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THE ANONYMOUS AUTHOR of “Me & My Monkey” (1/13) gave a graphic description of addiction to heroin and other drugs. Unfortunately, the author has had limited experience with recovery from addiction and provided a highly distorted depiction of methadone. Many lives have been saved, and many more turned around through the use of methadone along with treatment services.
Contrary to popular belief, an individual stabilized on methadone does not get “high.” If stabilized on a medically appropriate dose, the individual also cannot get high using heroin. Methadone can be taken over many years without causing any harmful physical effects, and the only two common side effects of methadone are constipation and sweating. Although methadone does require daily administration, patients who demonstrate improvement in treatment are generally permitted to have take-home doses for two to six days a week. In addition, a new longer-acting alternative to methadone, LAAM, requires dosage administration only once every 48 to 72 hours. Abrupt discontinuation of methadone can cause a longer and more agonizing withdrawal syndrome than heroin withdrawal; however, medically monitored tapering of the medication generally produces very mild and manageable withdrawal symptoms.
When methadone is used in a structured treatment program that emphasizes counseling and other supportive services, heroin-addicted individuals are highly likely to discontinue the use of heroin and other illicit drugs. These individuals begin to lead productive lives, often for the first time in 15 or 20 years. Methadone treatment reduces the likelihood of contracting or transmitting HIV, and also reduces the likelihood of death due to other causes. Individuals in methadone treatment also stop stealing and committing other crimes necessary to support their heroin habit.
So why is methadone demonized as a “Hitler pill” or “deathadone”? Methadone treatment, like antidepressants or even antibiotic medications, is not effective for everyone. In addition, many individuals enter methadone treatment without any desire to stop getting high. They use methadone temporarily to prevent withdrawal, while they continue to use drugs. These individuals usually drop out of treatment quickly or are discharged for not complying with program rules. Some of these individuals do experience abrupt and painful withdrawal from methadone or revert immediately to heroin addiction. These are the individuals who are the most adamant that methadone does not work and is a “curse.”
The other reason methadone is negatively perceived is that some treatment programs are not operated properly. Physicians must be trained in the proper dosing of methadone, and methadone must be regarded as an adjunct to effective treatment. Intensive counseling by trained staff must be provided. Co-existing medical and psychiatric problems must also be identified and treated. Finally, for those individuals who have deficits in vocational or educational areas, assistance must be provided to help them to become self-sufficient. When this kind of comprehensive treatment is provided, most individuals benefit tremendously, as do their families and communities.
Executive Director, Center for Drug Treatment and Research, Koba Institute, Downtown