Many consider methadone treatment to be the best for opiate addictionIt might not be perfect, but it’s the best solution we’ve got.
By: John Lundy, Duluth News Tribune
It might not be perfect, but it’s the best solution we’ve got.
That sums up why methadone proponents say that despite the risks, it’s the best treatment for opiate addiction.
“It has been recognized by the most authoritative, objective voices nationally and internationally for decades as being the most effective form of treatment for narcotic addiction,” said Dr. Robert Newman, director of the Baron Edmond de Rothschild Chemical Dependency Institute of Beth Israel Medical Center in New York.
Treatments for most drug addictions involve a combination of medications and behavioral therapy, according to the National Institute of Drug Abuse.
Methadone, itself an opiate, is used to treat addiction to heroin and other opiates because its effect is gradual and sustained, reducing the desire for other opioid drugs while preventing withdrawal symptoms, according to the National Institute of Drug Abuse. Administered properly, it is neither intoxicating nor sedating, and its effects do not interfere with regular activities.
The Centers for Disease Control and Prevention, in a 2002 fact sheet, said when methadone is used to treat opiate addiction, it produces a 30 percent lower death rate than among opiate addicts who are not treated with methadone. It also results in reduced criminal activity, improved family stability and employment potential, and improved pregnancy outcomes, the CDC said.
Nick Reuter, a senior policy analyst for the Substance Abuse and Mental Health Services Administration in Washington, D.C., adds a caveat.
“We’re sure that methadone is effective only when the medication is combined with other therapies like counseling, vocational, rehabilitation and all those things,” Reuter said. “So it’s not the medication alone.”
But methadone is effective enough that it should be made available even when counseling isn’t, said Newman, who is so vociferous in his advocacy that he has been referred to in print as “the methadone pope.”
Interim methadone treatment is preferable to no methadone treatment at all, Newman said. Interim treatment means methadone is offered without support services. He cites interim treatment instances from Hong Kong to Saint John, New Brunswick, to New York City, where he is president emeritus of the city’s third-largest health-care system.
“It’s not the ideal way, but compared to abandonment, anything’s ideal,” said Newman, a methadone advocate for more than 40 years. “The alternative was stay on the street, shooting dope.”
Using an analogy that crops up frequently, Newman said a diabetic would be given insulin even if nutritional counseling were not available with it.
The primary short-term risk from methadone is overdose, Reuter said. But he said deaths from overdose occur far more often when methadone is given for pain than when it is given as treatment for heroin addiction. A CDC “Vital Signs” report on July 3 cited studies based on medical examiner data that concluded fewer than
25 percent of deaths from methadone overdoses involve clients in opioid addiction programs.
Both Reuter and Newman said they were surprised by the News Tribune’s analysis showing that, of 38 methadone-related overdose deaths in the area, 36 appeared to be drug addicts using methadone as part of treatment or to get high, and only one was someone prescribed methadone for pain.
“That is the antithesis of every study I’ve seen published,” Newman said.
The risk of dying from methadone treatment probably occurs in the earliest phases of the therapy, Reuter said.
“The first two weeks of treatment are very tenuous,” he said. “There’s a lot of risk. The patient is sort of in treatment and sort of not in treatment. They’re still out doing things that are dangerous.”
The longer-term risk is heart arrhythmia, Reuter said. Because of that, he said, programs should give potential clients EKGs.
The average length of treatment, Reuter said, is 6.8 years. But he said he has known patients in their 80s who have been using methadone for 30 or 40 years.
Indeed, methadone advocates say its effectiveness shouldn’t be measured by the ability of clients to stop using it at some point. Instead, they say opioid addiction should be understood as a chronic illness similar to diabetes or depression.
“I’d love to see someone go in and say, ‘You know what, diabetics? We’re going to discontinue insulin therapy in another six months,’ ” said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, a trade group. “Can you imagine that kind of discussion? It does not exist.”
“It’s not a treatment that works for everybody,” Newman said of methadone. “But compared to most treatments of chronic medical illnesses, it is extremely effective. It is very readily made available on a massive scale to all who want it. And it can be made available at a very low cost.”
But it’s only relatively cheap. The average cost per patient for methadone treatment at the Hennepin County Medical Center is about $4,500 a year, said Dr. Gavin Bart, who directs the program.
“Compared to the cost to society for repeat hospitalizations related to overdose, treatment of Hepatitis C, HIV, lost jobs, inability to support family, being on public assistance, crime-related costs and criminal justice enforcement related costs,” Bart said, “all of these things are dramatically reduced when people are in treatment and on medication.”
If the end goal of methadone treatment is abstinence from drugs, Bart said, “none of our treatments work very well,” he said. “But if you look at it as a reduction in use and improved social indicators, that’s where we start seeing the differences.”