Post image for Series: 10 Things You Should Know About Methadone (Number 10)

Series: 10 Things You Should Know About Methadone (Number 10)

by recoveryhelpdesk on May 14, 2010 · 17 comments

1.  Methadone is a medication used to treat opiate dependence

2.  Methadone prevents withdrawal, limits cravings and blocks the effects of heroin, oxycontin and other opiates

3.  Opiate dependent people who are in treatment with methadone live longer

4.  Long term treatment with methadone is better than short term treatment with methadone

5.  A low methadone dose is not necessarily the best methadone dose

6.  Methadone is the gold standard treatment for pregnant women who are opiate dependent

7.  Methadone has drug overdose risks and benefits that you should understand

8.  Methadone treatment requires a strong commitment to recovery

9.  Methadone-assisted recovery is real recovery

10. Methadone treatment is the single most effective treatment for opiate dependence

Top experts at the US Department of Health and Human Services, Center for Disease Control state that, “methadone maintenance treatment is the most effective treatment for opiate addiction.”

Find a link to the CDC Methadone Fact Sheet here:  methadone

Methadone treatment is an evidence-based treatment.  It is not based on a theory or a philosophy.  It is based on medical research.

Scientists and other experts have extensively studied methadone treatment for decades.  Methadone has a long and well documented track record of success.

Let’s consider the range of available treatments for opiate dependence, and see how methadone stacks up.

No treatment

Many people who use heroin or other opiates are able to stop using and build a stable recovery without any treatment at all.  On the other end of the spectrum, many others have tried their best dozens of times to stop using without success, even with treatment.

Most of the time, the difference isn’t about how hard they tried, how much they wanted it, or anything to do with willpower.

Instead, it’s about how long the person has used, how much they have used, whether they have a genetic predisposition for addiction, whether opiate use has changed their brain chemistry, or whether they also have mental health challenges.  It’s fair to say that those who have tried repeatedly to stop using without success have a complex addiction.

Methadone treatment is not appropriate for people who are able to stop using on their own without any treatment.  But methadone has helped many of those on the other end of the spectrum who are living with a complex addiction succeed in recovery when nothing else worked.

Self-help groups

Self-help groups, including 12-step groups like AA and NA, are a useful recovery support tool for many people.  However, self-help group participation alone is usually not enough to result in long term recovery for people with complex addiction to opiates.

Methadone treatment is not appropriate for people who are able to sustain recovery through self-help groups alone.  But methadone is appropriate for people who are not able to sustain recovery through self-help groups alone.

Methadone treatment is much more successful than self-help groups in creating the conditions for long term recovery among people with complex addiction to opiates.  Participation in a self-help group without more is unlikely to be an effective recovery plan for a person with a complex addiction to opiates.

Some people choose to use self-help groups as a recovery support while participating in methadone treatment.

Detox

Detoxification or detox is simply the process of stopping opiate use and allowing the body to readjust to functioning without taking opiates.

Detox can be done at home, through an outpatient detox program or through a residential detox program.  Detox can be done quickly by a sudden termination of opiate use, or more slowly via a gradual reduction in doses over a period of days, weeks or months.  Detox can be done “cold turkey” or with a variety of supports including use of medications like clonadine, methadone or buprenorphine.  It can even be done under anesthesia such as in so-called “rapid detox” programs (these so-called rapid detox programs are potentially fatal and are not recommended).

Detox is a necessary first step for those who are seeking recovery for those who are not participating in medication-assisted treatment with methadone or buprenorphine (Suboxone/Subutex).  But detox alone is not effective in producing a long term recovery from opiate dependence, especially among people with complex addiction.  I would compare it to one-time fasting as a way to create long term weight loss.

It’s worth noting that the need to detox is a major barrier to recovery for many people.  It’s difficult for many people to voluntarily sign up for that kind of agony –especially since many have already been through detox multiple times and already realize that detox alone has not been enough for them to achieve lasting recovery in the past.

One of the benefits of methadone treatment is that detox is not required  because methadone prevents withdrawals.  Methadone also limits the cravings that follow detoxification.  These are two of the reasons that methadone treatment program is much more likely to result in long term recovery than a detox program.

Another reason is that many people have experienced changes to their brain chemistry because of opiate use.  For these people, detox results in a brain that is deprived of what we all need to feel normal or happy.  In contrast, methadone helps the person in recovery maintain a healthy chemical balance in the brain and feel normal.

