More on Methadone

My recent post on methadone prompted several comments, some making really great points. I decided to post all of them so that they would not be missed. The last 4 comments are great, you can guess what I think of the first 2.

armme said...

Your still working on the idea that addiction is some spiritual malady. Your way of thinking is in the DARK AGES, my friend. Your idea of recovery will soon be a thing of the past. It will be like performing an Exorcism on mental illness...once thought to be the ONLY form of treatment, but now considered completely irrational.

Your still trying to stop drug use...when you should be focusing how to get the addict to live a better life. Your treating an illness of endorphin dysfunction by taking away the only thing that corrects that dysfunction with stability.

You can continue to offer people your "exorcism approach" or you can learn the science behind opiate addiction and realize stopping people from using drugs doesn't stop the disease.

Do you want to treat the disorder so these people can have a better life--or do you just want them to stop using drugs no matter HOW miserable they have to be to do so?

Sometimes, MANY TIMES, you can't have both. Not with opiate addiction.

Anonymous said...

"counseling", while possibly helpful to some who may need referrals to things like job training, childcare, housing options, etc, is NOT the answer to most hardcore addiction problems. Science has shown clearly that addiction is a brain disease, a disruption of the brain chemistry. That is not something you can repair with a few hours of talk therapy. If talk therapy (or meetings or group therapy) worked even fairly well for addiction, there would have been no need to come up with something else to treat it--but it didn't and doesn't. We don't treat ANY other legitimate disease this way. People with schizophrenia, bipolar disorder, clinical depression, etc--all brain chemistry disorders--may receive some therapy sessions but it is almost always in conjunction with MEDICATION, which does the actual work of repairing and restabilizing the brain. Why should addiction be treated differently--especially when it has been clearly shown that abstinence based treatment has an extremely low effectiveness rate for addicts and particularly for opiate addicts?

Anonymous said...

As a recovering IV addict for more than 35 years, I continue to be appalled by these guys who push needles, methadone maintenance, etc. with their well-meaning efforts to "help us." Thankfully, none of you were around when I got clean - only people who assured me that I could in fact get clean and live a happy life.

The expectation that people like me are largely unable to find lasting clean time undermines our chances - and makes the way for the "experiments" by psychiatrists and others - naltrexone, methadone (now at new and much high doses!), acamprosate - hell, the Chinese drill out our limbic system with a Makita.

The lie is exposed - we CAN recover.

Anonymous said...

I too am a recovering IV user. I had the experience of being on maintenance several times and also of doing 21 day methadone detoxes in California a few times. My experience when I was using was that every time the methadone kicked in, the urge for CRACK became overwhelming. My problem is that I am a drug addict who has an allergy to drugs. When I get drugs in my system I want more and more and more. There is not enough methadone in the world to make me happy, or to fix whats wrong with me. I could drink a ton of methadone and be close to death but still be crawling across the floor trying to find more drugs. It doesn't work for me. Recovery after many years of using and living the lifestyle was not easy, but it did get better, and the alternative was way worse. I am SO glad that I was introduced to a program of abstinence based recovery and that the system did not give up on me by relegating me to a methadone clinic for the rest of my life. I am also quite sure that my family, the courts and everyone else on the road is glad as well. Recovery has changed my life!

Anonymous said...

You are SPOT ON in describing the "study" practices of those who want the world to believe that methadone is a miracle. Thanks for stating it this way.

The belief that methadone maintenance has a higher success rate than abstinance-based treatments is another huge lie these people use. They want to compare the people taking methadone to the people who have tried abstinance, without holding the same goals for each method. The maintenance population as about a quarter of the success rate at remaining abstinant as the other group after leaving mmt.

I personally think that nearly every sample used in these studies has a bias, and it is meant to be that way. The people conducting these "studies" have something to sell, and I think people should keep that in mind. It's little more that advertising in a free market economy, IMO...

Dr Dave said...

Nice critical appraisal of another tired study that does not help move things on at all. I couldn't agree more that low expectations of what opiate addicts might achieve is fundamental in ensuring that they don't achieve more.

I'm a doctor who is also a recovering opiate addict. At no point was methadone suggested as a treatment choice (apart from detoxification). The expectation was that I would recover with the right sort (and duration) of treatment. Now I adopt the same high expectation of my heroin addicted patients. They get better and stay better in the main. Our service is filled with reovered addicts who infectiously pass recovery on to their peers. Okay, so my recovery capital is arguably much higher, but we can increase the chances of success with some simple interventions (linking into recovery communities, providing housing and employment solutions, giving aftercare and long term management plans which focus on the client self-managing). We do it. It works. People get better.

