Methadone Maintenance Treatment

Methadone Maintenance Treatment (MMT) has been in place for over 30 years.  Initially used as an analgesic before the Second World War, it was used to rectify the heroine epidemic in the post-World War II era.  At present, MMT is used as a harm-reduction strategy – a tool to help withdrawing heroine addicts, reduce crime and deaths associated with opiate use and to reduce incidences of HIV/AIDS that results from heroin injection and needle use.  There is still however a controversy surrounding the treatment basically because of the misconception associated with MMT.  Health officials believe that MMT should be kept in a short duration as possible while researchers contend that higher doses and longer treatment duration may lead to lower cases of relapse.

Heroin addiction is a persistent problem in the United States especially in New York City where heroin abuse, replacing opium smoking, started in the early 20th century (Frank, 2000).  The post-World War II era saw an epidemic rise in the number of heroin addicts such that between 1950 and 1961, heroin injection became one of the leading causes of death among young adults in New York City (Joseph, Stancliff & Langrod, 2000).  The average age of heroin-related deaths was 29 years old, both for men and women.

Initially used as an analgesic in Germany before the Second World War, methadone was considered as an answer to the prevalence of the illicit drug and the consequent criminal offenses and deaths associated with its use.  This started in 1949 when Isbell and Vogel demonstrated methadone to be effective in helping addicts withdraw from heroin (Joseph et. al, 2000).  In 1964, methadone maintenance treatment (MMT) was launched as a research program in Rockefeller Institute under the direction of Dr. Vincent P. Dole and Dr. Marie E. Nyswander.

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At present, methadone maintenance treatment is one of the common medications used to treat heroin and other opiate addiction.  Judging from the number of researches and assessments on MMT, it is evidently the drug abuse treatment that has received the most thorough evaluation and has been shown to be effective in reducing opioid use, HIV incidences, criminal activity and mortality (“Literature Review – Methadone Maintenance Treatment”, 2007).  Consequently, it has also been demonstrated to improve physical and mental health and a person’s ability to regain normal social functioning.

Despite the staggering number of studies associated with MMT and the scientific data resulting from these studies showing that the treatment is an effective medication for withdrawing opiate addicts, controversies still surround the treatment.  There seem to be conflicting views between scientists/researchers and health officials as to how the treatment must be dispensed.  Aside from discussing those controversies, this paper will also:

•  present methadone facts
•  present the advantages and disadvantages of MMT and determine the people that can benefit from such a treatment; and
•  assess whether MMT is an effective harm-reduction strategy.

Methadone Facts

Methadone, initially used as an analgesic, is a synthetic narcotic that has been used to treat opiate addiction for more than 3 decades (Office of National Drug Control Policy [ONDCP], 2000).  Heroin and opioid addicts feel the need to continually take in these substances because opiates occupy a receptor in the brain which sends a signal to the body when opiate levels are low.  Methadone works by “occupying” these receptor sites and consequently hinders the euphoria caused by heroin use, relieves the craving for opiate and reduces the withdrawal symptoms associated with abrupt cessation of opiate use (Centers for Disease Control and Prevention [CDC], 2002).

Taken orally once a day, the effect of methadone can last from 24 to 36 hours. As with any medication, there is the risk of abuse and dependency.  In a controlled and supervised treatment, a former heroine addict may remain physically dependent on methadone but does not experience the highs and lows resulting from the increase and decrease of heroine in blood levels (ONDCP, 2000). A person on methadone treatment can therefore be integrated into the society and become a functional citizen.

Who Benefits From MMT

Methadone will only be effective for those recovering from opiate addiction and will have no effect for those who are taking other mood-altering substances apart from opiates (Stimmel & Kreek, 2000).  In the past, admission to MMT was limited only to applicants between the ages of 21 and 40 with a minimum of 4 years narcotic addiction.  Joseph, et. al. (2000) noticed that the admission criteria is much more liberal now as rehabilitation clinics now admit patients younger than 21 and older than 40.

Because the link between heroin abuse and alcoholism has long been acknowledged, the New York State Office of Alcoholism and Substance Abuse Services (OASAS) changed its former rules of separating treatment for heroin addicts and alcoholics and instead ordered that Addiction Treatment Centers (ATCs) admit methadone patients into alcoholism rehabilitation programs and vice versa (Kipnis, Herron, Perez & Joseph, 2001).

Even pregnant women can be treated using methadone as long as the mother is closely monitored and has to be enrolled in a comprehensive program that not only includes MMT but also prenatal care, nutritional counseling and other medical services that the pregnant woman may need (Joseph, et. al, 2000).  Ward (1998) as cited in “Literature Review – Methadone Maintenance Treatment” (2207) asserted that nobody should be excluded from the treatment (in the context of heroin and opiate use) because no reliable criteria exist that has determined a group of people that will not respond to treatment.

