Methadone…a long treatment that may not work as well as advertised

Does gradual methadone detoxification work?

The first study, by the University of California at San Francisco, compared the success rates of methadone therapy in a controlled study of two groups. The first group of heroin addicts was given methadone maintenance therapy, with some limited peer group and educational support services. The patients in this group received methadone at a maintenance level, and the doses of the drug were never tapered down. The second group received 120 days of methadone maintenance therapy, coupled with intensive education and drug rehab programming, and for the final 60 days of the study, the doses of methadone were gradually tapered down to nothing.

The results were that long term methadone maintenance induced greater heroin avoidance than did intensive therapy and methadone reduction, although the usage of heroin remained relatively high amongst both groups. Essentially, neither program worked very well, but the program that tried to wean addicts off of the methadone worked very poorly.

Are methadone patients abusing other drugs?

A second San Francisco methadone study as published in the American Journal of Drug and Alcohol Abuse, looked at the actual occurrence of concurrent drug taking during methadone maintenance therapy, and wanted to see if the actual occurrence rates matched commonly accepted statistics of abstinence as released by the methadone treatment centers. The way they did this was to increase the frequency of drug urine testing performed on participants in several methadone maintenance programs.

Most programs will test monthly for the initial period, and decrease the testing to as little as once a quarter after the initial period of treatment. The study authors, aware that many drugs are metabolized out of the body relatively quickly, estimated that actual drug taking prevalence rates might be significantly higher than published rates. By testing as often as every 2 days, they found that heroin or other opiates were being abused 50% more regularly than the clinics had reported, and that cocaine was being abused 77% more regularly.

So what do these two studies tell us about methadone therapy?

Firstly, it seems to me that if the ultimate goal of methadone therapy is to ultimately wean the addict off of the drug, then the very low success rates of the methadone detoxification study indicate that perhaps this is unrealistic. There may be nothing wrong with a very long, or even indefinite, program of methadone therapy; but if that’s what’s actually needed then we should be clear on the true obligations of treatment, and addicts considering methadone should be aware that they may be signing up for a very long commitment.

Public health officials may promote methadone as a very cost effective solution to a drug problem, and it may very well be the cheapest way towards societal harm reduction, but individual addicts signing up for methadone therapy may not have access to the needed therapies towards sobriety. Something caused the initial abuse, and simply by eliminating the pain of detox from an addiction, you have not conquered whatever it was that led, and will likely lead back, to continuing abuse. Methadone therapy may allow for better opiate sobriety, but if an addict starts using cocaine instead, had anything good been accomplished? Methadone therapy is extremely contentious, and advocates for the therapy argue passionately of the benefits and of the thousands saved by the program.

I would never argue that methadone has not worked for many, and we need to keep any aspects of drug treatment that have efficacy; but I would argue that the methadone treatments as currently offered don’t do enough to rehabilitate addicts, and that the statistics of success are likely very inflated. Advocates for methadone often point to the high recidivism rates of conventional drug therapy, but if methadone therapy is not offering better recovery rates, and the commitment to methadone may well be for life, is it any better? And if even intensive therapy and methadone doesn’t induce much change, maybe there is something fundamentally flawed with the idea that withdrawal doesn’t require discomfort?

I have trouble looking at addiction as a public health issue since I have felt the pain of addiction personally. What is good for the many is not always good for the individual, and although methadone may well decrease crime and HIV as advertised, it does not seem to offer enough of its participants the hope of a life free from addiction.

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Does gradual methadone detoxification work?

The first study, by the University of California at San Francisco, compared the success rates of methadone therapy in a controlled study of two groups. The first group of heroin addicts was given methadone maintenance therapy, with some limited peer group and educational support services. The patients in this group received methadone at a maintenance level, and the doses of the drug were never tapered down. The second group received 120 days of methadone maintenance therapy, coupled with intensive education and drug rehab programming, and for the final 60 days of the study, the doses of methadone were gradually tapered down to nothing.

The results were that long term methadone maintenance induced greater heroin avoidance than did intensive therapy and methadone reduction, although the usage of heroin remained relatively high amongst both groups. Essentially, neither program worked very well, but the program that tried to wean addicts off of the methadone worked very poorly.

Are methadone patients abusing other drugs?

A second San Francisco methadone study as published in the American Journal of Drug and Alcohol Abuse, looked at the actual occurrence of concurrent drug taking during methadone maintenance therapy, and wanted to see if the actual occurrence rates matched commonly accepted statistics of abstinence as released by the methadone treatment centers. The way they did this was to increase the frequency of drug urine testing performed on participants in several methadone maintenance programs.

Most programs will test monthly for the initial period, and decrease the testing to as little as once a quarter after the initial period of treatment. The study authors, aware that many drugs are metabolized out of the body relatively quickly, estimated that actual drug taking prevalence rates might be significantly higher than published rates. By testing as often as every 2 days, they found that heroin or other opiates were being abused 50% more regularly than the clinics had reported, and that cocaine was being abused 77% more regularly.

So what do these two studies tell us about methadone therapy?

Firstly, it seems to me that if the ultimate goal of methadone therapy is to ultimately wean the addict off of the drug, then the very low success rates of the methadone detoxification study indicate that perhaps this is unrealistic. There may be nothing wrong with a very long, or even indefinite, program of methadone therapy; but if that’s what’s actually needed then we should be clear on the true obligations of treatment, and addicts considering methadone should be aware that they may be signing up for a very long commitment.

Public health officials may promote methadone as a very cost effective solution to a drug problem, and it may very well be the cheapest way towards societal harm reduction, but individual addicts signing up for methadone therapy may not have access to the needed therapies towards sobriety. Something caused the initial abuse, and simply by eliminating the pain of detox from an addiction, you have not conquered whatever it was that led, and will likely lead back, to continuing abuse. Methadone therapy may allow for better opiate sobriety, but if an addict starts using cocaine instead, had anything good been accomplished? Methadone therapy is extremely contentious, and advocates for the therapy argue passionately of the benefits and of the thousands saved by the program.

I would never argue that methadone has not worked for many, and we need to keep any aspects of drug treatment that have efficacy; but I would argue that the methadone treatments as currently offered don’t do enough to rehabilitate addicts, and that the statistics of success are likely very inflated. Advocates for methadone often point to the high recidivism rates of conventional drug therapy, but if methadone therapy is not offering better recovery rates, and the commitment to methadone may well be for life, is it any better? And if even intensive therapy and methadone doesn’t induce much change, maybe there is something fundamentally flawed with the idea that withdrawal doesn’t require discomfort?

I have trouble looking at addiction as a public health issue since I have felt the pain of addiction personally. What is good for the many is not always good for the individual, and although methadone may well decrease crime and HIV as advertised, it does not seem to offer enough of its participants the hope of a life free from addiction.

One thought on “Methadone…a long treatment that may not work as well as advertised”

  1. Methadone is now the #2 Killer Drug in the U.S. and #1 killer per perscription. This is a legal drug that has been thought to be safe for the past 40 years. Only recently when its use became approved for pain management patients has the cardio toxic risks emerged. Previously methadone has been used exclusively for replacement therapy for heroin patients and death was thought to be an effect of the accumulation of many years of drug abuse. With the surge in pain medication misuse and abuse more patients are being referred to methadone clinics and physicians treating pain who believe the myth that methadone is safer or non addictive because of it’s use with weaning addicts from heroin. Methadone is more addictive then any other pain medication including heroin and because of it’s extremely long half life, cardio toxic risks, numerous fatal drug interactions, dosages based on tolerance, and small margin of error. Up until Nov 2006 the government and pharmaceutical companies have been suppressing the numerous health and fatality risks related to methadone.

    there are between 800,000 & 900,000 (some stats give diff numbers) heroin addicts in the U.S and 1,881 people died from heroin in the U.S. in 2004.

    there are 200,000 people on methadone for drug treatment and I don’t have the number of people on it for pain but even if we double the 200,000 and assume it’s 400,000 total people on methadone there were 3,849 deaths in 2004

    It looks like the “gold standard” is killing more then the drug its supposed to save people from!!!!

    Every day 10.9 people die from Methadone (according to 2004 stats)

    We (the families of methadone victims) are requesting new laws surrounding who can prescribe Methadone, clinic rules and regulations as well as stiffer penalties for those caught selling their take home doses. The whole methadone maintenance system needs an overhauling. We cannot continue to allow a legal medication to be killing more people then the illegal drugs. Our government cannot be allowed to use tax dollars to fund their legal drug dealing operations.

    We are asking government agencies to enact stricter guidelines in prescribing methadone for any reason. It must be mandatory that all doctors be certified and trained in the pharmacology of methadone; inpatient stays must be required during induction to methadone; all staff be extensively trained in monitoring methadone patients for symptoms of toxicity. Clinic patients should be tested weekly for legal and illegal drugs that are taken with methadone to get “ hi gh” or experience “euphoria” such as benzodiazepines, alcohol, cocaine, heroin, marijuana etc… and face severe consequences or mandatory detoxification from the methadone program after 3 dirty urines. Selling of take home doses must result in termination from methadone program permanently throughout the U.S. When presenting inebriated at clinic, clinic should also document such activity as well as prevent client from driving. Take home doses for all patients receiving methadone should be eliminated thus preventing the risk of diversion or precautions such as pill safe should be implemented. http://www.thepillsafe.com/

    Current statistics show that nearly 4000 people a year die from methadone. These deaths are mostly happening to pain management and detoxification patients’ wit hi n the first 10 days of taking initial dose. Most of these deaths are related to methadone prescribed with other medications that react as additives with the methadone. Diversion of methadone is a serious problem because it lands t hi s most deadly drug on streets. Statistics also state that methadone is contributing to more deaths nationwide then heroin and only second to cocaine deaths.

    The potential of abuse, diversion, and overdose to new patients being prescribed methadone is overwhelming. The unique properties of methadone, it’s long half life, and it’s negative interaction with numerous drugs make it an optimal choice as a last result treatment for chronic pain and addiction.

    Thank you for taking the time to read this letter.

    Sincerely

    Melissa Zuppardi

    Like

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