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.
When dispensed on a daily basis from regulated, government certified methadone clinics, methadone is safe and effective for treating opiate addiction, including heroin and fentanyl addiction. In fact, methadone has a 75% success rate, which is excellent when it comes to medication-assisted treatment of opioid use disorder.
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 clean and 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 resulted in people overdosing on heroin and fentanyl on the streets because they were determined to get clean without resorting to going to a methadone maintenance treatment program.
So, to answer the question, methadone maintenance is not bad at all. For many people, it is life-saving. While abstinence-based treatments for opiate addiction have a very low success rate, methadone maintenance has a very high rate of success. 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.
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 be aware that they are not the only solution and often not the best solution, but there are circumstances where I might recommend a 12-step program to an individual. 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 typically recommend specific addiction treatment programs in my blog articles. However, you may want to start at the SAMHSA official website to use their treatment locator feature. SAMHSA is the Substance Abuse and Mental Health Services Administration, an agency within the US Department of Health and Human Services. If you look on their website, there is a menu item that says “Find Treatment.” That is a good place to start.
What service do you provide in your medical 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.
Additionally, I provide motivational and coaching services as well as consulting in the area of life improvement as an important component of the recovery process. 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 where inconceivable before giving up drugs or alcohol.
When it comes to medication-assisted treatment for opioid addiction, I provide treatment with buprenorphine-based medications, including Suboxone, Subutex, ZubSolv, Bunavail, and naltrexone, as well coordination with world-class therapists. For alcohol addiction, I provide medical treatment with naltrexone, including The Sinclair Method, a highly successful treatment protocol for treating alcohol use disorder.
For more information about my medical practice and telemedicine/telehealth services and how to become a patient, please contact me with the contact form on this website. Thank you for your time and attention in reading this article. If you find it helpful, please share it on social media or on your website.