What is methadone maintenance therapy?
In the 1960s, Dr. Vincent Dole and his wife, Dr. Marie Nyswander, developed the original methadone maintenance program in New York City. At the time, heroin use was rampant and out of control.
Methadone is a potent opioid drug with a long half-life. It is an effective painkiller for severe pain, but its use as an analgesic is limited because of the risk of respiratory depression and overdose.
Methadone itself is older than the clinics. It was first made in Germany in the late 1930s as a painkiller, reached this country after the war as Dolophine, and is still prescribed for chronic pain today.
When dispensed under supervision from regulated, government certified methadone clinics, methadone is safe and effective for treating opiate addiction, including heroin and fentanyl addiction. In fact, it remains one of the most effective forms of medication-assisted treatment of opioid use disorder, and it has held that place for more than half a century.
Many years later, when Dr. Dole was confronted about the use of methadone being a crutch, he responded by saying that using a crutch is not necessarily a bad thing. A crutch is a piece of medical equipment with that, when used correctly, allows a person, with a broken leg for example, to function and heal.
Is methadone maintenance a bad way to treat opioid addiction?
Regardless of the ongoing safe use of methadone by methadone maintenance programs all over the United States, the drug still carries with it a significant stigma. If you were to stop 100 people on the street and ask for their opinions of methadone maintenance therapy, you would very likely get a majority of these people responding that methadone maintenance is not a good thing. It simply has a bad reputation with the public and with healthcare professionals, even those in the rehab industry.
Why do most people think that methadone maintenance treatment is bad? Why do they say that it is simply trading one addiction for another?
To better understand public opinion on the subject of methadone, it helps to look at the history of Alcoholics Anonymous and its influence on addiction treatment in the US. Alcoholics Anonymous, or AA, was founded in 1935 by Bill Wilson.
In 1939, an influential woman named Marty Mann discovered the program and became sober in 1940. Ms. Mann then worked closely with Mr. Wilson to spread the word about the effectiveness of AA in helping alcoholics to get sober.
Over the years, the philosophy of AA became entrenched in the addiction treatment industry, court system and American society in general. People came to accept that the twelve steps of AA were the best, and possibly only, way to get sober.
In 1953, the Narcotics Anonymous program was founded, based on the AA program. In the 1980s, NA took off and became the best-known alternative twelve-step program for people struggling with addiction to drugs other than alcohol. NA has had an official position against the use of what they refer to as “replacement drugs.”
12-Step leaders made a decision to make it an official policy to disapprove of medication-assisted treatment of addiction.
In 1996, they came out with a pamphlet titled, Bulletin #29, which established NA’s official position against methadone. In recent years, they have come out with literature that re-establishes their abstinence-only position and an official position against the use of any medication to treat addiction.
In a 2016 pamphlet with the title, Narcotics Anonymous and Persons Receiving Medication-Assisted Treatment, NA World Services, Inc. States, “By definition, medically assisted therapy indicates that medication is being given to people to treat addiction. In NA, addiction is treated by abstinence and through application of the spiritual principles contained in the Twelve Steps of Narcotics Anonymous.”
We can conclude from this statement that NA is not only against the opioid medications methadone and buprenorphine, but also the non-opioid drug, naltrexone, when used for addiction treatment. Interestingly, this position against these drugs only applies to addiction treatment. If an NA member takes any of these three drugs for chronic pain or any other medical use, there is no issue at all.
While AA does not have an official anti-medication-assisted treatment position, many AA members are also against the use of medical therapy to treat addiction. So, why did Bill Wilson start a program that was at odds with medical treatment of addiction, especially since he was one of the earliest proponents of the idea that addiction is a disease?
Bill W., the founder of Alcoholics Anonymous, was not against medication-assisted treatment.
You might be surprised to learn that Bill Wilson was not at all against medication-assisted treatment. There is an account that Mr. Wilson met with Dr. Dole to discuss the success of methadone maintenance therapy. He was so impressed that he asked if there might be a medication that would help alcoholics to overcome cravings and sickness, so they could focus better on their recovery program.
There are also reports that Mr. Wilson was interested in the possible use of psychedelic drugs to treat alcoholism and addiction. In the 1960s, psychedelics were in widespread use, being recommended to the public by prominent Harvard psychologists. While psychedelic drugs went into disfavor for many decades afterwards, there is now a resurgence of interest and research into their possible usefulness in treating addiction and other mental health issues.
Still, even though Bill Wilson may have been forward thinking in his ideas about medication-assisted treatment, the evolution of his 12-step fellowship program has resulted in resistance of much of the addiction treatment industry to the use of medications to treat addiction. While methadone is used safely and effectively by hundreds of thousands of people around the world to treat opioid addiction, in the US, there is still a significant stigma against methadone maintenance programs. Unfortunately, this has led people to overdose on heroin and fentanyl because they were determined to quit without going to a methadone program.
