and communities.

Image: 
A man with his hands up, wondering.
When we’re given accurate information and effective options, we can make intelligent, healthy choices.

Methadone saved my life. Literally--I wouldn’t be here if someone hadn’t helped me get into a program. And I’m not alone. While stigma traps many methadone maintenance (MMT) or other medication assisted treatment (MAT) patients in a closet, it continues working in the background to save and improve the lives of countless people struggling with heroin addiction and other opioid use disorders.

Methadone remains controversial though, with no shortage of myths, misinformation, and outright lies aimed at steering people away from this potentially lifesaving treatment. MAT has helped me more than I can express, but I won’t argue that everyone with opioid problems needs methadone. They do deserve access to accurate and reliable information about methadone, buprenorphine (Suboxone), and other medications, though.

Here are seven pieces of information about methadone which would have saved me years of pain and trouble if I’d found them when I first started looking for help, and which could prove vital if you or someone you love is struggling with opioids.

1. Methadone has been used to help treat heroin addiction and other opioid use disorders for over 50 years.

The medication was first developed in Germany during World War II by scientists in a desperate search for a synthetic alternative to morphine. It wasn’t until over 20 years later that it would be used to treat opioid addiction.

Doctors Vincent Dole and Marie Nyswander of Rockefeller University in New York pioneered what came to be known as methadone maintenance treatment (MMT) in the mid-1960s. Their research showed dramatic and almost immediate improvements for participants in initial MMT studies. Patients were able to return to work and school, reduce or eliminate criminal activity, and rebuild relationships with their families. Dr. Dole and Nyswander’s research laid the groundwork for modern methadone treatment programs.

Methadone in the U.S. is dispensed in federally-licensed clinics which provide counseling, basic medical testing, and access to vocational, medical, and psychiatric resources. Unfortunately, the clinic model is limited, with patients often having difficulty meeting expectations, affording treatment costs, or finding transportation to their clinic during dosing hours.

Still, at 50 years old, methadone is one of the oldest and most reliable treatment options available for opioid dependence and addiction. 

2. Methadone is the most successful treatment option for opioid misuse, period.

Despite a decades-long record of success, methadone treatment remains shrouded in controversy. But the research and statistics are irrefutable: methadone treatment is successful at improving almost every quality of life measurement for patients and creates safer, healthier conditions for families and communities.

Methadone success rates range from 60 to 90 percent, with outcomes improving the longer a patient remains in treatment. Compared to the reported 5 to 10 percent long-term success rate for abstinence-based, non-medical treatments, methadone’s value becomes clear.

Defining “success” is difficult. It can be highly subjective, varying by person, and even between treatment and medical professionals. But looking at objective research, it’s clear methadone is effective at:

  • Reducing risk of overdose or acquiring and transmitting HIV, hepatitis C, and other diseases
  • Reducing mortality (median death rate of opioid-dependent people in MMT is 30% that of those who aren’t)
  • Reducing criminal activity
  • Improving family stability and employment potential
  • Improving pregnancy outcomes

These areas are significant and represent just a few of the improvements which can result from MMT. Methadone is unquestionably effective at improving quality of life for the person using drugs, their families, and their communities. It also has one of the highest retention rates of any available treatment option.

3. Methadone isn’t just harm reduction, it’s a medical treatment for what is--at least in part--a medical condition.

Methadone is medication. When patients take methadone daily and reach a stable dose, they experience no euphoria or “high,” they simply feel “normal.”

Clinics can also provide a vital link to medical and mental health services. If not for the initial medical screening my clinic performed when I entered treatment, I might have never learned that I’d contracted hepatitis C (HCV). Services like this are vital, especially considering the high number of injecting drug users who have been exposed to HCV, HIV, and other diseases, and that many of us have limited access to medical care.

Clinics also provide structure. For me, the clinic took the adventure away from the drug-seeking process, which was significant. Instead of breaking the law (stealing to support my habit became a minor addiction of its own for me) and tracking down heroin, I went to what was basically a doctor’s office each day to receive medication. The clinical setting helped refocus my thinking on my physical and mental health.

One key factor that marked a major turning point for me was finding SMART Recovery. It was the first support group where I actually felt like I fit in. There was no expectation of immediate abstinence and they fully accepted methadone and other medications taken under professional medical care.

