For Many Heroin Addicts, Methadone is the Answer!

For Many Heroin Addicts, Methadone is the Answer!
Posted by FoM on January 26, 1999 at 06:11:56 PT

The emergence of Methadone as a treatment for heroin addiction 30 years ago sparked a debate that has endured and intensified to this day. 
A Dose of Reality! For many Heroin Addicts, Methadone is the only path to 'normal' life! Last July, Mayor Giuliani announced that he planned to abolish methadone programs in the city. Then, 10 days ago — a month after a National Institutes of Health consensus panel published a report recommending expanding methadone programs — he flip-flopped on the issue. "How about we make a deal?" he asked. "Instead of doing away with methadone completely, suppose we reverse the percentages. Suppose that instead of 63% of the slots used for keeping people chemically dependent, 63% of the slots will be used toward moving people to drug freedom."  A nurse prepares medication at Metropolitan Hospital Center.  But addiction is not just a drug issue. It is also a political, social, psychological, philosophical and spiritual issue. And, while the use of methadone certainly has an important medical component, that is just the tip of the iceberg for most addicts. If, for example, methadone patients are unable to work, it is probably not because of the methadone itself but because of lack of skills or psychiatric disorders that can accompany addiction. "If I had the world's best pill to wipe away drug abuse, that drug addict would still be left with serious problems that are going to be triggers for readdiction unless something is done about them," says Dr. Tom McLellan, a professor of psychiatry at the University of Pennsylvania and head of the methadone program at the Philadelphia Veterans Administration. "You don't walk around unemployed with a serious medical problem and serious psychiatric problems drug-free for long." Addiction and the BrainHeroin and other opiates work by attaching to the receptors in the brain which are normally occupied by endorphins — naturally occurring narcotics that are responsible (along with other neurotransmitters such as dopamine) for giving us feelings of pleasure when we do things like eat and socialize. There is a working theory that people may become addicted to opiates because there is some dysfunction in their endorphin system. In that case, the illicit narcotics make them feel "normal." The problem is that heroin and other short-acting opiates tend to further disrupt the brain's delicate balance. The addict ends up overusing the substance in hopes of regaining that original good feeling — a physical impossibility because the brain is no longer structured to provide it.  A patient gets his methadone.  Methadone works by attaching itself to the same receptor as heroin does, but it does not produce euphoria. While heroin's effect is very short-lived, methadone lasts much longer (up to 24 hours) and so manages to eliminate the cravings for heroin along with the extreme mood swings that accompany its use. Further, the drug appears to have no long-term adverse side effects. "Hundreds and hundreds of studies are uniform in their conclusions," says McLellan. "Methadone does not affect your metabolism. It does not get into your bones. It does not produce lasting problems." Dr. Edwin Salsitz, who runs the Medical Maintenance project (a U.S. Food and Drug Administration methadone research protocol) at Beth Israel Medical Center, is also emphatic: "We believe that methadone is medication for opiate addiction — that some people need exogynous opiates [narcotics from outside the body] to feel normal." All of Salsitz' patients are middle or upper middle class and all pay for their own treatment. Their average family income is $75,000 a year. Their average length of time on methadone is 20 to 25 years. Only one among the group is HIV-positive. "I'd be dead without this," says one patient. "I know this because most of the people I was shooting up with are dead." "Jake," 48, is similarly grateful. He used heroin for two years in his late teens and has been on methadone for 28 years. "I run a multi-million-dollar business, on my own," he says. "I'm a good husband and a good father. I don't want to take the chance of going back to heroin. Methadone has been good to me."  Dr. Edwin Salsitz is a vigorous advocate of methadone treatment.  During the course of a weekday morning that begins at 7:30 because patients are all on their way to work, Salsitz also sees "Susan," 48, an executive who used heroin for two years in her late teens and who has been on methadone for 29 years; "George," a 70-year-old jazz musician who used heroin for 20 years and has been taking methadone for 32 years, and "David," 47, a working man with a wife and a teenage son who has been on methadone for 24 years (his heroin habit lasted eight years). All of them have managed to do much more with their lives than just stay off heroin. But even Salsitz, a vociferous advocate of methadone, will tell you that this particular group is not representative. For the most part, his patients had family support when they needed it, they were educated and they had some prospects once they stopped using. Salsitz says that they used heroin to compensate for a deficient endorphin system. "It really looks like a medical problem," he says. But there are many other factors beside biochemistry that make a person vulnerable to addiction — availability of the substance, poor education, low skill levels, poverty. If an individual begins using heroin at age 14, as is increasingly common, he or she probably has social and educational deficiencies along with emotional and developmental problems, says Kevin McEneaney, executive vice president of Phoenix House Foundation, the largest network of private treatment centers in the country. Methadone cannot do anything about those problems — nor can it do much for the person who is cross-addicted to other substances. "The typical methadone patient needs counseling, support services of some kind," says Dr. Alan Leshner, director of the National Institute on Drug Addiction. Adds Dr. Herbert Kleber, executive vice president and medical director of the National Center for Addiction and Substance Abuse at Columbia University: "Methadone is a medication. It's not a treatment. Treatment is giving methadone in the context of a psychosocial program. There are far too many programs which dispense methadone without adequate intervention." Methadone did not work for Reinaldo, a 55-year-old father of five and grandfather of eight who used heroin. In the mid-90s, he spent two years in a methadone maintenance program with no support services on Spring and Lafayette Sts, and used heroin the entire time. Sometimes he sold his extra bottle of methadone (given out on Saturday for consumption on Sunday, when the clinic was closed) so he could buy a bag of dope and a pack of cigarettes.  