Outpatient counseling

Outpatient counseling is sufficient treatment to result in successful recovery from opiate dependence for some people.  Methadone treatment is not appropriate for people who are able to stop using with outpatient counseling alone.   But for people with a complex addiction to opiates, the combination of medication plus counseling is very powerful.  This is why most methadone maintenance programs include outpatient counseling as part of the treatment mix.

Outpatient counseling is very helpful in that it provides an opportunity for the counselor and person living with addiction to assess the addiction, address co-occurring or underlying conditions such as mental health conditions, address barriers to recovery, and create a realistic long-term recovery plan.  Outpatient counseling has the potential to be highly individualized and flexible.  And outpatient counseling can provide treatment and support over an extended period of time.

Done right, the counselor and counseling client form a therapeutic alliance that helps keep the client engaged in treatment, and helps the client build and sustain motivation for positive change.  This requires significant skill on the part of the counselor, and a good match between counselor and client.

Unfortunately, many counselors lack the skill to effectively engage clients, retain clients, build and sustain motivation, or support action toward positive change.

This is why the most common number of treatment sessions between and outpatient counselor and a person living with opiate dependence is zero (meaning the outpatient counseling program is not successful in attracting the person into treatment).  And the second most common number of treatment sessions is one (meaning the person was willing to try meeting with the counselor, but the counselor was not successful at engaging the client).  This is too bad, because these are opportunities lost.

Combining outpatient counseling with methadone maintenance significantly improves engagement, retention and treatment outcomes over counseling alone for people with complex addiction to opiates.  The addition of methadone maintenance improves the safety of the treatment both because people stay in treatment longer and because methadone limits relapse risk.  And the addition of methadone improves recovery sustainability because people tend to be more successful at achieving abstinence from harmful drugs and stay in treatment longer.

Outpatient counseling is less intrusive upon the life of a person living with opiate dependence than residential treatment.  In other words, there are fewer barriers to accessing outpatient counseling for most people than for accessing residential treatment.  For example, people can continue working and caring for their children when in outpatient counseling and this is often impossible if the person is in residential treatment.  This is an important benefit in terms of attracting and retaining clients in treatment.

Outpatient counseling is most effective in addressing complex addiction to opiates when it is combined with medication-assisted treatment with methadone.  Outpatient counseling plus medication is a realistic core treatment for a person with complex opiate addiction, and is often a solid foundation for a safe and sustainable long term recovery.

Residential Treatment

Residential treatment provides a useful interrupt for those experiencing chaotic drug use.  Residential treatment provides a safe place for a person to stay while they seek to stabilize.

Many people benefit from getting out of their usual environment for a while as they seek to initiate abstinence from harmful drugs.  Part of this is separating from harmful people and places, and the temptations they face in the community where drugs are plentiful and readily available.

Residential treatment can be a good place to detox from harmful drugs.  It can be a good place to begin taking medications that support recovery such as buprenorphine (Suboxone/Subutex) or methadone.  And it can be a time and a place for people to learn about treatment and recovery.

The combination of long term residential treatment plus methadone (or buprenorphine) is a very powerful combination that can be highly effective for people with a complex addiction to opiates –even those who have not been successful with outpatient methadone treatment or residential treatment alone.  Unfortunately, there are not many programs that combine these two elements.

Once a person leaves residential treatment, the person is at an increased risk for both relapse and fatal drug overdose.  Having a solid after care plan in place is critical because recovery success rates for people with complex addiction to opiates after short term residential treatment  alone is low.  Success after long-term residential treatment (meaning over 90 days and the longer the better) is better, but relapse is still common.

Success is improved if residential treatment was combined with medication-assisted treatment with methadone or buprenorphine.  But many residential treatment programs lack the capacity to provide medication-assisted treatment.  Many are not supportive of medication-assisted treatment on “philosophical” grounds, and therefore ignore the science of recovery to the detriment of their clients.

Many residential treatment programs have low treatment retention (lots of people leave treatment early or are discharged from treatment early).  Part of the reason is that residential treatment is very disruptive to people’s lives.  Many people are uncomfortable in the residential environment and miss the comforts of home.  Added to this is the fact that people who are newly in treatment are often detoxing, have little momentum in their recovery, and are experiencing powerful drug cravings.  Many programs lack skilled and professional staff, make no attempt to provide good customer service, and consider a confrontational approach to be somehow therapeutic.

