Five Things You Need to Know About Methadone and Methadone Clinics

The research and statistics are irrefutable: methadone treatment is successful at improving almost every quality of life measurement for patients and creates safer, healthier conditions for families and communities. It is one of the many treatment options for those suffering from addiction.

Methadone remains controversial though, with no shortage of myths, misinformation, and outright lies aimed at steering people away from this potentially lifesaving treatment. MAT has helped me more than I can express, but I won’t argue that everyone with opioid problems needs methadone. They do deserve access to accurate and reliable information about methadone, buprenorphine (Suboxone), and other medications, though.

Here are the five things you need to know about Methadone and Methadone clinics.

1. What is Methadone used for?

Methadone has been used to help treat heroin addiction and other opioid use disorders for over 50 years. This medication was developed first in Germany during World War II by scientists who were seeking a synthetic alternative to morphine. More than 20 years later, it would come to be that it used to treat opioid addiction.

In the mid-1960s, doctors Vincent Dole and Marie Nyswander of Rockefeller University in New York pioneered what came to be known as methadone maintenance treatment (MMT). Their research showed great promise, with dramatic (and almost immediate) improvements for participants in the initial MMT studies. Patients were quickly able to return to school or work and further studies showed a significant reduction or elimination of criminal activity. Patients were also more successful at rebuilding relationships with their families. This research laid the groundwork for modern methadone treatment programs.

Methadone is dispensed in the U.S. in federally-licensed clinics which provide counseling, basic medical testing, and access to supportive services like vocational training, medical treatment, and psychiatric counseling. There have been some limitation so the clinical, primarily in that patients sometimes have difficulty meeting expectations, can’t afford treatment costs, or they have trouble finding transportation to their clinic during dosing hours.

Still, at 50 years old, methadone clinics remain one of the oldest and most reliable treatment options available for opioid dependence and addiction.

2. Methadone has proven to be the most successful treatment option for opioid misuse, period.

Although it is the most successful with a decades-long record of success, methadone clinics and treatment remains controversial. The research and statistics seem to be irrefutable: methadone treatment is successful at improving almost every quality of life measurement for patients and creates safer, healthier conditions for families and communities.

Methadone success rates range from 60 to 90 percent, with outcomes improving the longer a patient remains in treatment. No surprise here, as continuing treatment yields better results in most forms of addiction treatment. However, it really shines when compared to the reported 5 to 10 percent long-term success rate for abstinence-based, non-medical treatments. Compared in parallel, methadone’s value becomes clear.

The term “success” can be highly subjective, but looking at objective research, it’s clear methadone is effective at:

  • Reducing risk of overdose or acquiring and transmitting HIV, hepatitis C, and other diseases
  • Reducing mortality (median death rate of opioid-dependent people in MMT is 30% that of those who aren’t)
  • Reducing criminal activity
  • Improving family stability and employment potential
  • Improving pregnancy outcomes

These considerations are significant and represent just a few of the improvements which can result from MMT. Methadone is undeniably effective at improving quality of life for the person using drugs, their families, and their communities. It also has one of the highest retention rates of any available treatment option.

3. Methadone is a medical treatment for what is a medical condition.

Methadone is medication. When patients take methadone daily and reach a stable dose, they experience no euphoria or “high,” they simply feel “normal.”

Methadone clinics can also provide a vital link to medical and mental health services. Services like this are vital, especially considering the high number of injecting drug users who have been exposed to HCV, HIV, and other diseases, and that many of us have limited access to medical care.

Clinics also provide structure. For many, the clinic takes the adventure away from the drug-seeking process, which is significant. Instead of breaking the law (stealing to support one’s habit becomes a minor addiction of its own) and tracking down heroin, addicts instead go what is basically a doctor’s office each day to receive medication. The clinical setting helps to refocus one’s thinking about their physical and mental health.

4. Propaganda and stigma prevent many people from seeking MAT and can contribute to people leaving treatment early.

Despite its success, methadone clinics still carry a strong social stigma. Many patients are forced to hide the treatment from family members, friends, employers, and even probation or parole officers. In such an environment it’s inevitable that many patients will internalize that stigma.

