For more than a decade, I’ve been caring for patients who struggle with opioid addiction and have seen firsthand the devastating toll it takes on their lives. For many, medications for addiction treatment, including methadone, have given them their lives back. Yet, I see time and again the demonization of methadone as a treatment option for opioid addiction. In fact, a proposed bill in West Virginia aims to eliminate standalone Opioid Treatment Programs (OTPs), or methadone clinics—a vital service for many who depend on this lifesaving medication.
Targeting methadone in this way simply continues the stigma around addiction and treatment medications and threatens the lives of those who struggle with opioid use disorder. Research shows a 59% reduction in opioid overdose death rates for those prescribed methadone maintenance as compared to patients without it. In the midst of an ongoing overdose epidemic, mainly driven by opioids such as fentanyl, this is simply irresponsible.
Closing OTPs, which provide medication for opioid use disorder (MOUD), including methadone, would be catastrophic for patients, the community, and local governments. We would once again see an increase in opioid overdose deaths, in addition to a rise in neighborhood crime, an exponential escalation in the transmission of viral infections (e.g., hepatitis C and HIV), and other disastrous consequences for the community.
It’s time to recognize the vital role that methadone plays in the lives of those in recovery from opioid addiction. We need to stop stigmatizing methadone, as well as those who need it, if we ever want to truly get a handle on our nation’s opioid crisis.
Methadone: Misunderstood and Misrepresented
Methadone and other medications for addiction treatment are often dismissed by their opponents as trading one addiction for another—a harmful notion that effectively punishes those who struggle with addiction and seeks to promote a rigid abstinence-only approach to addiction recovery. Senator Eric Tarr, who introduced the West Virginia opioid treatment bill, went so far as to call methadone clinics “just another form of drug dealing.”
A lot of the pushback against addiction treatment medications seems to stem from the false belief that addiction is the result of a moral shortcoming. And since methadone maintenance represents the most aggressive treatment available for OUD, its prescription is considered not only unnecessary but a contributor to further “immoral behavior”.
When we understand that opioid use disorder is not a moral failing but a chronic disease, we can see more clearly that methadone and other medications are vital, lifesaving interventions. Yes, methadone, like many medications, has side effects (including sedation, constipation, and sweating) and a potential for misuse/diversion. However, we don’t withhold other lifesaving medications, such as cancer drugs, from patients due to their potential side effects because the benefits outweigh the risks. Why do we do it for methadone when it has been shown in a plethora of studies to be critical in prolonging the life of individuals with opioid use disorder?
The Real Truth About Methadone
As a long-acting synthetic opioid agonist, methadone works by suppressing opioid withdrawal, reducing opioid cravings, and blocking the euphoric high associated with other opioids like heroin, fentanyl, and prescription painkillers. Thus, methadone may be used for both acute detox and as a maintenance medication for long-term opioid use disorder treatment, always used in tandem with therapy and counseling.
For individuals who have become dependent on opioids—meaning the brain has become so accustomed to having opioids in the system that it cannot function normally without them—the withdrawal process can be incredibly uncomfortable, even intolerable. Methadone can be started at the earliest signs of withdrawal without fear of increasing withdrawal symptoms and is, therefore, the best available medication to eliminate opioid withdrawal symptoms because the effects are immediate and significant.
Critics often harp on the medication’s potential for misuse. However, it’s important to note that this is why methadone is under strict federal regulation. Rigid rules around methadone distribution—which include witnessed dosing at the clinic—obviates diversion of the medication.
Additionally, patients are only trusted to take methadone doses home after months of individual and group counseling attendance, daily witnessed dosing, a complete absence of aberrant behavior, no irregular urine drug tests, and successful callbacks, which require patients to return to the clinic 4 hours after dosing to screen for both adequacy of dose and assess for any overmedicating or misuse.
The Case for Methadone
At AdCare Rhode Island, follow-up calls to our patients who have started methadone maintenance at the facility confirm a marked decrease in illicit opioid use with subsequent enrollment in a clinic. Less illicit opioid use results in fewer opioid overdoses and deaths.
Additionally, our patients who continue methadone maintenance and are compliant with treatment often experience significant behavior changes. We see them move from prioritizing compulsive opioid seeking above all else to acting as productive members of their households, families, and society.
While methadone maintenance may not be the right treatment approach for all patients, it has been shown to produce better outcomes for certain individuals, including those who have been using opioids intravenously, have used opioids for a long time, have medical complications as a result of opioid use, participate in polysubstance use, have experienced multiple overdoses, or who have severe mental health issues.
In the face of an opioid crisis that continues to claim thousands of lives each year, we cannot afford to ignore effective treatment options. Instead of reducing access to methadone treatment for opioid use disorder, we should be expanding access to it, which would most certainly help mitigate the overdose crisis.
Methadone offers hope, not harm, to many of those struggling with addiction, and it plays a pivotal role in addressing the opioid crisis. It’s time to stop the misinformation, fear-mongering, and stigma. People’s lives depend on it.
Dr. Michael Coburn, MD, is the Medical Director of AdCare Rhode Island, an American Addiction Centers facility.