4. Propaganda and stigma prevent many people from seeking MAT and can contribute to people leaving treatment early.

Despite its success, methadone treatment still carries a strong social stigma. Many patients are forced to hide the treatment from family members, friends, employers, and even probation or parole officers. In such an environment it’s inevitable that many patients will internalize that stigma.

When I first entered a program over six years ago the first thing people asked when learning I was on methadone was: “How long will you have to be on that stuff?”

That question is a trap. Not only does it miss the point of treatment with medications like methadone--which sometimes requires indefinite care--it’s potentially dangerous. Like many of the people who asked that question, I presumed the goal was to be “free” from methadone as soon as possible.

Methadone clinics frequently face resistance from communities where they plan to provide treatment, especially in suburban and rural areas. This scrutiny is not only misguided, it can be harmful to the communities opponents claim to be defending. There’s little evidence to support claims that methadone clinics attract crime. In fact, they almost always have the opposite effect, reducing criminal activity among patients--many of whom are members of those very same communities.

Eastern Tennessee, Kentucky, West Virginia, and similar places have been hit especially hard by recent increases in heroin use and opioid-related overdoses. People in these areas often have limited access to methadone treatment. As I reported last year, methadone patients from Virginia and Eastern Tennessee travel over an hour each way every day to dose.

Imagine the number of people who aren’t able to make the trip who continue using other opioids dangerously. Not only are they at increased risk of overdose death, they also have an increased likelihood of incarceration or contracting HIV or hepatitis C, as reflected by recent outbreaks of those diseases in rural America.

5. Relapse is much less likely to result in a fatal overdose because methadone maintains the patient’s tolerance to opioids.

Many overdose deaths occur when drug users return to using after a period of abstinence.

Methadone and buprenorphine are opioids, so they maintain the patient’s tolerance to other opioids. This greatly reduces the risk of an accidental overdose, a huge benefit over ‘abstinence-only’ approaches.

Methadone treatment reduces the risk of drug poisoning mortality by 75%, compared to heroin users receiving no treatment. Kenneth Anderson, MA, founder of the Harm Reduction, Abstinence, and Moderation Supports (HAMS) Network calls this the “protective effect” of methadone.

Dependent heroin users who enter traditional 28-day treatment programs leave with no protective barrier, making them 32 times more likely to die from an overdose than users who are on some type of maintenance medication like methadone or buprenorphine. “This suggests that programs which rapidly detoxify dependent heroin users and place them quickly back on the street put these users at high risk of overdose death,” Anderson says.

Opioid users who are incarcerated and then released, after losing their tolerance, are at a similarly increased risk of overdose. Rehabs and correctional facilities which fail to educate people about overdose risk factors and don’t equip them with naloxone are negligent and hold some accountability when they overdose. I’ve worked to educate methadone clinic staff about harm reduction and to help them equip patients with naloxone here in North Georgia, which has been met with almost universal acceptance. Many clinics are already proactively providing naloxone overdose rescue kits to new patients during intake.

6. Methadone is one of the most tightly-regulated medications in the U.S.

There are extensive federal and state regulations to prevent diversion of methadone. When patients initiate methadone treatment they’re required to visit the clinic every day (except, in may cases, Sundays) and ingest their dose under supervision by nurses. Patients are given incentives to advance, but are also subject to punishment when they slip up. Places like France take a more laid-back approach, as was recently chronicled in The Fix.

These regulations supposedly exist to limit diversion of methadone for illicit use. While people do overdose and even die from methadone, it’s significant that while overdose rates for other opioids increased dramatically between 2013 and 2014, the overdose rate for methadone remained unchanged. And most methadone overdoses, according to the Substance Abuse and Mental Health Services Administration, are caused by methadone prescribed for pain relief, not from methadone clinics.

While the daily structure and accountability created by these requirements can benefit some patients, for many--especially those who work or have limited access to transportation--they add another layer of barriers to treatment which is already difficult to access and maintain.

