Friday Feedback: Methadone Maintenance Does Work

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Every Friday the LA Progressive features a comment that was particularly noteworthy. This week we are featuring a comment submitted by Zenith in response Eric Schneider’s “The War on Drugs Redux.” Zenith writes:

I have to disagree that the methadone experiemnt prved less promising than expected, or that it was “failing”. In fact MMT is the MOST successful treatment method for opioid addiction available today. One of the primary reasons that later methadone clinics were less successful than Dole’s earlier ones was that Dole was careful to ensure the patients were adequately dosed, whereas later clinics, anxious to appear strict and punitive, lowered doses to the point that they were virtually ineffective for most patients.

The average required dose is 80-120 mgs, yet in the 1980’s, average dose dropped to around 40-50mgs for most patients. Not only did this not provide the narcotic blockade (which usually kicks in at around 80mgs)that keeps patients from feeling any effects from other opiates, but it also leaves them feeling extremely sick for half the day, rendering them unable to work and far more vulnerable to relapse. Properly dosed patients do much better overall, as studies have consistently shown,

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Comments

  1. Leonard Krivitsky, MD says

    I cannot agree more with Gregg’s comment. When prescribed properly for the management of narcotic addiction, methadone is the most effective medication there is, and it should not be viewed as “different” from other medications used to treat chronic conditions, such as asthma, diabetes or high blood pressure. However, we must remember that methadone is a powerful drug, so the doses administered for maintenance should be established on an individual basis, be adequate, yet at the same time safe. I view establishing a proper methadone dose for every one of my patients as a fine “balancing act” between the proper suppression of illicit opiate use or cravings and the equally serious dangers of “over-medicating” or “under-medicating” a patient. Therefore, I agree with the experts that methadone clinics should strive to adhere to the medication’s “therapeutic range”, that is the doses between 80 and 120 mg/day with the clear understanding that an occasional patient may require doses outside of the above-mentioned range, but such a patient will be an exception rather than the rule.

  2. Gregg says

    It is sad that methadone is getting such a bad rap these days. The medication when used and prescribed has saved many persons and lives from the associated ills of addiction. As methadone is reviewed, written about and criticized it is important to know that much of the negativity surrounding this issue is not because of methadone clinics. Many of the deaths, overdoses and street sales of this medication are rooted in the prescribing of this medication by primary doctors. In the past several years there has been an increase in the amount of primary doctors and pain clinics prescribing methadone. This increased in prescribing by these doctors and pain clinics has contributed to the negative reputation of methadone. These Drs not trained in addiction, not trained in drug seeking behaviors who do not monitor urine drug screens and just write prescriptions are responsible for the recent rise in deaths and misuse. It should be a requirement that any physician who prescribes methadone be trained on risks factors and addiction. Its about time that methadone be given the credit and recognition as an effective and safe medication when prescribed and monitored properly. Vigilante groups seeking to further regulated OTPs’ should focus on primary care doctors and the pain clinics reform rather than further restricting access to a medication that can save a life.

  3. Leonard Krivitsky, MD says

    I have been working in Philadelphia, PA methadone clinics for about eight years now, and I wholeheartedly support the concept that most patients in maintenance need to be on doses of 80-120 mg/day. Unfortunately, many physicians and clinics are trying to “re-invent the wheel” when it comes to methadone maintenance therapy, prescribing the doses that are either too high or too low, with quite disastrous results. It is time for the scientific community to unite on this issue and urge every physician involved in methadone maintenance to prescribe the correct (and adequate) methadone doses for maintenance of narcotic addiction.

  4. John says

    I do mental health screenings and evaluation in a large jail, it is my exprience that anyone on methadone over 6 mos is addicted to methadone and is not being treated, indeed it would be called malpractice. The withdrawals from methadone are worse too. For heroin users (only one of the opioids a more global approach is mansdatroy like changin environments and not hanging aroudn methadone clinics where networks are formed to get drugs instead of recover. Where are the research number on this “stupid” article. this is a farce giving people who want to recover a “magic fix” that makes them more addicted This is pure BS

  5. says

    Hollis:

    For many years, I was involved with a nonprofit recovery home for alcoholics that often, at least in the years I was most closely involved with the daily operations, also opened its doors to heroin addicts looking to use spiritual means to break their addiction.

    In the short run, that approach worked quite well, as ours was one of the few places that welcomed heroin addicts which wasn’t a jail with nurses or required someone to give themselves over body and soul as did Synanon.

    A little group of fellows — it was a men’s house, though we also had a recovering female addict as the cook — stayed clean and sober for a number of months, and I know several them have now stayed free from their addiction for 20 years or more.

    But in many cases, the recovered addicts relapsed shortly after leaving the house.

    A part of the problem is that too many people have a stake in the heroin addiction business, from the growers who need markets, to the pushers who need customers, to the police who need someone to chase, from the prison guards who need someone to torment, to the poorly paid counselors who need someone to counsel. And, I guess, the gravediggers who need someone to bury.

    A saner country would take the crime out of the equation and the profit, too. Now, of course, a heroin user is a criminal just for possessing and using the drug, and many — like your friend the methodone pusher — often resort to crime to pay for their habits.

    If we could help addicts break their addiction, scale it back, or even just maintain it without wrapping them up in the criminal justice system — the prison-industrial complex — then the impact on their lives would be drastically reduced, as would be the damage they inflict on the victims of their crimes and on our treasury that goes to rounding them up and jailing them.

    I wish that saner country sounded more like America. Maybe someday.

    – Dick

  6. Hollis says

    I have a good friend and in the early/mid 70s his wife was a heroin/opiates addict. She tried Synanon, he went too as a family thing, but dance the dance as hard as she could she was still an addict. So, when methadone treatment became available she got on that as her new junk so she could get “cleaned up”. After a while she went to work for a methadone maintenance clinic dispensing methadope to other addicts and stealing enough methadone that she could sell it on the street and support her heroin habit so that she didn’t have to become a skaggy sex worker. She said it was just fine being high on H, so why put up with feeling like s__t on methadone and I guess, though I didn’t see it, there was logic involved there someplace. I believe her story would have to qualify as a win/win for methadone as she stayed out of jail and high and others got to be metha-junkies.

    Personally, I think that we ought to decriminalize drugs and kick the hell out of the big profits that are boosted by the fact that the products are illegal and therefore, with the taboos and all, over-valued, scarce, sellers market commodities — sort of like gasoline controlled by the mega-erl companies. One person’s junkie is another’s livelyhood, hey, that’s Capitalism. Why do we reward banks that have screwed the economy with taxpayer bailouts and spit on folks with addictions (except of course alcoholics whose dealers we reward with mega-profits, licenses and monopoly regulation to insure profitability). Oh, that’s right, it is easier to kick little people than to do the work to force our “lected leaders” to fight the banks, insurance companies, and the wealthy elites. Or, maybe in the mirror of our own cowardice or avarice we envy the rich and hope to be like them and therefore excuse their crime.

    Let’s get real about the problems we face as a society and get the big monkeys off our backs: a dysfunctional medical system, out of control consumerism, a realestate/mortgage/banking industry peopled by crooks, etc. Junkies didn’t bring down the American economy — Wall Street did it and they are going scot free while we imprison little people and victimize the poor. Happy Days are here again!

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