Recovery success rates with short term residential treatment alone for people with complex opiate addiction are not good.  Short-term residential treatment is best viewed as a tool to be used for the benefits it does provide in the context of a broader recovery plan.

Success rates for long term residential treatment are better than for short term residential treatment, but not better than success rates for outpatient methadone maintenance treatment.

Sober houses/Halfway houses

Stable housing is an important part of stable recovery.  Sober houses or other halfway houses are a useful recovery support tool.  However, taking up residence in a sober house alone is usually not enough to result in long term recovery for people with complex addiction to opiates.

Success is more likely if the sober house is part of a larger plan that includes adequate treatment and other supports.

Most sober houses or halfway houses are primarily housing.  They usually offer no formal treatment.

The best include a core group of residents who are stable and have been in recovery for quite a while.

Those with a lot of turnover often are not safe places to live.  Most of the residents will be in early recovery, and some will not be in recovery at all (either they have no place else to go, or they are mandated to live in sober housing by the criminal justice system).  Some of those living in such houses are probably using or will relapse, and this can make it difficult for others to stay sober.

Many sober/halfway houses refuse to accept people in methadone treatment.  This is apparently a “philosophical” decision.  It is a counter-productive policy however, because it denies people in recovery access to housing options that may be helpful to them, and pushes away residents with a higher likelihood of stability in favor of residents with a higher likelihood of instability.

Opiate-dependent people in methadone treatment are generally more stable in their recovery than their peers who are not in medication-assisted treatment.  This is especially true for those in early recovery, and those with complex addiction.

Suboxone/Subutex (buprenorphine)

Buprenorphine (brand name Subutex, and brand name Suboxone when the formulation includes the drug nalaxone), is a medication used to treat opiate dependence.   Buprenorphine is methadone’s strongest competition in the contest for the title, “Single Most Effective Treatment for Opiate Dependence.”

Buprenorphine treatment shares many of the characteristics of methadone as a medication-assisted treatment for opiate dependence.  Their are two reasons that buprenorphine can’t quite take the Most Effective title away from methadone.

First, buprenorphine has a “ceiling effect.”  This means that at some point, taking a higher dose of buprenorphine will have little or no additional effect.  For some people, there is no effective dose of buprenorphine.  For these people, methadone offers a broader range of effective dosing options.  In this sense, methadone is a “stronger” medication.  Methadone is able to provide a therapeutic dose to a broader range of people with opiate dependence.

Second, buprenorphine is commonly prescribed by private doctors in office-based settings.  This means that the medication usually comes with little monitoring and few supports.  For an opiate-dependent person in early recovery, this can be challenging.  It takes a certain level of recovery stability for a buprenorphine patient to hold their own medication.  This is because buprenorphine has a street value, and can be sold for cash or traded for other drugs.

In contrast, methadone treatment for opiate dependence must be provided in a clinic-based setting.  And under federal law, the clinic must hold the medication for the patient and provide the medication at the clinic in daily doses.  It takes months for patients to earn the right to have limited take home doses under federal regulations.  This can create barriers to treatment and recovery.  But it also supports people in early recovery stabilize in recovery.

In combination, these two differences make methadone a more effective treatment for many people with complex addiction to opiates.

Conclusion

Much maligned and often misunderstood, methadone remains a wonderful gift.  A gift that has saved thousands of lives, held together families, and brought hope and success to many who felt hopeless and defeated by their addiction.

Methadone is not a magic bullet, and it is not an appropriate treatment for everyone.  But if you care about people with opiate dependence, I urge you to speak up and help others understand the value of this important path to recovery.

Get FREE Recovery Tips!
Get occasional emails from me with awesome recovery tips and info!

{ 12 comments… read them below or add one }

1 So-and-so May 17, 2010 at 1:40 pm

Julian Keeling, a therapist and a former drug counselor, was quoted as saying, ( http://stark-raving-sober.blogspot.com/2010/05/pill-that-can-replace-12-step-programs.html ) “It [a pill] doesn’t address underlying issues…and most people don’t tend to destroy their life with alcohol and drugs unless they’ve got some fairly pronounced emotional disturbances that they’re trying to escape from and medicate.”