Many of the problems with the U.S. methadone system stem not from methadone itself, or even problematic clinic administrators; they’re often a byproduct of these strict regulations. Methadone patient and advocate Peter Vanderkloot writes in Harm Reduction Communication:

There are no other medications in the US pharmacopoeia subject to the restrictions applied to methadone hydrochloride... No other prescribed drug is administered only through federally licensed clinics. No other medication is so restricted that most patients must ingest it daily under the scrutiny of suspicious staff. No other substance can be prescribed only under the condition that the patient submit to ‘counseling’ and screens for illicit drug use—in perpetuity. No other medical treatment is used as the means to ensure a captive population of subjects for research. In short, no other system takes a medication of such potential benefit, and uses it to cause so much harm.

On top of this, methadone patients across the country report frequent harassment by local police. Only the failed War on Drugs could produce an environment where patients in a legal, medically-recognized treatment program find themselves victims of targeting by law enforcement. This reflects a broader attitude of contempt within the criminal justice system, where judges and probation/parole officers assume the role of doctors, often denying people with a long history of opioid problems access to a potentially life-saving treatment.

7. Methadone isn’t right for everyone. 

Methadone worked wonders for me, but there’s no ‘one-size-fits-all’ treatment approach for problematic opioid use. Methadone is one of many tools which, when applied correctly, can be remarkably successful. But when methadone doesn’t work, there are other options.

In countries like Switzerland, Germany, the United Kingdom, and most recently Canada, people seeking help for problematic opioid use have another option: heroin-assisted treatment (HAT). While it sounds radical in a society where strict prohibition has been normalized, HAT programs are not only safe, they’ve shown success rates similar to methadone and buprenorphine treatment, and they have the highest retention rates of any treatment available.

A 2007 study of HAT in different countries concluded, “...in several different contexts that the implementation of HAT is feasible, effective, and safe as a therapeutic intervention.” Pharmaceutical-grade heroin (diacetylmorphine), like methadone, is safe when given at controlled doses to patients who have developed a tolerance. Some studies even indicate that HAT might be significantly more effective than MMT.

Programs like SALOME in Canada have been so successful the national government recently moved to allow doctors to prescribe heroin to patients. Despite steadily-increasing opioid overdose rates in the United States, and mounting evidence that drug decriminalization and options like heroin-assisted treatment are effective at improving quality of life for drug users and their communities, it’s difficult to imagine HAT coming here in the near future. However, as reported last year in The Fix, studies of hydromorphone (Dilaudid) assisted treatment have produced success rates similar to HAT.

None of these options are a “silver bullet” that can promise an end to opioid addiction. Medication-assisted treatment is the greatest tool we have to combat problematic opioid use and the growing threat of overdose deaths, but it’s not the only one.

Ultimately the decision as to which treatment, if any, someone chooses should be theirs, free from coercion or intimidation. When we’re given accurate information and effective options, those of us with a history of problematic drug use are remarkably capable of making intelligent, healthy choices.

Unfortunately there’s still a sea of anti-methadone and anti-Suboxone misinformation and propaganda for opioid users and their families to wade through. Until we break down treatment barriers and provide an honest, non-judgmental environment for people seeking relief, the potentially harmful--and often lethal--consequences of heroin and other opioids will haunt us. At a time when many are raising the alarm about an opioid overdose epidemic, we have solutions that can stop our nation’s opioid problem in its tracks. Limiting or denying access to people who could benefit from those services is not only irresponsible, it’s cruel, inhumane.

We can either go the route of countries like the Philippines, who have cast human rights aside to criminalize and dehumanize even the most minor drug offenders. Or we can follow in the footsteps of Canada, which treats drug users with respect, dignity, and compassion. The path we choose will speak volumes about our national character to the rest of the world, and could very well set the tone for the international process of healing from the devastating impacts of The War on Drugs.

Please read our comment policy. - The Fix
Disqus comments
jeremy-galloway.jpg

Jeremy Galloway is a co-founder of Georgia Overdose Prevention, Harm Reduction Coordinator with Families for Sensible Drug Policy, and advocates for the rights of people who actively or formerly used drugs and those impacted by drug criminalization. He's part of a network of advocates, academics, and public health officials from across the South working to combat the recent wave of overdoses and opioid-related problems in the the region. You can find Jeremy on Linkedin and Twitter.

Disqus comments