Is it true that any doctor prescribe methadone to their patients?
Methadone is an opioid that has multiple uses.
Methadone was created in the 1930s in Germany. It was originally intended to be used to treat pain and was marketed under the brand name Dolophine. In fact, even today doctors write methadone for the treatment of chronic pain. It is an inexpensive and effective treatment and relatively safe when taken prescribed by a qualified doctor and taken as directed.
In the 1960s, Dr. Vincent Dole started the methadone maintenance treatment program in New York City so that methadone could be used to treat heroin addiction. There was an opioid epidemic following World War II and there was no adequate medical treatment for opioid addiction at the time. Dr. Dole noted that his patients were able to return to normal functioning, taking care of and being involved with their families and performing well at their jobs. The constant drug obsessions, seeking heroin on the streets and frequent sickness were no longer a problem for patients receiving treatment.
The 12-step connection to medication-assisted treatment.
MMT worked so well for Dr. Dole’s patients that his success attracted the attention of Bill W., founder of Alcoholics Anonymous. Bill met with Dr. Dole and asked him if it were possible that a similar treatment might be developed for alcoholism so that alcoholics could stop obsessing about drinking and get to work on their step programs. It is interesting that the founder of AA approved of medication-assisted treatment of opioid addiction. Narcotics Anonymous is a program which branched off of AA and is now the second-largest 12-step program in the world, after AA. NA, however, about 30 years after Dr. Dole founded the first MMT program in New York, released a pamphlet that made it clear that NA did not approve of MMT.
Methadone Maintenance Treatment today.
Decades after the first methadone clinic was established in New York City, there are still methadone clinics across the country to this day. Methadone continues to be a successful treatment for opioid dependence. In fact, methadone may enjoy a resurgence of interest and use in treating opioid addiction due to the long-acting nature of fentanyl analogs being found in street heroin. While buprenorphine has been taking over as the drug of choice in treating opioid addiction, the new opioids on the streets today may require methadone’s unique qualities. One of the main differences in how methadone works for addiction treatment compared to Suboxone is that the patient must wait for hours after the last opioid use before starting Suboxone. If they start too soon, the Suboxone will make them sick with withdrawal symptoms. Methadone, on the other hand, does not require a waiting period. Patients can go to the methadone doctor the same day they quit heroin or fentanyl and get started on treatment.
Is methadone addiction a problem? Is it possible to have a methadone overdose?
It is possible to get addicted to methadone. Although it is not as likely as becoming addicted to other opioids. Many opiate users report that while they do get a high feeling from methadone, it is not a drug they would prefer to use for getting high. As far as the risk of overdose, it is definitely possible for a methadone user to overdose on methadone. Because of the drug’s high potency and very long half-life, there is a significant risk for breathing problems, specifically respiratory depression. Methadone is longer-acting than other opioids. The risk of abuse, diversion, and overdose are reasons why methadone clinics are so heavily regulated by the federal government. Only doctors who work in a registered methadone clinic may prescribe and dispense methadone for the treatment of opioid addiction.
So then it is not possible for just any doctor to prescribe methadone?
Here is where things get a bit strange. Actually, any doctor who can prescribe schedule II opioids, such as Vicodin and Percocet, can also prescribe methadone. The way that they are allowed to prescribe methadone treatment is to prescribe methadone for the treatment of pain. They are not allowed to prescribe it as part of an opioid treatment program outside of a methadone clinic, but they can write up to a full month of medication to a patient as long as they document that the prescription is for the treatment of pain. Contrast this with the methadone maintenance program clinic where patients must come in every day to get their single daily dose.
How well does methadone work for opioid use disorder?
You may think that Suboxone works better for the treatment of opiate dependence. It is safer and more accessible for patients. Yet, methadone is known to have a higher success rate. Officially, the success rate is 75% compared to 50% for Suboxone. Both medications have their place in the world of medication-assisted treatment (MAT). It is important that we stop fighting the use of these highly successful treatments and work harder to establish programs and protocols to make certain that patients get the best possible treatment.