When first entering such a program over, people often ask “How long will you have to be on that stuff?”

That question is a trap. Not only does it miss the point of treatment with medications like methadone–which sometimes requires indefinite care–it’s potentially dangerous. Like many of the people who asked that question, most presume the goal was to be “free” from methadone as soon as possible.

Methadone clinics frequently face resistance from communities where they plan to provide treatment, especially in suburban and rural areas. This scrutiny is not only misguided, it can be harmful to the communities opponents claim to be defending. There’s little evidence to support claims that methadone clinics attract crime. In fact, they almost always have the opposite effect, reducing criminal activity among patients–many of whom are members of those very same communities.

5. Relapse is much less likely to result in a fatal overdose.

Many overdose deaths occur when drug users return to using after a period of abstinence.

Methadone and buprenorphine are opioids, so they maintain the patient’s tolerance to other opioids. This greatly reduces the risk of an accidental overdose, a huge benefit over ‘abstinence-only’ approaches.

Methadone treatment reduces the risk of drug poisoning mortality by 75%, compared to heroin users receiving no treatment. Kenneth Anderson, MA, founder of the Harm Reduction, Abstinence, and Moderation Supports (HAMS) Network calls this the “protective effect” of methadone.

Dependent heroin users who enter traditional 28-day treatment programs leave with no protective barrier, making them 32 times more likely to die from an overdose than users who are on some type of maintenance medication like methadone or buprenorphine. “This suggests that programs which rapidly detoxify dependent heroin users and place them quickly back on the street put these users at high risk of overdose death,” Anderson says.

There are extensive federal and state regulations to prevent diversion of methadone. When patients initiate methadone treatment they’re required to visit the clinic every day (except, in may cases, Sundays) and ingest their dose under supervision by nurses. Patients are given incentives to advance, but are also subject to punishment when they slip up. Places like France take a more laid-back approach, as was recently chronicled in The Fix.

These regulations supposedly exist to limit diversion of methadone for illicit use. While people do overdose and even die from methadone, it’s significant that while overdose rates for other opioids increased dramatically between 2013 and 2014, the overdose rate for methadone remained unchanged. And most methadone overdoses, according to the Substance Abuse and Mental Health Services Administration, are caused by methadone prescribed for pain relief, not from methadone clinics.

Methadone patient and advocate Peter Vanderkloot writes in Harm Reduction Communication: There are no other medications in the US pharmacopoeia subject to the restrictions applied to methadone hydrochloride… No other prescribed drug is administered only through federally licensed clinics. No other medication is so restricted that most patients must ingest it daily under the scrutiny of suspicious staff. No other substance can be prescribed only under the condition that the patient submit to ‘counseling’ and screens for illicit drug use—in perpetuity. No other medical treatment is used as the means to ensure a captive population of subjects for research. In short, no other system takes a medication of such potential benefit, and uses it to cause so much harm.

On top of this, methadone patients across the country report frequent harassment by local police. Only the failed War on Drugs could produce an environment where patients in a legal, medically-recognized treatment program find themselves victims of targeting by law enforcement. This reflects a broader attitude of contempt within the criminal justice system, where judges and probation/parole officers assume the role of doctors, often denying people with a long history of opioid problems access to a potentially life-saving treatment.

So are Methadone Clinics Right for Everyone?

There’s no ‘one-size-fits-all’ treatment approach for problematic opioid use. Methadone is one of many tools which, when applied correctly, can has shown to be very successful. When methadone doesn’t work, there are still other options.

None of these options are a “silver bullet” that can promise an end to opioid addiction. Medication-assisted treatment is the greatest tool we have to combat problematic opioid use and the growing threat of overdose deaths, but it’s not the only one.

Ultimately the decision as to which treatment, if any, someone chooses should be theirs, free from coercion or intimidation. When we’re given accurate information and effective options, those of us with a history of problematic drug use are remarkably capable of making intelligent, healthy choices.

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