Benefits & Risks of methadone to combat opiate addiction

Issues With Methadone Treatment To Be Aware Of

During the 1960s, scientists, researchers, psychologists, and medical professionals first started to look at the potential of methadone as a treatment for addiction to narcotics. Fast forward by around 50 years and methadone is now the most recognized form of treatment for opiate addictions. Significant research has taken place into the success rate of different treatment modalities and methadone seems to be the most successful of all.

“Substance disorders can be treated most cost-effectively in outpatient drug-free settings. Savings from transitioning to the most cost-effective treatment modality may free resources that could be reinvested to improve access to substance abuse treatment for a larger number of individuals in need of such treatment.”

Some research suggests that those who detox or take part in a completely drug-free modality can expect a success rate of between 5% and 10%. In contrast, methadone treatment, particularly methadone maintenance programs, have a success rate of 60% to 90%. The longer patients remain under treatment, the more successful they become in getting rehabilitated.

Various studies have been conducted on the impact of heroin addiction among prisoners in particular. Unfortunately, it seems that prisoners, who theoretically should not have access to addictive substances while incarcerated, are at the greatest risk of overdose upon their release.

“Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with a gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs.”

One of the key reasons for this seems to be the fact that very few inmates are offered the opportunity to undergo methadone maintenance treatment, either during incarceration or afterward. According to some researchers, this is because the focus is too strong on drug-free modalities. The prison system is cited as a clear example of why this attitude fails because the reality is that inmates are able to access addictive substances while in prison.

California has been an example of best practice to a certain degree as they mentioned methadone maintenance in Proposition 36 – the Substance Abuse and Crime Prevention Act.

“This initiative allows first and second time non-violent, simple drug possession offenders the opportunity to receive substance abuse treatment instead of incarceration.”

Unfortunately, it also seems that the state has struggled to incorporate methadone into their treatment options. There appears to be a strong bias against the synthetic opiate, and this is believed to be directly responsible for the failure of treatment in many heroin addicts in the state in particular. Unfortunately, this also renders drug courts less effective and leads to wastage of vital resources.

It is believed that the reason why some people are against methadone is a lack of understanding of tolerance. Essentially, people who use methadone as a form of treatment no longer experience a euphoric effect. If properly administered, methadone treatment does not make the patient high. Furthermore, there is a significant lack of understanding of the impact of chronic opiate exposure to brain chemistry. Thankfully, the National Institute on Drug Abuse (NIDA) is making an effort to increase understanding of what tolerance is and how the brain is affected by both short and long term opiate abuse.

“Tolerance to drugs can be produced by several different mechanisms, but in the case of morphine or heroin, tolerance develops at the level of the cellular targets.”

Until there is a better understanding of the continued changes in brain chemistry as a result of opiate addiction, even after detoxification, it is likely that opiate addicts who do not receive methadone treatment will continue to experience very high relapse rates.

Fortunately, there are alternatives to methadone treatment, one of which is buprenorphine.

“Buprenorphine is a semi-synthetic opioid derived from thebaine, an alkaloid of the poppy Papaver somniferum. Buprenorphine is an opioid partial agonist. This means that, although Buprenorphine is an opioid, and thus can produce typical opioid effects and side effects such as euphoria and respiratory depression, its maximal effects are less than those of full agonists like heroin and methadone.”

This medication, which has the same effectiveness rates as methadone, is currently available but only outside of the methadone system. This either-or approach means that those who opt for buprenorphine often do not receive other forms of addiction care such as counseling. It is vital, therefore, that changes are made.

Studies on Outcomes of Drug Treatment

One of the most significant pieces of research ever conducted into the outcomes of drug treatment was the Drug Treatment Outcomes Research Study (DTORS) in the 1980s, ordered by Governor Wilson.

“Taking all costs and outcomes together, the authors’ preferred analysis suggests that the mean net benefit associated with structured treatment is positive. At the level of the individual, the probability that structured drug treatment is cost-effective is 81 per cent.”

Specifically, the report showed that for every $1 that was spent on drug treatment, a total of $12 was saved. Unfortunately, there has always been difficulty in getting those addicted to opiates to become interested in the treatment options. As a result, the consequences have affected overall community safety and public health. In a study by the UCLA, it was noted that deaths due to violence, infections, and accidents, as well as many repeated incarcerations, could have been avoided had methadone been used in a more aggressive manner.

Methadone treatment works. Several studies have demonstrated that the treatment, particularly on the long term, has fantastic positive effects. It increases the quality of life of patients, rebuilds family relationships, increases the possibility of them becoming productive community members, saves money for the legal justice and public health system, reduces criminality and risky behavior, and more. Unfortunately, those in the legislature, in particular, must still be educated on the fact that narcotic addictions are a medical condition that requires treatment rather than punishment. One way to achieve that is by demonstrating the effectiveness of methadone treatment, and by continuing to show that investing in treatment leads to considerable financial savings to the taxpayer. Perhaps then, a difference can finally be made.

If you have more questions about Methadone Treatment, please give us a call at  855-976-2092 or check out our website.

Sources


[1] Mojtabai, R., & Zivin, J. G. (2003). Effectiveness and cost-effectiveness of four treatment modalities for substance disorders: a propensity score analysis. Health services research38(1 Pt 1), 233-59. Retrieved From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360883/

[2] Binswanger, I. A., Nowels, C., Corsi, K. F., Glanz, J., Long, J., Booth, R. E., & Steiner, J. F. (2012). Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors. Addiction science & clinical practice7(1), 3. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414824/

[3] California Society of Addiction Medicine. (n.d.). Retrieved from https://csam-asam.org/404.aspx?404;www.csam-asam.org:80/proposition-36-revisited

[4] NIDA. (2007, January 2). The Neurobiology of Drug Addiction. Retrieved from https://www.drugabuse.gov/neurobiology-drug-addiction on 2019, February 20

[5] What exactly is Buprenorphine? (n.d.). Retrieved from https://www.naabt.org/faq_answers.cfm?ID=2

[6] Davies, L., Jones, A., Vamvakas, G., Dubourg, R., & Donmall, M. (2009, December). The Drug Treatment Outcomes Research Study (DTORS) Cost-effective Analysis 2nd Edition. Retrieved from https://webarchive.nationalarchives.gov.uk/20110218141228/http://rds.homeoffice.gov.uk/rds/pdfs09/horr25c.pdf

About the author

Dr. Michael Carlton, MD.

Leading addictionologist, Michael Carlton, M.D. has over 25 years of experience as a medical practitioner. He earned a bachelor’s degree in Mechanical Engineering and returned for his MD from the College of Medicine at the University of Arizona in 1990. He completed his dual residency in Internal Medicine and Pediatrics and his Fellowship in Toxicology at Good Samaritan Regional Medical Center and Phoenix Children’s Hospital.

He has published articles in the fields of toxicology and biomedicine, crafted articles for WebMD, and lectured to his peers on medication-assisted treatment. Dr. Carlton was a medical director of Community Bridges and medically supervised the medical detoxification of over 30,000 chemically dependent patients annually.

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