If someone may be overdosing, call 911 right away.
So, to answer the question, methadone maintenance is not bad at all. For many people, it is life-saving. Methadone maintenance is one of the best-studied treatments for opioid addiction, and it works for a great many people who could not stay off of heroin or fentanyl by abstinence alone. It is a medical therapy that works very well in protecting patients from death and illness while allowing them to function without cravings or withdrawal sickness.
I am looking for methadone maintenance near me. Why don’t you prescribe methadone?
In my medical practice, I prescribe buprenorphine, usually in the form of Suboxone, and naltrexone to treat addiction. Naltrexone can be used to treat opioid use disorder and alcohol use disorder.
So, if I am able to prescribe two out of the three US-approved drugs for medication-assisted treatment, or MAT, why not the third, methadone? Why not provide all available therapies to help patients quit dangerous street opiates and opioids, such as heroin and fentanyl?
Methadone maintenance may only be provided in specialized clinics. While methadone can be dispensed safely using strict protocols, it is a highly dangerous opioid drug that can be deadly when misused.
Because my medical practice is a small, concierge medical practice without methadone maintenance program certification, I am unable to provided methadone maintenance treatment. So, why do I write about methadone on my website and in my blog articles? The reason for writing about it is for completeness, to be thorough in covering all options when it comes to addiction treatment, especially for opioid use disorder.
Here is where things get a bit strange. Any doctor with a DEA registration for Schedule II drugs may prescribe methadone for pain. Yet, when the diagnosis is opioid use disorder, federal rules confine methadone, with narrow exceptions, to certified opioid treatment programs, the formal name for methadone clinics.
So, the same tablet is legal for one diagnosis and off limits for the other. A doctor in private practice may write methadone for pain and may not write it for addiction. Calling addiction by another name on the chart is not the answer. It would be dishonest, and it would strip away the supervision that makes methadone treatment safe.
The FDA label for methadone carries boxed warnings for life-threatening respiratory depression and for QT prolongation, a dangerous heart rhythm disturbance. A medicine with that label belongs in a program built to watch it closely.
A methadone program does one thing better than I can, and it matters more in the fentanyl era. A person can walk in the same day as their last dose and start methadone without waiting. Buprenorphine started too soon after a full opioid can set off precipitated withdrawal, a sudden and severe sickness, so the traditional approach has been to wait until withdrawal is well under way.
Fortunately, that wait is no longer the only way in. When fentanyl is involved, I can use a low-dose initiation when it is needed, building up from very small doses over several days, so there is no long gap and much less risk of a bad start. Methadone still has the simpler first day. Buprenorphine can be started at home, by telemedicine, with the doctor a phone call away.
Read more: What Are The Differences Between Methadone and Buprenorphine?
Why advertise services that you do not provide?
While this website does, to an extent, advertise my private medical practice, it serves as more than simply an advertisement for my small clinic and the services that I provide. The greater purpose of this website is to educate and inform visitors of many options that are available for the treatment of addiction.
After reading this article, you may believe that I am against 12-step programs, such as AA and NA. However, I am not at all against these programs. I do believe that people should know these programs are not the only solution and often not the best one. I no longer recommend group meetings as part of medical care, but patients who choose to attend them are respected, and the choice is theirs. I have covered this topic in this blog and on my podcast as well.
My goal is to offer information on a wide variety of services and medical treatment options for various types of addiction, regardless of the availability of these services in my own limited medical practice. So, while you may find information about methadone maintenance here and elsewhere in the pages and posts of this website, I have chosen not to be involved in providing methadone maintenance.
Can you recommend a methadone maintenance program near me?
I do not recommend specific programs in my articles, but the federal locator at FindTreatment.gov, run by the Substance Abuse and Mental Health Services Administration (SAMHSA), lists certified methadone programs near you.
How do I treat opioid addiction in my practice?
My clinic is a small, private medical practice, known as a micropractice, or an ideal clinic. It is a practice model that allows for the best possible communication between patient and doctor and provides an atmosphere of mutual respect.
I also coach my patients as part of their medical care, because recovery is about more than the medication. Often, when patients put aside drugs and alcohol, they do not realize their true potential in living a life of happiness and fulfillment. By providing inspiration and insight, I am able to help patients to find their way on a path to success and achievement in areas that were inconceivable before giving up drugs or alcohol.
For opioid use disorder, I prescribe buprenorphine-based medications, including Suboxone, ZubSolv and the buprenorphine-only tablet formerly sold as Subutex, and naltrexone, by telemedicine for patients in Florida.
To learn more about telemedicine treatment in Florida and how to become a patient, contact the office today.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