2 recoveryhelpdesk May 17, 2010 at 9:19 pm

Methadone will not address any underlying mental health issues all by it self, but it will address opiate dependence which will allow the person much more freedom to take a look at any underlying issues.

As I said in the post, methadone plus counseling is a powerful combination. For someone with underlying mental health issues, mental health treatment in combination with treatment for addiction makes sense.

3 Debby May 29, 2010 at 11:51 pm

Tom, I’m going to read this lengthy article tomorrow when I have more time to read it carefully. In skimming through it, tonight, I have to say that I was one of THE most skeptical moms when my mom wanted to try methadone treatment. I swore it was a crutch. Suboxone didn’t work for my son. He found a way to “chip”. Much to my surprise, methadone has helped my son to quit using heroin altogether. Granted, it’s been six months and he’s beginning to taper town. I am in the “let’s wait and see” phase of hoping and praying he will come out of this clean– which his best friend did…who was addicted to meth and then started slamming heroin. I think there is no one-for-all method to help people who want to be clean. Every single person is so different, so I don’t judge. Bottom line, my son isn’t using illegal drugs and he is holding a job…best of all, he is the kid I knew. He’s smiling again and gaining weight.

4 recoveryhelpdesk May 30, 2010 at 10:46 pm

Debby, Thanks for stopping by and commenting.

I agree with you that there is no one for all method to support recovery.

My goal in talking about methadone is to help people understand the option enough to make an informed decision (not a decision based on myths, philosophical discomfort or lack of knowledge). In my work, I have seen first hand that methadone is one of our most powerful recovery tools for opiate dependence. I want people to understand methadone and how methadone fits into the big picture.

I consider your voice as a mother and your work at your blog howismyson.blogspot.com very important in showing others that methadone is an option worth considering. Thank you for your efforts.

5 delmar June 13, 2010 at 11:27 am

Though there are some myths surrounding methadone maintenence, there are also plenty of untruths used to support it.

Lets start with :
>>#10 Methadone treatment is the single most effective treatment for opiate dependence<> Long term treatment with methadone is better than short term treatment with methadone<<

is not true. Long term methadone maintenence creates an opiate habit so severe that it takes several years to detox and get past it's after effects – post-acute withdrawal syndrome.

Like most all the argumets used to promote methadone, your statements only make some sense when methadone maintenence is compared to active heroin addiction. Most addicts these days are hooked on hydrocodone and methadone is only going to make their habit worse. A detox using suboxone makes a lot more sense.

Your statement that there is no effective dose of suboxone for some addicts is true only because some addicts have gotten enormous habits taking methadone.

It seems as if you must be a methadone advocate or else maybe you've never experienced opiate addiction yourself. People like me, who have been through it, including getting off methadone and finding recovery, know the truth.

Methadone is another addictive drug. As maintenence, it can stablize you to where you can make it to work provided you find some way to avoid benzos, drinking, or cocaine which many, if not most, addicts on methadone use.

At the end of the day recovery from drug addiction comes when we find a way to stop using and start facing the issues we were avoiding by getting high. Taking away some of the negative consequences of addiction is what methadone maintenence does.

6 recoveryhelpdesk June 15, 2010 at 11:04 pm

Delmar, The statement that methadone treatment is the single most effective treatment for opiate dependence is not an opinion, it is a fact based on scientific research. As is the fact that long term methadone use is more effective than short term methadone use. This doesn’t mean that methadone maintenance is the best option for everyone in every situation.

For example, if someone is able to maintain abstinence without medication, that would be a better option. But the truth is that many people have not been successful at maintaining abstinence without medication, and for those people medication is often effective. That is their truth, and they know it as well as you know that your path to recovery is working for you.

For them, as you say, methadone takes away negative consequences of addiction. That is a wonderful thing.

I don’t consider myself an “advocate” for methadone. I do consider myself an advocate for people who are living with opiate addiction. And I do consider myself an advocate for research-based treatment. I’ve examined the research and observed hundreds of opiate dependent people benefit from methadone treatment.

There is an edge to your comment. You do not seem to be interested in evidence based practices. Instead you assert that you and “people like you” know the truth. You imply that your path to recovery is the only real or true path to recovery. You ignore or discount the experience of hundreds of thousands of people who have found safe and sustainable recovery through methadone treatment. You imply that reducing the negative consequences of addiction is a bad thing.