Recovering addict Reinaldo at a counseling session  Today, Reinaldo has been heroin-free for five months without the help of methadone. He is now in the Cumberland Diagnostic and Treatment Center, a city-run facility in Fort Greene. Cumberland operates under the assumption that pursuit of the high has eclipsed all other facets of the addict's life — that children, relationships, support networks, home, health and self-respect all will vanish if, in fact, they ever existed. "We take a disease-oriented approach," says Phillip Hogan, Cumberland's acupuncture coordinator (all patients receive acupuncture for 21 days at the beginning of the program). "We look at the person's emotions, a person's thinking, we look at a person's behavior. All three of those domains have been affected by the addiction." Treatment then involves an attempt to reclaim these aspects of the patient's life. Reinaldo's day now includes several hours of "classes" or groups on such topics as relapse prevention, stress management, AIDS education and vocational testing. "They teach you almost everything here," says Reinaldo, who is also reconciling with his children. "When they were kids, they were ashamed of me," he says. "They saw me on the street using drugs." A Twin-Track ApproachThere may be an increasing recognition that drug treatment programs do not have to be an either/or proposition. In August, the New York City Health and Hospitals Corporation began converting its five methadone-maintenance programs (serving 2,100 addicts and representing 6% of all methadone slots in the city) into methadone-to-abstinence programs buttressed by "enhanced" programs. Patients like "McCoy," 32, a recovering heroin addict, continued to receive methadone but, it was hoped, group programs and vocational counseling would help him and others like him to eventually move off methadone completely. That experiment seems to have failed — in five months, only 21 addicts managed to come off methadone and five of those went back to heroin. Since addiction is a disease of isolation — medically as well as socially— the ultimate question becomes: Is effective treatment one that produces clean urine or one that touches other aspects of a person's life as well? Overall, says Dr. Michael Smith, head of the recovery center at Lincoln Hospital in the South Bronx: "There are bio-psycho-social issues, but then you need to add something that has to do with someone's whole definition of their purpose and their whole reaction to life. These drugs [heroin, etc.] affect your relationship to other people and to yourself. It goes right to the heart of humanity." Program Costs Treating an addict with methadone alone costs approximately $13 a day. Researchers at Yale University recently did a comparison of two methadone programs incorporating different levels of adjunctive psychosocial services. "Enhanced methadone" (methadone plus one weekly coping-skill session) cost $18 per patient per day. The other, "Day treatment program" (methadone plus five hours of additional treatment a day), cost $55 per patient per day. The outcome: no significant difference in terms of reducing illicit drug use. "Our findings, in conjunction with findings from other studies we cite, suggest that a 'medium' level of ancillary services is probably the most cost-effective for the average patient," says Dr. Kelly Avants, the study's lead author. Other Treatments to Combat Heroin Although methadone remains the most prescribed drug in the treatment of heroin addiction, there are two other alternatives out there, with a third likely to join the ranks later this year. LAAM (which stands for levomethadyl acetate hydrochloride), minimizes withdrawal symptoms and craving for heroin by blocking the same brain receptors as methadone, but is longer-lasting so it only needs to be taken about three times a week. The downside is that LAAM requires more time to take effect. Naltrexone blocks the effect of opiates, but rather than eliminating withdrawal symptoms, it might actually exacerbate them — patients need to be detoxed from heroin before starting. As a result, the drugs tend to work primarily with "people who are motivated to stay off drugs for one reason or another," says Frank Vocci, director of the medications development division at the National Institue on Drug Abuse. Buprenorphine, which is not yet approved, stands somewhere between methadone and naltrexone, alleviating withdrawal symptoms in mild to moderately dependent individuals. Acupuncture is an increasingly popular nondrug therapy, which tends to calm the patient initially, making followup treatments more effective. Resources Phoenix House's referral line provides information on Phoenix House and other drug treatment programs around the country.1-800-DRUG-HELP The National Clearinghouse for Alcohol and Drug Information 1-800-729-6686 National Institute on Drug Abuse (NIDA) Infofax 1-888-NIH-NIDA White House Drug Office  Substance Abuse and Mental Health Services Administration 
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Comment #1 posted by Tammy on July 14, 2001 at 16:23:48 PT:
Hi,I was addicted to heroin for awhile and I went to Narconon. I learned that I was doing drugs because I wanted to go numb and not deal with my problems. I almost went on Methadone but after seeing the withdrawls from that I am very thankful that I didn't touch the stuff. My friend couldn't sleep coming off that stuff for 17 days because it DOES get into your bones and it hurts your body in many ways. Before going on methadone please consider going to Narconon, it is a great place. Good luck everyone. If you do chose to use methadone I totally understand why but please think about it hard and don't let anyone pursuade you.Tammy
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