How methadone research works

Start with the premise that opiate addicts don't get well. (Unless they're doctors.)

Perform a study offering only two variations of your preferred treatment. (Cheap and crime reducing.) One is high dose or long duration and the other low dose or short duration. Do not offer a recovery oriented option at all, or offer a recovery oriented option of inadequate duration and intensity.

Find that, when offering 2 lousy options, the lousy option with the longer duration or higher intensity reduces symptoms better at follow-up.

Run a headline of, "Methadone Detoxification Remains No Match for Methadone Maintenance, Even with Minimal Counseling." In the comments, declare, "Methadone maintenance is the preferred treatment approach for heroin dependence."

Bonus: "No difference between groups was found for cocaine use or depressive symptoms."

Bonus bonus: "Results for MM with standard counseling (2 hours a month) did not differ from those for MM with minimal counseling (15 minutes a month)."

Question: Do you think this will be used to justify offering even less counseling to methadone recipients?

UPDATE: I got some grief on this post. Here's my response:

Five points:

• First, a question. If methadone is a superior treatment option, why don't they use it for opiate addicted health professionals? Health professionals have high rates of opiate addiction and typically receive long term treatment with monitoring that lasts several years. Treatment is stepped up or down as needed. Guess what? They have great treatment outcomes. You might be inclined to chalk it up to a population with lots of recovery capital. To be sure, that plays a role, but surely a real chronic disease management approach plays a role too. 
  
• Second, is it coincidence that this study was done on poor black men? Why aren't studies like this done on young adults from affluent communities?
  
• Third, methadone used to be one component of some comprehensive bio-psycho-social treatment programs. I understand that there are still some programs that fit this description, but every program in my area is a dosing clinic and little more.
  
• Fourth, regarding misery, notice that there was no difference in depressive symptoms. 
  
• Fifth, heroin addicts in our long term programs do just as well as everyone else. It's all about hope and expectations. Beware of the subtle bigotry of low expectations.
  

All I want is a day when addicts are offered recovery oriented treatment of an adequate duration and intensity. I have no problem with drug-assisted treatment being offered. Give the client accurate information and let them choose.

Methadone in the news

Two recent stories on methadone. First, researchers may have identified a genetic marker that indicates the person's drug metabolism. They believe that these finding could be important in determining dosing for methadone. Second, a story about prison-based methadone programs.

The needle and the damage done

This 2 year old article about the disciplinary of some British methadone maintenance physicians has been making the rounds today. It has a pretty clear bias for maintenance, but it offers quite a bit of history about the British opiate addiction treatment. It also illustrates how committed the British system has been to methadone. The whole debate is between methadone detox and methadone maintenance.

As the story of these doctors progresses, it includes drugs (obviously), Madonna, Hollywood and martial arts--what more could you want?

Three of the doctors involved were found guilty of misconduct and one was stripped of his license.

Cold turkey plan for Scots addicts

The Labour Party in Scotland is rolling out a new drug policy. I've posted several times about their treatment system, which pushes methadone and successfully detoxes very few people.

The new policy has a couple of good points, including abstinence based treatment and accountability for reducing wait times:

One senior Labour figure said: "Our view is that there is a place for methadone but it should not be about people being parked on it and then left for years. There has to be an aim of getting them drug-free. Yes, we will help them but they have got a responsibility. People have just thought up till now that they have a right to methadone and that's it."

The insider added: "We feel very strongly that this agenda has been run by a fairly narrow range of people and not enough attention is being paid to people and their families. It is time to shift the balance away from them".

Justice Minister Cathy Jamieson is understood to be furious over the lengthy wait addicts are being forced to endure in order to get into rehabilitation, and is now pressing Health Minister Andy Kerr to put pressure on health boards.

It also has some points that are less recovery focused, including searching prison visitors and having addicts talk to kids about drug use.

Methadone Substitute: New And Cheaper Way To Treat Heroin Addiction

A cheaper and safer alternative to methadone. How does it compare to buprenorphine?

In contrast to methadone --which comes in liquid not tablet form -- dihydrocodeine is much easier to store and comes under less stringent regulations because it is not as toxic and less likely to cause a fatal overdose. It is estimated that whereas methadone treatment can cost almost £1,500 annually per patient, the cost of dihydrocodeine is £713.