Methadone Treatment Issues

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Methadone treatment for narcotic addiction was originally researched during the 1960’s. In the intervening 40 years, methadone has come to be recognized as the standard care for opiate addiction. Detoxifications and drug free modalities, although appealing to an understandable desire for recovery without medications, produces only 5-10% success rate. Methadone maintenance is associated with success rates ranging from 60 – 90%. The longer the people are in this modality the greater their chances are of achieving stable long-term abstinence.

A recently completed 33-year follow-up of California heroin addicts recruited from the California prison system in the 1960’s revealed that, of the 600 original participants, half are now dead. Only ten percent of the original cohort had established a stable abstinence. Very few had any exposure to methadone maintenance. This study points up the problems with our current approach to opiate addiction, with a misplaced emphasis on incarceration, detoxification, and drug-free modalities.

In California, methadone maintenance was specifically mentioned in Proposition 36 as one of the approved treatment modalities. However, we have had very poor incorporation of methadone into the mix of treatment programs throughout the state. Bias against methadone in many jurisdictions has resulted in dismal recovery rates for heroin addicts in drug court programs. This undermines the credibility of drug courts and wastes resources on ineffective treatments.

Anti-methadone biases relate largely to ignorance of the phenomenon of tolerance which eliminates any euphoric effects from daily methadone doses. Patients do not get high. Also, there is lack of understanding of the changes in brain chemistry that occur after chronic exposure to opiates. These changes result in abnormalities of brain physiologic functioning that have been shown to persist for years after detoxification and are felt to be the cause of the extremely high relapse rate associated with non-methadone treatments of narcotic addiction.

Buprenorphine is now approved for the treatment of narcotic addiction and physicians can use it outside of the methadone system. It is as effective as methadone, but we need to work out a funding mechanism that will allow patients to take advantage of the opportunity to receive addiction care through private physicians.

Governor Wilson’s study of drug treatment outcomes in the 1980’s documented that methadone saved the taxpayers $12 for every $1 spent. Failure to engage more opiate addicts in methadone treatment has tremendous adverse consequences, both for public health and safety. The UCLA study documented repeated incarcerations, and deaths due to accidents, infections, and violence that could have been prevented by a more aggressive use of methadone.

We must continue to educate the legislature as well as the criminal justice community on the medical nature of narcotic addiction, on the effectiveness of treatment, and the cost savings associated with using this important modality.

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