Key Issues in MMT

The guiding principle of most rehabilitation centers is that an addict is “cured” if he is able to abstain from the use of an illicit drug.  Critics of MMT claim that the treatment is just a substitute for the stronger opiate (heroin) addiction.  This is viewed as the major disadvantage of MMT, especially by health officials.  Kipnis, et. al. (2001), Stimmel and Kreek (2000), Joseph, et. al. (2000) and a host of other researchers contend that there is a misconception and misunderstanding between health officials and researchers of MMT.  Even at present, there is a stigma associated with MMT because it still viewed as a physical dependence on a drug.

This explains why most patients in rehabilitation clinics receive insufficient doses which would lead to a likely relapse. A lot of health care officials believe that therapy using methadone has to be ceased as soon as possible.  Researchers disagree, arguing that there should not be a limit as to the duration of the treatment because patients may respond well to a short treatment while others may respond better to a longer treatment, possibly even a lifetime treatment.  Joseph et. al. (2000) also noted that higher doses lead to a higher treatment retention rate.  Even with increasing evidence pointing to the effectiveness of MMT as a therapy for heroin and opiate withdrawal, there is still only partial acceptance for the treatment by the public.  The media has also distorted the public’s view on MMT which resulted to a stigma associated to the treatment.

MMT as a Harm-Reduction Strategy

Drug Policy Alliance (2007) cited dozens of authors that supported MMT as a tool used to reduce crime, death and disease.  Researchers agree that methadone is the most effective treatment for heroin addiction.  Furthermore, methadone reduces criminal offenders because those who are in MMT are able to lead stable lives and can acquire legitimate employment.

Cases of HIV and other diseases caused by needle-sharing are also reduced by the treatment.  Methadone treatment is also a point of contact between the patient and the health official and an opportunity for the patient to learn about the techniques to prevent HIV/AIDS, hepatitis and other diseases that may inflict drug users. MMT is also cost-effective, costing only $13 per day and is a better alternative than incarceration (ONDCP, 2000).  Kipnis, et. al. (2001) however believes that there must be an organizational overhaul in order for MMT to be more effective.  The staff of ATCs must lose their held principles that MMT does not work or that it is a form of addiction.  Discrimination for MMT patients must have no place in the 12-step rehabilitation programs and the public also needs to be educated of the proper and real function of MMT in the community.

Conclusion

MMT has been proven to be effective in more than 3 decades of its use.  Social factors however prevent it from being used properly.  Misconceptions that health officials have regarding the treatment, its use and the dosage to be dispensed lead to a great number of relapses.  Staff culture and beliefs have to be changed in order for methadone maintenance treatment to be fully accepted in the community and for its effectivity to be optimized.

References

1. Drug Policy Alliance (2007). Methadone Maintenance Treatment. Drug Policy Alliance. Retrieved September 1, 2007 from http://www.lindesmith.org/library/ research/methadone.cfm
2. Frank. B. (2000). An Overview of Heroin Trends in New York City: Past, Present and Future. The Mount Sinai Journal of Medicine, 67 (5-6).
3. Kipnis, S., Herron, A., Perez, J. & Joseph, H. (2001 January). Integrating the Methadone Patient In the Traditional Addiction Inpatient Rehabilitation Program – Problems and Solutions [electronic version]. The Mount Sinai Journal of Medicine, 68 (1). Retrieved August 31, 2007 from http://www.mssm.edu/msjournal/68/PAGE28_32.pdf
4. Joseph, H., Stancliff, S. & Langrod J. (2000). Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues. The Mount Sinai Journal of Medicine, 67 (5). 347-364. Retrieved August 31, 2007 from http://www.mssm.edu/msjournal/67/page347_364.pdf
5. Literature Review – Methadone Maintenance Treatment (2007). Health Canada. Retrieved August 31, 2007 from  http://www.hc-sc.gc.ca/hl-vs/pubs/adp-apd/methadone/policy-politique_e.html#adm
6. Stimmel, B & Kreek, M.J. (2000). Neurobiology of Addictive Behaviors and Its Relationship to Methadone Maintenance [electronic version]. The Mount Sinai Journal of Medicine, 67, (5-6). 375-380. Retrieved September 1, 2007 from http://www.mssm.edu/msjournal/67/page375_380.pdf
7. U.S. Centers for Disease Control and Prevention [CDC] (2002 February). Methadone Maintenance Treatment. IDU HIV Prevention. Retrieved August 30, 2007 from http://www.cdc.gov/idu/facts/MethadoneFin.pdf

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