Keeping Score 1998

Drug Strategies

Keeping Score 1998

SPOTLIGHT

Methadone Maintenance Treatment

Methadone maintenance, a drug treatment developed over 30 years ago, provides addicts with daily doses of a legal, synthetic narcotic (methadone) which blocks the effects of heroin. Methadone maintenance has proved effective in reducing heroin use, increasing productivity and curtailing criminal activity. In 1993, researchers at the University of Pennsylvania found that methadone treatment, when properly administered and combined with intensive counseling, reduces illicit drug use by 79 percent. Clients in methadone programs were five times less likely to become infected with HIV than addicts who were not in treatment. After extensive study, a distinguished panel of the National Academy of Sciences' Institute of Medicine recently recommended expanding methadone treatment and allowing doctors to dispense methadone directly. A 1997 review by a NIH consensus panel also called for the expansion of methadone maintenance treatment.

The National Institute on Drug Abuse reports that of the estimated 4 million drug addicts in the United States, 800,000 are addicted to heroin. There are only 115,000 methadone slots nationwide to treat this population-36,000 of them are in New York City which has an estimated 250,000 heroin addicts. In July 1998, Mayor Rudolph Giuliani proposed a new policy to eliminate methadone programs in New York City within four years, criticizing these programs as substituting one narcotic drug for another. His methadone-to-abstinence policy has met with strong objections from the scientific community. A review this year by the General Accounting Office concluded that "research provides strong evidence to support methadone maintenance as the most effective treatment for heroin addiction." General Barry McCaffrey, Director of the White House Office of National Drug Control Policy, strongly supports expanding the availability of well-run methadone programs in both public clinics and private doctor's offices.

Methadone Is A Medication, Not A Heroin Substitute

Views of Avram Goldstein, MD, Professor Emeritus of Pharmacalogy at StanfordUniversity As a medical scientist I find it amazing that an established medical treatment can be "controversial" after 34 years. Some people, on ideological grounds, oppose all medication for the addictions. Some politicians imagine (wrongly) that they can save money by shutting down methadone clinics.

Massive scientific evidence shows that methadone, in sufficient dosage, in a well-run treatment program, allows heroin addicts to stop using heroin, to become rehabilitated, and to enter the socioeconomic mainstream.

Here I discuss the main ideologic objection to methadone-a misconception that flies in the face of what we know about the neurobiology of heroin addiction. Numerous brain chemicals send signals from one neuron to another, keeping the complex circuits in stable balance. Among these neurotransmitters are our natural endorphins, which act on special receptors in the "reward system" to produce normal feelings of satisfaction from such normal activities as eating, drinking, and sexual activity.

An addict using heroin typically injects several times a day. Each time, the endorphin receptors are flooded by this drug (actually by morphine, to which heroin is converted), and a dramatic change in mood occurs-the heroin "high." This lasts but a short time, to be replaced by a state of withdrawal sickness-time for another injection! These repeated spikes of heroin, swamping the endorphin receptors, drastically upset the fine-tuned regulations that keep the brain in a normal state of equilibrium.

Although it is true that methadone, like heroin, occupies the endorphin receptors, the nature of the interaction is completely different. There is no methadone "high" because methadone occupies those receptors in a long-lasting stable way in contrast to the spiking pattern of intravenous heroin use. Thus, it is wrong to call methadone a heroin substitute, to say we are "just substituting another addictive opiate for heroin. "Methadone is a medication, which occupies the endorphin receptors and stabilizes the disrupted endorphin systems. Methadone is best described as an endorphin substitute, not a heroin substitute.

Methadone Treatment Reduces Crime and HIV Can an addict under treatment with methadone ever stop taking the medication? Some can, and remain abstinent, but others relapse to heroin use. Many find it useful to continue methadone indefinitely. All physical and mental functions are normal in a methadone-maintained person. No test other than an actual methadone assay can pick out such a person.Yes, a methadone patient who abruptly stops taking methadone will suffer unpleasant withdrawal symptoms. But these are much less serious than if a diabetic stops insulin, a patient with rheumatoid arthritis stops steroids,or a patient with heart disease stops digoxin. Curiously, the pejorative term "addictive drug" is never applied to those and other instances of long-term drug therapy. In short, methadone is a safe and effective medication for a chronic relapsing disease that if untreated wreaks havoc on the addict and on society. A special benefit is that it is taken by mouth, so intravenous drug use can cease. That means reduced risk of AIDS, hepatitis, and other serious infections spread by contaminated needles.

All this is supported by experimental and epidemiologic evidence published in the medical journals and in official government and quasi-government sources. The ultimate absurdity is the notion that stopping methadone treatment will be cost-effective. On the contrary, as addicts relapse, the costs of crime, law enforcement, and health care will inevitably escalate. Why, then, do politicians and ideologues persist in ignoring or distorting the facts?

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Spotlight | Methadone Maintenance Treatment | Welfare Reform and Drug Abuse
Women and Drug Abuse: Court Innovations

Programs | Prevention Programs | Pregnant and Parenting Women's Programs
Family Treatment Programs| Criminal Justice Programs

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