Gradual methadone detoxification may not work as well as very long term methadone maintenance, and methadone recovery statistics are revealed to be inflated.
Two separate San Francisco studies on methadone therapy further complicate an already contentious issue. Is methadone therapy working as it should?
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.
Recently in Methadone Category
Gradual methadone detoxification may not work as well as very long term methadone maintenance, and methadone recovery statistics are revealed to be inflated.
Two separate San Francisco studies on methadone therapy further complicate an already contentious issue. Is methadone therapy working as it should?
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.
Using methadone to break free from heroin abuse is relatively painless, and will allow you to function normally in society. But methadone is in itself a very addictive substance, and a lot addicts who try to get off methadone remain users many years into treatment. Methadone therapy is a synonym for methadone addiction, and is not a real cure from drug dependency. The best way to get off heroin is to do it the hard way, and the honest way. Suffer the pains of detox, do the counseling, and then begin your life in recovery. It's never easy, but it can work, and it can really free you from your heroin addiction.
Any addiction to opiates is tough (I know firsthand!) and the dreaded agony of the pains of withdrawal make the thought of getting clean a pretty scary proposition. So when avoiding detox is coupled with some pretty impressive long term success rates when on methadone, it can be tempting to go the opiate substitution route, and try to get clean through a very long process of tapering down.
Methadone maintenance therapy has addicts trade their heroin use for safe doses of methadone. Doses that will keep the pains of withdrawal well away, but will not serve to intoxicate and will allow the user to function normally in society. The downside to this of course is that some people that entered methadone maintenance 10 or even 20 years ago remain methadone addicts, and although they are not using heroin (and as such are a part of the success rates as advertised by the statistics) they remain addicts, and much of their time and energy remains devoted to maintaining enough opiates in their blood to keep the pain of withdrawal away. Better than heroin abuse, but I wouldn't call that a cure.
When using methadone, you need to visit a registered methadone clinic every day, or every other day, and take your oral dosage of methadone under supervision. You need to spend hours almost daily in the process of getting your drug, and remain in the company of other opiate addicts during all that time spent waiting around in methadone clinic waiting rooms.
Additionally, many doctors are now arguing that the addiction to methadone is in fact more potent than the addiction to heroin, and as such the withdrawal, and the pains of withdrawal, are longer and more severe with methadone than with the original problem drug. So why is switching to a more addictive drug considered a medically sound policy of drug cessation?
I think that it comes down to a matter of public policy. In the view of the greater good, it is better to have heroin addicts functioning well in society, and receiving regular and free doses of a drug that keeps withdrawal away; but for the individual addict, this may not be a positive outcome.
Much better is to endure the painful days of withdrawal, get the therapy and counseling you need, and try to rebuild your life without the need for any drug. It's not the shortcut to "sobriety" that methadone is, but it's a real cure, and it offers a life free from drugs and free from addiction.
Detox is hard, and it is painful, and it's understandable that addicts would try to avoid it; but if the alternative to a few days of discomfort is a lifetime of addiction to methadone, then isn't the price of withdrawal avoidance too high?
On methadone, you're not taking a trip out of town, you're never going to Disneyland with the family and you're always in the company of the people that remind you of what you once were. Get clean the hard and honest way, and learn what you need to live free from drug abuse, and stay sober over the long term.
Not many addicts can resist the cravings and temptation to use during the first days of rehab, and the best way to detox is under medical supervision. A supervised detox makes the process as safe and comfortable as possible, and at the very least, keeps you well away from access to drugs until the metabolites have been cleansed from your body. Detox alone is very rarely an effective cure, and most addicts will need the help of professionals, counseling, and education to have a real chance of staying clean for good.
Heroin addiction is tough, but a life in drug recovery is a life full of hope and promise, and is surely better than a life of continuing addiction with methadone.
