Introduction to Methadone

Editor’s Note: Today we welcome a new guest blogger, “Grey Ryder”– the pen name of an attorney and methadone patient whose blog at aboutmethadone.org discusses methadone treatment and policy.  In a three part series over the next weeks, he’ll introduce the history of methadone treatment, its clinical rationales, and recent attacks on it by conservative politicians.

Society’s perception of methadone is almost uniformly negative.  Most people envision methadone clinics as nasty places where zombie-like addicts line up for their daily dose, then return to their squalid lives to do God knows what.  As a society, we hold our nose and permit these junkies to have their drugs; otherwise they’d be out pillaging our neighborhoods and killing themselves with A.I.D.S.

Call It a “Foundation,” Not a “Methadone Clinic”

Most negative stereotypes of methadone are unfounded, and are rooted in a poor understanding of a drug that has been the gold standard for treating opiate addiction for neatly fifty years.

After the allies cut off Germany’s morphine supplies in the Second World War, the Germans were in desperate need of a replacement.  While trying to solve this problem, they created a synthetic narcotic called methadone.  They had no idea that they had developed what would become the world’s most successful treatment for opiate addiction. When morphine imports resumed, research in to this new drug’s treatment potential ended, and it was forgotten about.

In fact, twenty-five years went by until scientists started noticing methadone again.  By the early 1960’s, as Herman Joseph has noted, heroin addiction was a growing problem in the United States, and had reached epidemic proportions in urban areas like New York City.  Even during the 1950’s, heroin was one of the leading causes of death in young adults in New York.  Experiences at facilities such as the narcotic “farm” in Lexington, KY made doctors and scientists aware that something other than abstinence-based treatment was needed to get addicts to stay clean.

Heroin addiction is notoriously hard to treat.  Researchers became frustrated watching addicts break their physical addiction after days of wrenching withdrawals, only to invariably pick up their habits again within short periods of time.  Reports began filtering in to addiction doctors that some hospitals were successfully treating heroin addicts using methadone.  News of a treatment that could help break this cycle aroused cautious interest among physicians treating addiction.

Vincent Dole, Rockefeller University

This news piqued the interest of a physician named Vincent Dole.  Doe was one of the first physicians to promote the idea of “replacement therapy”, the substitution for some other drug in place of heroin.  His first experiments involved a group of patients who were given access to morphine.  He was interested in their reactions and patterns of behavior.  What he found was that the morphine group cycled between sedation and withdrawal, always waiting for their next dose of morphine.

In 1963, a group led by Dole began studies with methadone at New York’s Rockefeller Hospital.  Within six months, his team discovered that methadone was successfully getting and keeping addicts off of heroin.  As Dole’s studies grew, patients were transferred from inpatient to outpatient status.  Law enforcement officials were not pleased with the expansion of this treatment, and applied pressure to shut down the research, but researchers overcame their objections.  In 1966, all patients were made outpatient, creating the first methadone clinic.  The clinic model rapidly expanded in many cities, and nationwide methadone maintenance treatment was born.

The primary reason for methadone’s success in treating opiate addiction lies in its chemical makeup.  Researchers had tried treating heroin addicts with narcotics like morphine, but the problem was always the same: the addicts would still experience “highs” and “crashes”, while cravings for the drug remained.  Unlike morphine and other narcotics, methadone enters and builds up in the body very slowly.  Methadone users do not experience the intense highs and lows of these other drugs. Methadone’s long half-life also prevents the intense cravings that result when an opiate’s effects wear off.  Doctors found that many of the problems associated with heroin were eliminated by a once daily dose of methadone.

According to Department of Justice statistics, there are an estimated 750 thousand to 1 million heroin addicts in the United States alone.  The New York Times claims that of these, about 180 thousand in treatment; about 18-25% of the total.  There are two primary goals of treatment with methadone: the relief of cravings, and the “blockade” of other opiates.  Methadone and its cousin buprenorphine are the only drugs that act to relieve cravings for opiates.  Other medications used in treatment simply lessen withdrawal symptoms.  While the relief of withdrawal symptoms can be very valuable when an addict decides to stop using opiates, the chances of relapse are extraordinarily high while the addict still craves the drug.

Methadone also has another great advantage: at the proper dose, it plugs up the brain’s opiate receptors and users lose their ability to enjoy heroin.  As the user stops deriving pleasure from it, he stops using it.  This is known as the “blockade effect”.  Some users avoid this by staying on a sub-optimum dose of methadone, but for committed patients, it can dissuade them from continuing to use opiates, knowing that their money will be wasted in a fruitless attempt to get high.

Methadone is a particularly safe drug.  Its effects have been studied for nearly fifty years.  Like all other opiates, it is habit-forming.  Methadone users trade conspiracy theories about the drug’s effects: that it rots your teeth, deteriorates your bones and damages your liver.  None of these are true. The main side effects are sweating and constipation.  Methadone is even considered safe for pregnant women. When a woman who is addicted to opiates becomes pregnant, doctors advise that she immediately switch to methadone.  When a pregnant woman stops using heroin and experiences withdrawal, the shock to her body can kill her fetus.

Methadone is not a silver bullet, however.  Poly-drug abuse is a serious problem among opiate addicts.  For instance, forty percent of addicts have cocaine in their system upon admission to treatment.  Many addicts, once they stop using heroin, turn to cocaine to satisfy the drive that drove them to hard drugs in the first place.  Several studies have suggested that the same happens with alcohol and benzodiazepines like Xanax.  This is especially dangerous, as alcohol and benzodiazepines dramatically increase the risk of overdose.  In fact, the vast majority of methadone overdoses are due to mixing alcohol and benzodiazepines with methadone.  When used as directed, methadone is the safest, best treatment for opiate addiction.

After a slow start, doctors began using methadone more often to treat opiate addiction.  The next piece in this series explores methadone’s effectiveness in treating addicted patients, and its effect on combating drug use and its associated negative behaviors.

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