Monday, April 13, 2009

Methadone: A blessing or a curse?

Methadone maintenance has been around for years- it's development stemmed from predictions in Nazi Germany that the war would cause shortages in opiates being able to cross into Germany's borders. In 1947 Eli Lilly's company started producing methadone stateside, and off we went. The drug was first published as a pain reliever, and now is mostly used in harm reduction around addiction.

I'm torn on the effectiveness of this methodology. What I've heard in anecdotes from members of 12-step programs is that their lives only really started to get better once they were able to detox off of the methadone, which creates a physical dependence of it's own. What is difficult to discern is that most of the people I've spoken with bout this have had resources for private addiction treatment- for those without resources, methadone seems to be a good start.

Methadone can be a start towards a path to a new life; however, it is not the be-all, end-all solution. Without therapy, a recovery program, and a plan to eventually remove oneself from a mind-altering substance, the chances of someone really recovering from addiction are slim. When planned correctly, methadone can be an important component in helping an individual get better.

The problem is in the profits- methadone maintenance is one of the most profitable businesses today, and I worry that clinics don't attempt to taper people off solely to make their numbers work on the bottom line. We need to respect the quality of life of our patients, and the easiest way to do this is to make a long term plan when someone begins a methadone maintenance plan. With all of the tools and resources available to us, we can put a plan together that allows methadone to be an active part of recovery.

Here's a link to the HBO special "Methadonia," a documentary regarding people who are hooked on methadone:

And here's a video on methadone and the consequences of not managing it correctly:

And, as always, here's something funny.

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  1. Methadone is the most researched pharmaceutical in existance today. Although it was originally created during WWII to replace Morphine, the works of Social Scientist Marie Nyswander and Physician Vincent Dole in the heroin ghettos of New York brought methadone into the addiction recovery arena. Because of its special properties, such as a 24-36 hr half-life, and its ability to block opiate receptors in the brain, Methadone is ideal for intractable heroin addicts. New regulations in DATA 2001 broadened the scope of Methadone Regulations, making it more suitable to addicts who have been able to lead a normal life on it, but the unintended sequelea is the prescribing for opiate naive patients, who easily overdose on this very valuable medication WITH VERY SPECIFIC AND LIMITED USES. To learn more, read the "Methadone Maintenance Therapy" posts (Part 1) at

  2. Hey Mike,
    I think that you're correct about the conundrum of methadone. I doubt that methadone is "the most researched pharmaceutical in existence," and even if it were, it is false that it blocks opiate receptor, unless your reader above meant to day that it fully activates them and therefore disables their activation by other chemicals (like heroin).
    The fact remains that methadone withdrawal is dangerous and that it is the objective of biomedical research to find better and better alternatives; methadone is without a doubt in need of an update.
    I think that the drug has its place in the addiction world, but that reliance on it as a sole treatment approach should be given up.
    Like you said, we need to think of our patients well-being, especially since most of them are initially unable to do so for themselves.