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.