Drug Watch
International
Position Statement
METHADONE PROGRAMS
Drug
Watch International recognizes the fact that public policy must be based on the
goal of promoting abstinence from dangerous psychoactive drugs. In treating drug
addiction, Drug Watch is steadfastly opposed to any substitution of one narcotic
for another on a continuing or permanent basis.
Methadone is an addictive narcotic that is sometimes used to expedite
detoxification of heroin addicts; however, it is abused when readily available
through methadone "maintenance" programs, which simply maintain drug
addiction. Methadone is divertible, has a high street value, and has
contributed to many deaths worldwide. It
should be used only as a last resort in those few cases when all other methods
of treatment have failed. In such
cases its use should be administered only by qualified drug treatment clinics
and should not exceed 180 days as specified by U.S. Federal regulations.
Background:
Methadone
is a synthesized opiate replacement substance with effects that can be very
similar to the opiates -- opium, morphine, heroin. Methadone differs from the opiates in that it has a
long-lasting effect in the body (24-36 hours compared to 3-4 hours for heroin).
The long lasting effect constitutes a major reason for its use in the
treatment of heroin addiction; however, methadone is effective only as a
substitute for opiates and therefore not useful in the case of other chemical
dependencies, such as alcohol, cocaine, or marijuana.
Methadone
can produce drug dependence of the morphine type and, therefore, has the
potential for being abused. Psychic
dependence, physical dependence, and tolerance may develop upon repeated
administration.
Methadone
is an opiate substitute and not a treatment, though it is sometimes used in the
management of chronic relapsing opioid dependence. However, it should never be viewed as a permanent endpoint or
"cure." Any use of methadone must be embedded in a comprehensive
program that includes mandatory drug testing, addresses the multiple problems
associated with addiction, and has abstinence as its ultimate goal.
Rationale:
Many
methadone clinics currently operate under the misconception that the only
standard an addict needs to meet to stay in the program is to show up for the
daily dose. Methadone programs that
permit open-ended methadone use and do not closely monitor other drug use deter
the addict from achieving drug-free status and are not in the community's, nor
the addict's, best interests. Current
systems which govern the dispensing of methadone to opioid addicts lack
appropriate controls.
Methadone
can produce a heroin-like euphoria for novice drug users or when injected into a
vein. The prescribed daily oral
dose should be controlled so that it does not have this effect.
Some clinics do not control the dosage well, sometimes dispensing doses
so high that the recipient displays zombie-like behavior.
Lethal over-doses are not uncommon when addicts are allowed to take the
methadone away from the clinic. Methadone
should be consumed under the supervision of experienced personnel.
Methadone
programs which are not properly administered become part of the narcotics
problem by supplying methadone to the illicit drug market.
Methadone has been known to cause death when accidentally ingested by
children in homes where it is carelessly handled by drug-addicted parents.
Numerous deaths due to overdose of methadone have been documented, in
some areas outnumbering heroin-related overdose deaths.
Babies of methadone dependent mothers are born addicted to methadone.
Current
state-of-the-art pharmacological treatment for opioid addiction includes
substances such as Naltrexone, or Naltrexone in combination with Buprenorphine,
or L-alpha-acetylmethadol (LAAM). These
treatments lack the potential for abuse and are preferred by many physicians who
deal with chronic opioid abusers. The
international movement to increase the use of methadone at the community level
is extremely dangerous and unnecessary.
Increased
access to methadone has failed to deter drug use. Since 1985, Australia has been dispensing methadone free, or
at a very low cost, to over 23,000 heroin addicts through public and private
clinics as well as pharmacies. Australia's
heroin addicts are now among the world's highest per-capita consumers of
methadone. A 1991 survey by the
Australian National Drug and Alcohol Research Centre found that two-thirds of
the methadone patients in Sydney continue to inject heroin. Clinics are now
being funded to get people off methadone.
Oversight
of methadone clinics is inadequate in many countries around the world, and there
is no standardized protocol. Currently,
addicts using methadone clinics often continue to use other drugs, such as
cocaine, alcohol, marijuana and tranquilizers.
Many clinics do not include drug testing or programs to address ongoing
drug use, lack adequate counseling for methadone recipients, and offer no
counseling related to vocational training and assistance.
Without proper oversight, many methadone programs sacrifice quality for
profit, with little concern about helping the addict return to mainstream
society.
COPYRIGHT:
Permission is granted to reproduce this article,
provided credit is given to Drug Watch International.
References:
Bejerot, N: Addiction
and Society.
Brookoff, Daniel, M.D., Ph.D., Methodist Hospital,
Memphis, TN.
DuPont, Robert L., M.D., The Selfish Brain: Learning From
Addiction, p. 190, 191. Chicago Tribune, October 23, 1998.
Curtis, James L., M.D., Director of Psychiatry and
Addiction Services, Harlem Hospital Center, New York.
de Lange, E.E., "Methadone and the Obstericus.
Abuse and pregnance," Dutch Journal for Alcohol and Drugs, 1979 (5)
nr 4.
EURAD; Methadone Position Statement, 1990.
Fink A. "Fatal intrevenous overdose of
methadone," Riv Tossicol Sper
Clin 7, 77-82, 1977.
Gollmisch G., Multiple predictors of illicit drug use in
methadone maintenance clients. Addictive
Behavior 1997;22:353-366.
Harbison, John, M.D.
Lapey, Janet, M.D., former Pathologist, New England
Deaconess Hospital, Boston, MA.
Ling W, Wesson DR, Caruvastra C, Klett CJ. A controlled
trial comparing buprenorphine and methadone maintenance in opioid dependence.
Arch Gen Psych 1996;53:401-407.
Marsch LA. The efficacy of methadone maintenance
interventions in reducing illicit opiate use,
Nahas, Gabriel G., M.D., Ph.D., Cocaine, the Brain and
Consciousness.
Pearman, Jill; Prevention Research Center, Australia.
Physicians' Desk Reference, 2234.
Reader's Digest, May 1998.
Reilly PM, Sees KL, Hall SM, Shopshire MS, Delucchi KL,
Tusel DJ, Banys P. Self efficacy and illicit opioid use in a 180-day methadone
detoxification treatment. Journal of Consulting and Clinical Psychology
1995;63:158-162.
Simon DL. The Rationale for Naltrexone therapy as an
alternative to methadone treatment for opiate addiction. Connecticut Medicine
1996;60:683-685.
Smith, Michael. "The
Methadone Connection, Feeding the Drug Problem." DHARMA, Vol No. 6,
June 1979.
Strain EC, Stitzer ML, Liebson IA, Bigelow GE.
Buprenorphine versus methadone in the treatment of opioid dependence: Self
reports, urinalysis, and Addiction Severity Index. Journal of Clinical
Psychopharmacology 1996;16:58-67.
Sydsvenskan Newspaper, Sweden, 11-12-93.
U.S. Code of Federal Regulations.
Victorian Institute of Forensic Pathology, South
Melbourne, Australia, 1989.
Voth, Eric, M.D., FACP.
Cotton-O'Neil Clinic, P.A., Topeka, KS. Chairman, The International Drug
Strategy Institute.
Wolff K, Hay AWM, Vail A, Harrison K, Raistrick D.
Non-prescription drug use during methadone treatment by clinic and
community-based patients. Addiction 1996;91:1699-1704.
(Methadone
Programs 1/99)
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