Much controversy surrounds methadone regarding its true effectiveness. Methadone has helped millions beat heroin addiction, but many believe using methadone just causes the addict to replace their heroin addiction with a methadone one. Read on to find out more about this drug and its potential to treat heroin addiction.
Origins of Methadone
Methadone is an opioid drug commonly used to treat heroin addiction. Methadone, like many other drugs currently on the market, was developed for different reasons than it is now being used. The drug was first formulated in Germany during WWII to be used as a pain reliever for injured soldiers when morphine was in short supply. Success of the drug in Germany encouraged American pharmaceutical companies to invest and eventually take control of methadone in 1947.
Post WWII, the United States was dealing with a huge influx of soldiers returning from war with a slew of mental and physical ailments – including the highest degree of heroin addiction ever seen in the American military population. Political pressures and public health concerns put this issue in the forefront and efforts to provide soldiers with treatment drove the U.S. to seek out innovative and alternative treatment methods.
The use of methadone to treat heroin addiction was experimented by many along the way but Vincent Dole, M.D. of Rockefeller University spearheaded the research on methadone in the 1960’s and had the most impact on the current application and dosing of the drug.
So how does Methadone work?
Methadone is an opioid, whereas heroin is an opiate. The major difference between these two drug classes is that opiates are naturally derived while opioids are at least partially if not fully synthetic. Essentially though, they are part of the same family of drugs and therefore induce similar effects in the user – ease of pain, sedation, relaxation, and reduction of anxiety – but heroin does so in a much stronger way and quicker fashion. Unlike heroin, methadone is a long-acting medicine and each dose stays in the body for a long time. It may take a couple of days after the first dose of methadone is taken to become fully effective.
In a controlled medical environment, methadone is taken orally and dispensed in a small amount of liquid such as a flavored juice by a medical professional. Once ingested, methadone works in a variety of ways within the brain and the spinal cord to block the ‘high’ caused by heroin.
Methadone allows people to avoid the physical and psychological highs and lows caused by changing levels of opiates in the blood. It also helps to reduce cravings and withdrawal symptoms. In essence, methadone is intended to help an addict maintain a feeling of normalcy and balance, not too high or too low. It is said that methadone eases the symptoms of heroin withdrawal for 24-36 hours, thereby dramatically decreasing the chance of relapse.
Most heroin addicts subscribe to a methadone maintenance treatment program (MMT). An MMT is a comprehensive treatment program that involves long-term prescription of methadone. Central to MMT is appropriate counselling, case management, and any other medical and psychosocial services to support the addict’s individual and changing needs.
Methadone is meant to be taken once a day, the specific dosage being dependent on the individual and their degree of addiction. Proper dosing should be determined by a team of medical professionals and the addict receiving the drug should also get routine check-ups in order to adjust the dosing of the drug to the appropriate level. Ideally, methadone should be administered in such a way that the addict is able to continue to reduce their dose until they no longer need to take either methadone or heroin. A proper treatment regime would be to start off with a high dose and gradually drop it down, beginning with 5 mg increments. As the dosage decreases so should the drop in increments. This approach ensures a slow and somewhat comfortable withdrawal process – at least way smoother than cold turkey.
The fact is, however, that many people enrolled in methadone treatment programs spend the remainder of their lives taking methadone and as we will discuss later, this is one of the major hang-ups among those against methadone.
Methadone replacement: pros and cons
As alluded to above, there are mixed opinions about the effectiveness of methadone as a heroin addiction recovery method. It is undeniable that methadone has helped millions of people beat heroin addiction, but at what cost?
One major issue with methadone is that its use causes just as much of a physical dependence as heroin use does and detox from methadone is an equally challenging task as detoxing from heroin with similar intense withdrawal symptoms. For this reason, many people view methadone treatment as merely offering addicts an alternate addiction and not truly confronting the underlying issues or even tackling the physical dependencies or health impacts.
Methadone overdose is also a very real danger because methadone is a slow-acting drug. When people don’t feel the effects right away, they take another dose and when the effects catch up with them, it is sometimes too late. Reports indicate that most of the deaths attributed to methadone overdose have resulted from take-home methadone as opposed to receiving methadone from a clinic on a daily and monitored basis. Reportedly, methadone accounts for 33% of opiate overdose deaths in the U.S. and it has become the fastest growing cause of drug deaths in the country.
Methadone should also not be combined with other drugs or alcohol but unfortunately this is often not the reality. Many critics of methadone maintenance treatment programs believe that a large amount of the narcotics make their way to the streets. On the black market, it is resold to addicts at high prices, just as heroin would be sold.
On the positive side, it has been found in a number of studies that MMT is associated with a reduction in heroin related deaths, as well as drug-injection risk behaviors, the use of other opioids, high-risk sexual behavior, and crime. When used as part of a treatment plan, it also enables more individuals to stay in treatment programs for a longer time and improves their physical and mental health.
Heroin addiction treatment alternatives
There are alternatives to MMT of course. Another pharmaceutical option is buprenorphine-based drugs. With buprenorphine, the euphoric effects are far less dramatic than with methadone and withdrawal symptoms are also less severe, so developing dependence on buprenorphine is far less likely than with methadone.
The other option is always quitting heroin cold turkey, which many believe to be the most effective route for long-lasting recovery from heroin addiction. Stories of horrific heroin withdrawa
ls are often enough to make addicts stay on the drug, but this doesn’t have to be the case. When done within a controlled and supportive environment with properly trained medical and clinical staff, heroin withdrawal symptoms are manageable – allowing the addict to focus fully on the psychological treatment they will receive in counselling to overcome their addiction and achieve recovery. As with any drug treatment program, proper preparation, support during, and follow-up after the program is necessary to ensure safety and stability throughout the process and of course, reduce the rate of relapse.
While pharmaceuticals may be a highly effective aid in reducing or eliminating heroin dependency, part of any heroin addiction treatment program should involve counselling and support by trained practitioners and proper diagnosis and treatment of any co-occurring disorders.
For more information on holistic addiction treatment approaches, please visit The Cabin Chiang Mai Drug & Alcohol Rehab Centre