Methadone maintenance: development, effectiveness, and treatment outcomes

Addiction

Methadone Maintenace

Methadone

Methadone Maintenance

Methadone maintenance is essentially the use of methadone over a period of time for the treatment of individuals who are addicted to opioid drugs such as heroin. In more formal terms the central aim of methadone maintenance is defined as follows: "Methadone maintenance treatment (MMT) can help injection drug users (IDUs) reduce or stop injecting and return to productive lives" (METHADONE MAINTENANCE TREATMENT, 2002)

There is still however a certain degree of debate and contention about this form of treatment. The controversy around the use of methadone will be included in this overview of research and the benefits and concerns surrounding this form of treatment.

Overview: Benefits and Treatment Concerns

There are an increasing number of people addicted to drugs like heroin in the United States. It is estimated that about 980, 000 people are addicted to heroin as well as other opiates. Furthermore, it is estimated that five to ten thousand of these users die from drug overdoses each year. (METHADONE MAINTENANCE TREATMENT, 2002) This figure includes addiction to other types of opiates, such as oxycontin, dilaudid, and hydrocone Users of these substances run a very high health risk and can also suffer from diseases such as hepatitis and even premature death.

This form of drug abuse also has a very high financial cost. As one study on the subject notes, "A 1997 National Institutes of Health (NIH) report estimated the financial costs of untreated opiate addiction at $20 billion per year" (METHADONE MAINTENANCE TREATMENT, 2002). These costs do not include the social and emotional costs to families and communities as a result of this form of drug abuse.

Methadone Maintenance

According to figures for 2008, there were about 260,000 individuals in the United States receiving Methadone Maintenance Treatment of MMT (KLeber, 2008, p.2303). However, this is not the case in many other countries and regions of the world and in Russia for example, there is strong government opposition to this form of treatment. It is argued in some quarters that the use of methadone"... replaces one form of opiate addiction with another" (Schwirtz 2008).

On the other hand, numerous reports also state that methadone maintenance as means of dealing with this form of drug addiction has been extremely successful. For example, an article entitled Thousands of Lives Saved But Still Controversial by Kleber (2008) states that, "A combination of the methadone treatment and a comprehensive program of rehabilitation was associated with marked improvement in patient problems such as jobs, returning to school, and family reconciliation. No adverse effect other than constipation was found" (KLeber, 2008, p.2303).

Methadone is essentially a synthetic agent which functions by acting on the various receptor sites in the brain that are commonly affected by heroin and other opiates (METHADONE MAINTENANCE TREATMENT, 2002). It functions by blocking the effects of the opiates as well relieving the craving for the drug, which is the major cause of a relapse and continuation of the drug abuse (METHADONE MAINTENANCE TREATMENT, 2002). It is also extremely effective in reducing the symptoms that are linked to withdrawal from heroin and other opiates. A further positive factor associated with methadone maintenance is that it, "… does not cause euphoria or intoxication itself (with stable dosing), thus allowing a person to work and participate normally in society... "( Narcotic Treatment Clinics). This treatment therefore results not only in stopping the addict from further addiction but also leads to the resolution of various related health and social problems caused by this form of drug abuse.

The use of methadone to treat drug addiction initially began in the 1960s. This was, and largely still is, seen not as an isolated treatment but to be used in conjunction with a program of treatment. These programs are multivalent and also include aspects such as re-socialization and vocational training.

However, controversy has raged about this form of treatment. It has been adversely linked to the milieu of drug usage and has, in some cases, been seen in a negative context. As one study notes:

Neighborhood groups often oppose a new clinic because they assume it will lead to higher rates of drug use and crime (studies show these rates actually go down). And those favoring a "drug-free" approach often dismiss methadone maintenance as merely "substituting one drug for another."

(Profile: Methadone Maintenance: The "Invisible" Success)

In spite of these views, recent research has tended to favor the positive aspects of this form of treatment and the criticism of the past have been largely shown to be biased and somewhat prejudiced. The negative views of this form of treatment still tend to persist but are countered by reports and results such as the following. "Studies on MMT & #8230; found no long-term damage to the heart, kidneys, liver, or lungs. Long-acting maintenance medications normalized the neuroendocrine alterations induced by short-acting opioids with minimal psychoactive impairment…"(KLeber, 2008, p.2304).

However, there are some legitimate concerns about this form of treatment and its long-term implications for the patient. A central concern among medical practitioners is, for example, that it can lead to "… a potentially fatal cardiac arrhythmia" (KLeber, 2008, p.2304). The central criticism of methadone as a treatment comes from outside the United States where it is seen as another form of addiction. One could reiterate the Russian point-of-view:

Methadone opponents in Russia say the therapy entraps patients in lifelong addiction; others accuse Western countries of pushing the treatment on Russia for commercial gain. There are also fears that methadone could seep into the black market, given the high level of corruption at many Russian clinics.

Schwirtz M, ( 2008)

There are also a number of concerns relating to the short- and long-term effects and consequences of methadone treatment. From one perspective, methadone is seen as being a long-term treatment which can continue indefinitely to control opiate dependence and possible relapses. From another point-of-view this treatment is seen as being effective in the short-term. The first approach is based on the view that dependence is a biological disorder and the second on the assumption that dependence is more of an emotional problem. In other words, with the short-term use of this treatment, the individual "…learns to deal with problems in other ways, and his or her life becomes stable and happier, there is less reason to look to drugs for help…" (Chapter 8 - Looking ahead on methadone. CAMH).