Methadone Treatment: Safe, Effective Management of the Painkiller Addiction Crisis

We are facing a tsunami of painkiller addiction that will flood our criminal justice, health care, behavioral health, and social services resources. Illicit online pharmacies have made prescriptions cheap and easy to acquire, fueling a massive wave of addiction that we actually have not seen yet. SAMHSA estimates that over 5% of the nations population, 12 years and older, are using painkillers, nowhere more prevalent than the heartland with Oklahoma leading the nation at 6.7%.

Opioid addiction used to be thought of as primarily heroin addiction, but that is changing rapidly. The masses currently addicted to prescription painkillers have conveniently been able to manage their addiction and manage other aspects of their lives like job and family. However, the Senate passed the Ryan Haight Online Pharmacy Act and the DEA is closing down those cheap and easy suppliers of prescription drugs.

When that happens this mass of addiction will suddenly become sick and desperate, and a foreseeable progression of consequences will follow. That means increased criminal activity, loss of jobs, which leads to loss of housing, which leads to the break-up of families and increased utilization of social services. 5.5% to 6.7% of the population 12 years and older may be headed toward this foreseeable progression of consequences.

Traditional approaches to substance abuse treatment have proven ineffective in treating opioid addiction, with high relapse rates. These approaches start with inpatient detox. In Oklahoma, according to ODMHSAS, there is a waiting list of 1,000-1,300 for residential substance abuse treatment. Detox and residential treatment are huge bottlenecks to an ineffective approach. Is there anything to stop this tidal wave of destruction?

SAMHSA has identified the evidence-based best practice, Medication Assisted Treatment, Treatment Improvement Protocol 43, as having the best outcomes for opioid addicts. Even better, in most cases, active opioid abusers can be taken directly into outpatient treatment, skipping inpatient detox and preserving jobs, housing, and families. While new generation drugs have been developed, they are very expensive and are not covered by Medicaid and Medicare, and many private health plans.

Methadone has been around for over thirty years in the treatment of opiate dependency and it is a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence. Opiates like heroin and prescription painkillers release an excess of dopamine in the body and causes users to need an opiate continuously occupying the opioid receptor in the brain. Methadone occupies this receptor and is the stabilizing factor that permits addicts on methadone to change their behavior and to discontinue heroin use.

Taken orally once a day, usually in the morning, methadone suppresses narcotic withdrawal for between 24 and 36 hours. Its effectiveness in eliminating withdrawal symptoms makes methadone useful in detoxifying opiate addicts. Methadone has not been proven effective in cases of addiction to other drugs, however, clinical trials are underway.

Methadone reduces the cravings associated with heroin use and blocks the high from heroin, but it does not provide the euphoric rush because of the longer half-life of the drug in the blood system. Consequently, methadone patients do not experience the extreme highs and lows that result from the waxing and waning of heroin and painkillers in blood levels. Ultimately, the patient remains physically dependent on the opioid, but is freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts. Lifestyle changes can be made that support the maintenance of healthy and responsible living.

The Oklahoma Department of Mental Health and Substance Abuse Services reports that heroin accounts for only 5% of substance abuse treatment admissions. Yet nearly 26% of those involved with the criminal justice system have addictions to heroin. Addiction to heroin is highly correlated to criminal activity. That type environment affects many areas of living in a manner that is detrimental to the addict and society as a whole. By removing the need to access that element in order to obtain drugs, whether heroin or diverted prescription painkillers, allows the opiate addict to pursue a different course of life that benefits the addict, their families, and society at large.

The rapid reduction in the supply of prescription painkillers, due to recent legislation and DEA and OBNDD initiatives, is occurring simultaneously with an increase in the prevalence and purity, and a reduction in the price, of heroin. This context is ripe for a conversion from prescription painkiller addiction to heroin addiction – and all the social and criminal ramifications of it. Withdrawal from methadone is much slower than that from heroin. As a result, it is possible to maintain an addict on methadone without harsh side effects, including the impulsive and compulsive behavior associated with extreme highs and lows.

Methadone maintenance treatment (MMT) provides the heroin addict with individualized health care and medically prescribed methadone to relieve withdrawal symptoms, reduces the opiate craving, and bring about a biochemical balance in the body. Important elements in heroin treatment include comprehensive social and rehabilitation services.

Like any controlled substance, there is a risk of abuse. When used as prescribed and under a physician's care, research and clinical studies suggest that long-term MMT is medically safe (COMPA, 1997). When methadone is taken under medical supervision, long-term maintenance causes no adverse effects to the heart, lungs, liver, kidneys, bones, blood, brain, or other vital body organs. Methadone produces no serious side effects, although some patients experience minor symptoms such as constipation, water retention, drowsiness, skin rash, excessive sweating, and changes in libido. Once methadone dosage is adjusted and stabilized or tolerance increases, these symptoms usually subside.

