The painfully thin young man with visible sores over much of his skin looked much older than his 24 years.
His body was wracked with pain and infection. He had trouble walking.
Two years of daily heroin injections had taken their toll on his emaciated frame.
Knowing he was in trouble, the man sought help from hospitals, but was refused admittance because he would not agree to stop using. Drug treatment centers would not accept him until his wounds were healed.
The young addict’s only option was medication-assisted treatment (methadone), but he didn’t believe it could really help him.
He was wrong. With the help of methadone treatment, the former addict has now been clean for more than 9 years.
Why It Works
Methadone is not the only medication used to treat drug addiction. But it appears to be the most successful. And it’s certainly been around the longest–since 1964.
One of the reasons opioid addiction is so powerful is that users must keep using in order to stave off painful withdrawal symptoms. They need to use just to feel “normal.”
Methadone stops this cycle. It satisfies the user’s cravings and halts withdrawal symptoms. The key is that it’s administered in a safe medical setting. When taken as prescribed, it does not produce the euphoric high normally association with opioid abuse.
Because the user no longer worries about avoiding withdrawal, his risk of relapse is significantly reduced. The research appears to support this theory. Several studies have indicated that methadone treatment can significantly reduce the mortality rate among addiction patients.
Which is why some of the largest and most prominent public health organizations (e.g., the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization) recognize the medical value of methadone treatment. It’s been described as “the gold standard” for drug addiction care.
Methadone can only be administered by federally approved Opioid Treatment Programs (OTPs), and it must be taken at the clinic where it’s dispensed. (Although take-home dosages may be allowed for long-term clients who have been on an established maintenance program.)
But critics maintain that medication-assisted treatment is nothing more than substituting one drug with another.
According to New York Judge Frank Gulotta Jr., methadone programs are crutches. “They’re substitutes for drugs and drug craving,without enabling the participant to actually rid him or herself of the addiction,” Gulotta has said. That sentiment has been echoed throughout much of the medical community. For decades, drug addiction has been entrenched in the American psyche as a failure of willpower.
In 2017 former Health and Human Services Secretary Tom Price reiterated his criticism of medication-assisted drug treatment:
“If we’re just substituting one opioid for another, we’re not moving the dial much. Folks need to be cured so they can be productive members of society and realize their dreams.”
Indeed, some drug addicts themselves are vocal critics of methadone treatment. To them, any drug use (even when treating addiction) runs counter to their goal of full sobriety. And many of them simply don’t trust the health care system. Folks who became addicted through prescription painkillers, for instance, may not trust doctors who now offer another medical solution.
But advocates contend that the key to effective methadone treatment is that it turns drug use into a much safer habit. So instead of stealing to buy drugs or engaging in other life-threatening behaviors, the user is able to attend to his daily obligations. He has a life.
On Methadone Forever?
Once started, can a drug patient expect to be on methadone for the rest of his life?
There are two schools of thought on this matter. One approach views methadone much like insulin for a diabetic. That is, it requires long-term–perhaps indefinite–maintenance.
This view regards opioid dependence as a biological disorder, and methadone as the medicine used to treat the condition. In keeping with this approach, many countries offer free methadone treatment to their citizens. (See related article, “Is Portugal Winning the War on Drugs?”)
The other approach looks at methadone as a short-term treatment. With this approach, opioid dependence is viewed as the result of attempting to solve emotional problems with drugs. When the drug user learns to deal with problems in other ways, he can then taper off methadone and progress toward a drug-free life.
Short-term methadone treatment typically lasts one to two years. However, studies indicate that those who withdraw from methadone after short-term treatment are more likely to relapse than those who remain in treatment for the long term.
No Quick Fix
Clearly, methadone treatment is not a “quick fix.” But for many caught in the vise of addiction, it does offer the opportunity to heal their wounds and build a sober life. Take a look: