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Free the Methadone: Image
Methadone maintenance treatment (MMT) is the gold standard of treatment for opioid use disorder. Methadone is a long-lasting opioid agonist whose safety has long been supported in the scientific literature, with its ability to ward off withdrawals proven as early as 1947.1 Methadone’s capacity to successfully block physiological cravings for a full 24-hour period enables people who use drugs to focus on things other than the highs and lows common with opioid addiction, including personal and professional development.1 Despite popular opinion, methadone in combination with other interventions such as counseling has not been proven necessary long-term.2-4 Moreover, drug-free programs (detoxification models) see little success in achieving positive, sustainable outcomes for people who use drugs. In treatment settings, emphasis should be on the medication itself, not on supplementary modes of support which have not been proven effective. Methadone has been established to reduce dependency on heroin and has been linked to improved quality of life among patients, and therefore should be the go-to method of opioid treatment.5-8
What You Need to Know:
● Science shows that methadone is more effective in higher doses.9,10 Flexible dosing policies allow patients to set their own bar for success. This is particularly important because tolerance and personal metabolism impact the rate at which methadone is processed. Dosing patterns must be adjusted to account for these variances.
● While some clinics try to push abstinence, it is important for patients to understand that any use of methadone to decrease dependence on other substances is positive change. A harm reduction model should be employed to allow methadone patients to achieve maximum benefit from treatment.11
● Unstable dose is frequently to blame for dissatisfaction among patients enrolled in methadone maintenance treatment.12
● Decreasing the threshold at which people who use drugs can access methadone increases its efficacy. Barriers, such as supervised urine screenings, denial of treatment due to use of other medications, and limited clinic hours and locations, make methadone harder to access and push stabilization further away.11,13
● Although far less likely than when using illicit substances, methadone can lead to an overdose. In particular, poly-substance use (mixing drugs) while on methadone increase one’s likelihood of overdose. With this in mind, it is important for anyone who is on methadone to have naloxone available in the case of an emergency.
● SAMHSA Methadone Page
● National Alliance for Medication Assisted Recovery References
1. Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis. 2012;31(3):207-225. doi:doi:10.1080/10550887.2012.694598.
2. Mayet S, Farrell M, Ferri M, Amato L, Davoli M. Psychosocial treatment for opiate abuse and dependence. Cochrane Database Syst Rev. 2004;4. doi:10.1002/14651858.CD004330.pub2.
3. Ward J, Hall W, Mattick R. Role of maintenance treatment in opioid dependence. Lancet Public Health. 1999;353(9148:221-226. doi:10.1016/S0140-6736(98)05356-2.
4. Gruber V, Delucchi K, Kielstein A, Batki S. A randomized trial of 6-month methadone maintenance with standard or minimal counseling versus 21-day methadone detoxification. Drug Alcohol Depend. 2008;94(1-3):199-206.
5. Mattick R, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence (review). Cochrane Database Syst Rev. 2009;3. doi:10.1002/14651858.CD002209.pub2.
6. Hser Y, Hoffman V, Grella C, Anglin M. A 33-year follow-up of narcotics addicts. Arch Gen Psychiatry. 2001;58(5):503-508. doi:10.1001/archpsyc.58.5.503.
7. Devi J, Azriani A, Zahiruddin W, Ariff M, Hashimah A. The effectiveness of methadone maintenance therapy among opiate-dependants registered with hospital raja perempuan zainab II kota bharu, kelantan. Malays J Med Sci. 2012;19(4):17-22.
8. Murray J. Effectiveness of methadone maintenance for heroin addiction. Psychol Rep. 1998;83:295-302.
9. Ward J, Mattick R, Hall W. The effectiveness of methadone maintenance treatment: an overview. Drug Alcohol Rev. 1994;13(3):327-335.doi:10.1080/09595239400185431.
10. Amato L, Davoli M, Perucci C, et al. An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform practice and research. J Subst Abuse Treat. 2005;28(4):321-329. doi:10.1016/j.jsat.2005.02.007.
11. Kourounis G, Richards B, Kyprianou E, et al. Opioid substitution therapy: lowering the
treatment thresholds. Drug Alcohol Depend. 2016;161:1-8. doi:10.1016/j.drugalcdep.2015.12.021.
12. Hayashi K, Ti L, Ayutthaya P, et al. Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed methods study. Harm Reduct J. 2017;14(63). doi:10.1186/s12954-017-0189-3.
13. Jamieson, Beals, Lalonde and Associates Inc. Best practices: methadone maintenance
treatment. Office of Canada’s Drug Strategy; 2002. https://www.publicsafety.gc.ca/lbrr/archives/cn2493-eng.pdf.
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