Methadone is a legal medication, produced by licensed and approved pharmaceutical companies using quality control standards, prescribed by specifically licensed physicians, and administered by specifically licensed clinics, all of which are under close regulatory scrutiny. Under a physician's supervision, and when it is administered orally on a daily basis with strict program conditions and guidelines, methadone can be very safe.

Methadone does not impair cognitive functions. It has no adverse effects on mental capability, intelligence, or employability. In appropriate therapeutic dosing, it is not sedating or intoxicating, nor does it interfere with ordinary activities such as driving a car or operating machinery. Patients are able to feel pain and experience emotional reactions. Most importantly, methadone relieves the craving associated with opiate addiction. For methadone patients, typical street doses of heroin are ineffective at producing euphoria, making the use of heroin less desirable.

However, there are differences among some clinics' internal policies and procedures that can make drastic differences in the safety of the patient. Below are some of the main considerations:

Studies show that diverted methadone often sold on the streets is responsible for the majority of methadone deaths. Daily dosing onsite allows for clinical assessment of speech, gait, eyes, etc., that prompt urine tests. Urine analysis should include a 12 drug panel and test for adulterants, or masking agents, which are used to flush the system of drug traces. The rampant use of such masking agents makes many tests yield false negatives. Unless the program tests for such adulterants, their patients are at risk.

2. Strict and limited carry-home doses prevents misuse. Carrying multiple doses home allows for:

Self administration of the drug which can result in not taking the drug as prescribed, i.e., overdosing.

Diversion of the drug to the street market. Since methadone potentiates many other drugs, it has a street value.

Supplementation of the methadone regimen with other drugs. Since methadone potentiates many other drugs, this represents a serious risk of drug interaction.

Not treating the underlying addiction places the opiate addict being maintained a significant risk of relapse while on a medication that potentiates other drugs. Likewise, opioid addiction medical management regimens that provide multiple doses, whether multiple carry-home doses of methadone or a 30 day prescription of a drug like Suboxone or buprenorphine, do not provide the accountability framework for psychotherapeutic treatment compliance, nor a safe monitoring system for administering potentially dangerous medications. Given the typical and symptomatic behavioral characteristics of addiction, this is not an optimal situation for treatment outcomes.

Every program should participate in the DEA's Prescription Monitoring Program and fax sole provider letters to all Opioid Treatment Programs in the state to confirm they are, in fact, the sole provider of medication in the Medication Assisted Treatment.

Programs that utilize the above safeguards and accountability protect the addict from him/herself and optimize the treatment outcomes.

Serving Native and Non-Native people with clinical excellence and warm tribal tradition.

“The problem with Methadone is the extremely long half-life and active metabolites.”

That is not the problem, that’s what makes it the ideal opiate substitute. It eliminates the highs and lows of opioid use while blocking withdrawal symptoms.

“Methadone is paid for by tax dollars - state and fed. I don’t understand why taxpayers have to pay for what amounts to a substitute drug for addicts. This is the part of the ‘legalize drugs’ argument I despise. If someone wants to be addicted to drugs - ok, I guess. But why do taxpayers have to pay for the damage they do to their own lives?”

In Oklahoma the vast majority of methadone treated patients are cash pay, not tax payer funded.

“Absolute nonsense. Patients with acute pain can be properly treated by ethical physicians. Patients with chronic pain can be properly treated by ethical physicians. If you are using illegal narcotics of any kind you are a criminal. If you are ordering illegal drugs from criminals you should both be arrested.

This article is ridiculous. “

Your response does not make sense. The article is about treating addiction, not pain management. Many people who are being treated for pain management become addicted. But the article is about treating addiction, not pain.

This article is ridiculous. “

“No one would use methadone if it wasn’t free.”

Methadone treatment is not free in Oklahoma. The vast majority of methadone treated patients in Oklahoma are cash paying.

CRC the nation’s largest methadone treatment provider with a nation-wide network of treatment centers states that 82 percent of clients are private pay. They did not identify the payer source for the other 18% but I would assume insurance. Most do not take Medicaid or Medicare.

Yes, and Al Gore did a documentary on An Inconvenient Truth, too. And let us not forget Michael Moore’s documentaries. If it is in a documentary it MUST be true!

yep.....there are people here locally that have been busted for possession, and are taking 30 MG oxycodone tablets like they are M&Ms. We’re talking 300 MG a day (and up!!) Oxy habits, and the frequency of local drug stores being held up for all of their opioids is on a steep rise.

Lots of scary, desperate junkies out there all over the place. I’m nervous about driving these days because there are so many functional junkies on the road at any given time.

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