What You Should Know About Methadone Treatment

Methadone is a synthetic opioid developed in Germany during World War II to treat pain initially. Methadone treatment for addiction did not appear until two decades later. In the latter half of the 20^th century, heroin use in the United States began climbing steadily. Knowledge about addiction treatment was in its infancy. Although American Medical Association and slowly increasing segment of the medical community understood alcohol addiction as a disease and mental disorder, addiction was still seen largely seen as a moral failing or lack of discipline. Heroin addicts were seen as a nuisance at best and a menace to society at worse when some would commit petty crime to fund their habit.

Methadone Treatment as Harm Reduction

During the 1960s as the drug counterculture was in full swing, the government and medical community were doing their best to cope with the scourge of drug abuse and addiction they would struggle to understand. It was then that methadone treatment for heroin addiction was developed as a harm reduction measure. The thinking was that, whilst users would remain opioid dependent, they would no longer be using street drugs without quality controls in place. The rate of overdose deaths would drop precipitously. It would also eliminate the intravenous use of heroin. Prior to the late 90s to early 2000s, most heroin in the United States came wasn’t potent enough to snort or in the tar form, which is impossible to snort. Because of this and a host of other reasons, IV was the primary route of administration for heroin. This, compounded with poor hygiene habits lead to the spread of hepatitis and other needle born illnesses. It also led to infections, cellulitis and abscesses. Methadone maintenance programs were an effective way of reducing a slew of public health problems surrounding IV heroin abuse.

Federal Programs Fund Methadone Treatment

Methadone treatment coordinated and financed by the federal government was effective for most participants initially. Methadone treatment consisted of dosing patients daily with the liquid form of the drug, which was administered in clinics daily so that patients would not be tempted to use more than prescribed or potentially lose or swap their methadone for other drugs. Then, as in many state-funded methadone treatment programs today, patients lined up outside clinics in the morning waiting to be let in and given their dose, which they were to drink on the spot in full view of staff for confirmation.

Methadone treatment for opioid dependence (almost exclusively heroin) was also referred to as “methadone maintenance” or MMT (Methadone Maintenance Treatment). The maintenance part of the equation came from the fact that methadone treatment wasn’t being used temporarily in an effort to ease withdrawal symptoms, but rather to take the place of heroin as a harm reduction strategy. The synthetic opioid had a high affinity for the brains opioid receptors and was quite “sticky” so it would remain lodged in the receptors for much longer than heroin and other naturally derived or semi-synthetic opioid, such as morphine.

How Methadone Works to Reduce Harm

People being dosed in methadone treatment would thereby avoid the “peaks and valleys” associated with the use of heroin and other opioids where intense highs are supplanted by deep lows and eventually rather horrid withdrawal symptoms that could last a week or more. Methadone had an effect users could feel, but it was nothing like the intense euphoria of heroin or other short acting opioids that have a high potential for abuse. As long as the dose was taken daily, methadone treatment kept the recovering heroin addicts on a relatively even keel. The “stickiness” of the molecule to the brain’s opioid receptors had the added benefit of blocking other opioids from occupying the same receptors.

If a person on methadone maintenance were to use heroin or other opioids, the euphoric effects are substantially diminished because far fewer molecules can anchor to opioid receptors due to the methadone’s presence. One early study found that even with no other form of treatment, about 75% patients in a methadone treatment program had ceased heroin use altogether when they were evaluated after 4 months of treatment. While this wasn’t a perfect result, it was dramatically better than anything that had been tried before. It was a breakthrough and the continued success of these programs being replicated in major cities around the country also spread to other countries. Within a decade most of the world’s major cities had methadone treatment programs (MMT).

Is Methadone Used Today? Why or Why Not?

Methadone treatment may sound like something of a success story and it was in many ways. However, methadone maintenance programs are not without their detractors and downsides. While methadone doesn’t produce the euphoria heroin does, some methadone uses found combining their done with benzodiazepines like Xanax or Valium gave them a high worth pursuing. Combining a powerful, long-acting synthetic opioid like methadone with benzos is especially dangerous. They compound the effects of one another and the risk of respiratory arrest and death skyrockets. Another issue methadone treatment participants found was that while methadone helped many of them, it was notoriously difficult to detox oneself off of methadone.

This is in part due to that “stickiness” of the molecule we discussed earlier. Methadone tends to linger in the brain and as a result, the unpleasant withdrawal symptoms that follow cessation linger too. Ordinary detox protocols used for heroin and other opioids simply aren’t effective for methadone withdrawal. It must be treated differently and detox can often that well over the usual 5-7 day span followed in opioid detoxes. This makes methadone detox more difficult and more costly. So much so that some facilities refuse to treat it. Methadone is still in use today, both as a maintenance medication and for chronic pain and as a detox medication