As the pandemic continues and protests dominate news coverage and our national consciousness, the country seems to have lost sight of the fact that we’re still in the midst of another public health crisis: the opioid epidemic. One approach to treatment for opioid addiction is widely misunderstood: methadone treatment. The myths about methadone are unfortunate, because they prevent people who need help from getting help — and methadone is one of the most effective tools we have to prevent the negative consequences of opioid addiction.
Myth #1: Methadone treatment replaces one addiction with another.
A person with an opioid use disorder — an addiction to black market oxycontin, for instance — has what’s called a substance use disorder. When the disorder causes significant impairment and behavior escalates to a level considered compulsive or out of control, that behavior is characterized as addictive. Addictive behavior — in the context of illicit oxycontin — includes things like petty crime, spending rent money on drugs, and doing things that jeopardize their ability to function as a viable member of society. They lose their ability to be an effective spouse, family member, employee, or citizen — all because of their addiction.
When that person begins methadone treatment, licensed physicians — like me — administer methadone to mitigate the withdrawal symptoms that appear in the absence of oxycontin. When withdrawal symptoms abate, the patient and the physician collaborate to find a methadone dosage and schedule that blocks the intense cravings that follow. Cravings are what often lead people with opioid use disorders to engage in self-destructive, addictive behaviors. In the absence of the cravings, the risky behaviors become unnecessary. The addicted individual stops engaging in them because they are no longer driven to do so.
Methadone does not replace one addiction with another: it treats a disease with a medication that prevents addictive behavior.
Myth #2: People in methadone programs use methadone to get high.
The strict medical criteria physicians like me use to determine methadone dosage — and the strict regulations surrounding the distribution and prescription of the medication — make it nearly impossible for someone to use methadone to get high. During the induction phase of a methadone program, we determine a dosage that blocks withdrawal symptoms, eliminates drug cravings, prevents the euphoric side effects of other opioids, and, apropos of dispelling Myth #2:
“A dosage at which tolerance of the sedative/euphoric effects of methadone is achieved.”
That’s the rub: people in methadone programs don’t use methadone to get high because they can’t. Physicians calibrate their dosage to prevent it. People who participate in methadone programs report feeling mild euphoric effects during the first few days of treatment, but they disappear quickly and completely. That’s because professional medical personnel make sure the dosage they take does not — cannot — get them high.
Myth #3: People in methadone programs lack willpower.
Unpacking this misconception means going back in time to the latter half of the 20th century, before scientists had reliable data on addiction and addiction treatment, before we understood the connections and relationships between genetics, neurobiology, environment, lifestyle, and substance use disorders, and before people understood addiction as a disease. That was when a majority of people — including medical professionals — considered addiction to be a moral failing, a character flaw, or simply something that happened to people who lacked willpower.
That stigma was deadly: it kept people from seeking and receiving lifesaving treatment. Rather than stigmatize people on methadone programs, we should treat them exactly as we do people in treatment for other chronic relapsing conditions, such as type 2 diabetes, cardiovascular disease, or cancer. We don’t stigmatize people with these chronic diseases. We support them. We help them stay on track with their medication and lifestyle changes. Many people look at the opioid problem from the outside — people with little or no stake in the crisis — and wonder what they can do. This is one thing they can do: help reduce stigma by spreading awareness about the effectiveness of methadone programs.
Myth #4: Methadone treatment only works for heroin addicts.
This is an easy myth to dispel. In fact, the National Alliance on Mental Illness (NAMI) can do it for us:
“Methadone is a prescription medication that works in the brain to treat pain and dependence on opioids. Opioids include heroin and prescription pain relievers such as hydrocodone, oxycodone, morphine, and fentanyl.”
That’s the quick answer. Methadone treatment is not only for “heroin addicts” — it’s an effective treatment for any opioid use disorder. The myth that methadone treatment is only for “heroin addicts” is part of the cultural stigma we mention above. This stigma keeps many individuals struggling with an opioid use disorder from getting the best possible treatment available for their disease. Not everyone who enters a methadone program will beat addiction. However, everyone who enters a methadone program for opioid addiction has an opportunity to stop their disordered drug use and turn their lives around.
Myth #5: Methadone treatment doesn’t really even work.
This myth is also fairly easy to dispel, because we have more than six decades of research proving methadone treatment does, in fact, work. That’s fact: we’ve known about the effectiveness of methadone treatment since 1948, when Dr. J.F. Maddux treated individuals addicted to heroin and morphine with oral methadone in a United States Public Health Service (USPHS) hospital in Fort Worth, Texas. The positive results of his trials led researchers V.P Dole, Mary Jeanne Kreek, and Marie Nyswander to open the first methadone clinic in New York City in 1964. The Food and Drug Administration (FDA) approved methadone replacement as a long-term treatment for opioid addiction in 1973.
Since then, scores of studies around the world have confirmed methadone as an effective and safe treatment for opioid addiction in general, and the most effective treatment available for heroin addiction in particular. Experts agree that for people with opioid use disorders, methadone treatment programs:
1. Decrease opioid use
2. Decrease opioid-related overdose deaths
3. Decrease criminal activity
4. Decrease transmission of infectious diseases
5. Increase social functioning
6. Increase time in treatment
In closing, I want to make one thing clear to anyone seeking treatment for themselves or a loved one struggling with an opioid use disorder: medical experts consider methadone treatment, in conjunction with counseling, to be one of the most effective treatments for opioid addiction currently available. Don’t believe the myths: methadone treatment saves lives.
Chris Johnston, MD ABPM-ADM, Chief Medical Officer, Pinnacle Treatment Centers