As a member of NADAAC since November 2000, I feel there needs to be more discussion in our profession concerning Opioid Agonist Treatment. There is a lot going on in this field right now. For example, federal rules have been passed and accreditation will now be required for a program to operate. This is a giant step in recognizing the treatment for what it is, a viable medical option for those seeking treatment for opiate addiction.

Methadone Maintenance Treatment (MMT) is the most misunderstood medical treatment in existence today. It has survived scrutiny for 35 years and has continuously shown positive results. However, there are still those who are against the treatment. In their opinion, methadone is no different from illicit drugs so using it does not qualify as "abstinence." I think we need to clear up the fact that methadone is not a drug, in the illicit sense, but a medication that is prescribed by a doctor. There is a big difference between the two. Since this is true, a person can be abstinent from drugs while still taking their medication, no matter if it is methadone for addiction, or lithium for bipolar disorder. It has been proven time and again that most chronic opioid addicts will need to be maintained on an agonist drug for long periods of time, many for life.

Methadone is corrective medicine for a biological disorder, and not a cure. Some people are of the opinion that everyone should be able to get off methadone after a certain amount of time. Saying, “their brain should have fixed itself by now, it’s been (fill in the blank) years.” Should we apply the same rationale to people who take Prozac for depression? I know that we are talking about different chemical functions, and we have seen some brain functions able to regenerate. However, everyone is different and you just cannot set an arbitrary time limit for patients on MMT unless you want to achieve certain failure. The research clearly shows that the longer a patient stays in maintenance treatment the better the chance for success. Too many people are set up for relapse by being pressured into prematurely coming off of methadone.

What is the real issue here? Why are people so dead set against MMT even in the face of 35 years of research showing uniform positive results? There is some research out there that shows negative results such as continued drug use during treatment. However, it has been suggested that research with negative results has come from programs that provide inadequate treatment, such as dose caps — “Everyone gets 40 mg.” This is not good medicine in any field, and yet these results are the ones the naysayers hold on to. Another example follows, “some patients abuse cocaine and other drugs while in MMT.” For some this is reason enough to not support the treatment. To me this says that another issue needs to be addressed (illicit drug use), not that the patient or the methadone failed. Then there are those that hold the opinion that since they are still taking a drug (methadone) they have not reached true recovery. (Never mind all of the other accomplishments that have been made.) Stable patients find themselves caring about things that they have not cared about in a long time. They are working, going back to school, raising their children, paying their bills, and everything else a “normal” person does in society. Isn’t that recovery?

This is more than a personal opinion. Methadone treatment is recognized by the American Medical Association as having proven public health and patient health benefits (American Medical Association Scientific Affairs Committee, AMA Assembly 1999). This 1999 declaration followed a report from the Institute of Medicine in 1995 and the conclusions of a 1997 National Institutes of Health Consensus Development Panel. Both of these panels recommended that opiate addiction be treated more like other medical conditions. The Institutes of Medicine stated that of all the forms of drug treatment, methadone maintenance has been the most rigorously studied modality and has yielded uniform positive results. As a result of methadone use, crime is reduced, fewer individuals become HIV positive, and individual functioning is improved. “We strongly recommend that legislators and regulators recognize that providing methadone maintenance treatment is both cost-effective and compassionate and that it constitutes a health benefit that should be a component of public and private health care” (National Institutes of Health, Consensus Statement, Nov. 1997).

Methadone patients do not get high from their medication. Motor skills are not affected in a stabilized patient. When taken as prescribed, long-term administration of methadone causes no adverse effects to the heart, lungs, liver, kidneys, blood, bones, brain, or other vital body organs. Minor side effects that subside or disappear with the stabilization of the patient include: constipation, water retention, drowsiness, skin rash, excessive sweating, and reported changes in sexual libido. The ongoing research by Dr. Mary Jeanne Kreek of Rockefeller University has demonstrated the unequivocal medical safety of long-term methadone treatment.

Tolerance and withdrawal alone do not make up addiction, yet methadone is often described by some in the field as trading one addiction for another. Methadone does cause a physical dependence, but the dependence is more like a chronic pain patient’s dependence to their pain medication, than the addiction to heroin. Behaviors that in part define addiction are non-existent in a stabilized methadone patient recovering from opioid addiction. When prescribed adequate doses, patients are indistinguishable from people who have never used heroin or methadone.

I was talking to a man one day and he commented that, “people on methadone need it because they could not deal with the spirituality that 12-step groups require.” I could not believe my ears. This was a “professional” from the field saying this to a spiritual God-fearing Christian who found no particular benefit from NA and the 12 steps it offers. For some people 12-step groups are not the answer. We see this everyday. People in 12-step groups relapse and it is blamed on their unwillingness to let the program work. I would not want to be the person to have to tell a child that their father/mother passed away because they “were just not ready to let the program work for them,” knowing that another option existed. I see it in a completely different way. There is no one treatment that works for everyone. I am not putting down 12-step groups. If something works for someone then they should do it. However, that should go both ways. We do not have a magic cure for anything; if we did no one would be sick at all. What we do have is a medical treatment that works for people who are dependent on opiates. Research published in “Substance Abuse: The Nation’s Number One Health Problem,” showed that after one year in treatment heroin use was reduced by approximately 70 percent.

Patients receiving Methadone Mainten-ance Treatment see the quality of their lives improve dramatically. It should make no difference that we have to take medicine everyday. Many chronic diseases and conditions are treated with a daily medication: diabetes, clinical depression, menopause, erectile dysfunction, heart disease, the list goes on and on. Methadone Maintenance Treatment works and it facilitates recovery.

By the way, I know firsthand that this treatment works. One year after enrolling in methadone treatment I started college — 13 years after dropping out of High School. In May 2001, I graduated Magna Cum Laude with my Associate’s degree in Social Science. I plan on getting my Master’s and more than likely I will still be taking this wonderful medication when I walk down the aisle for that third diploma. I am okay with this and everyone else should be as well.

Jay Clarke, is Director of Virginia Alliance of Methadone Advocates, Inc. Visit http://vamethadvocates.org. For more information. He can be reached via e-mail at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

This article is published in Counselor, The Magazine for Addiction Professionals, June 2003, v.4, n.3, pp. 68-69.

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