Many people who are in medication-assisted recovery will recognize your rigid approach to their recovery as characteristic of some people they encounter in 12 step meetings.

If you care about people who are opiate dependent, then you should support all paths to recovery. You should support all those who are seeking recovery and let them find the path that works for them. You should be humble enough to recognize that you and “people like you” do not know the truth about what is best for everyone else.

Some people are not able to achieve recovery without medication-assisted treatment, and some die trying. You do serious harm when you deny the truth about a treatment that has been proven to save lives.

It’s possible that methadone saved your life. It’s possible that methadone was an important step in your recovery. It’s possible that you or someone you love may need methadone at some time in the future.

Please keep an open mind, learn the facts, and allow your opinions to be influenced by more than your own experience (also consider scientific research and the experiences of others).

Please remember that abstinence is a means to an end: freedom from drug related harm. For many people, medication-assisted treatment is their path to freedom from drug related harm.

7 delmar June 16, 2010 at 2:12 am

recoveryhelpdesk,
Your form cut out parts of my response so maybe it sounded not quite as I intended.

I understand your goal of harm reduction, but when I said I understand the truth I meant only that I understand both what happens when an addict is using drugs, and what happens when he stops using.

And I would have to disagree that most of your ten points are facts, they are your point of view based on the idea that an opiate addict will be better off taking methadone than his previous drug. I don’t necessarily share that opinion.

I do support all paths to recovery I just think people considering methadone should know all the facts about it. Sure there are uneducated people who put it down just because they don’t approve of addicts. But there is plenty of misinformation, or what I would call half-truths, like a lot of your ten points, used to promote it.

It took me some years to get past all the post acute withdrwal from years of methadone and heroin use. There is no doubt in my mind that my years on methadone did harm to my body and made recovery much more difficult. On the other hand, I was an IV heroin addict and could very well have died had I not gone on methadone when I did.

All I’m saying is that harm comes in different forms. It’s a gray area at best. Rosy statements about the “gold standard” don’t speak of addiction in toto, only of the addict who is currently using and thinks he’ll never be able to stop.

8 recoveryhelpdesk June 16, 2010 at 8:47 pm

Delmar, I appreciate your clarifications. I also stand behind my statement that there are things we actually know to be true about methadone treatment for opiate dependence. These really are facts and not opinions.

For example, it’s a demonstrated fact that opiate dependent people in methadone treatment do live longer than those who are not in methadone treatment. This is just one of a long list of documented health and quality of life benefits.

Higher doses of methadone have been shown to be more effective than lower doses. Longer periods of treatment have been shown to be more effective than shorter periods of treatment. Methadone has been shown to have overdose prevention benefits for people who are opiate dependent. Methadone has been shown to prevent miscarriages in pregnant women who are opiate dependent.

These are truths and not half truths. I offer them so that people will understand their options.

In my work as a counselor, I never force any treatment or recovery support on anybody. I provide accurate information about all options and allow people to make their own choices. My goal is to make sure people have the information they need to make informed decisions. Many people choose something other than methadone for very valid reasons.

Keep in mind, too, that what is true for the majority is not always true for the individual. For example, research shows that higher doses of methadone tend to be more effective than lower doses of methadone. But the right therapeutic dose for a specific person may be a dose on the lower end of the range.

9 Matt H. August 14, 2011 at 4:27 pm

I appreciate you taking the time to explain the difference between medical fact and the philosophy that many 12-step program members share. If an opiate addict is capable of staying clean without medication and through counseling or a 12 step program I’m overwhelmed with with happiness for them. I have unfortunately seen individuals who became very stable while on buprenorphine or methadone maintenance (started working again, reunited with their family, and had ultimately become a productive member of society) only to be guilted into getting off of buprenorphine or methadone so that they could be “really clean”. Soon after discontinuing the medication and using a 12-step program exclusively they relapsed and because their opiate tolerance dramatically decreased after discontinuing buprenorphine or methadone and they overdosed and died. I think some people have different ideas of what being in “recovery” means but I really feel as though it’s an incredibly unproductive exercise when many tens of thousands of opiate addicts die anually. On another note if someone is able to avoid relapse while on buprenorphine or methadone and they’re living productive happy lives again why does it matter or why should they HAVE to discontinue the medication? There are so many diseases that are best treated by maintenance medication take diabetes type 1 or 2….. or hypertension even though methadone and buprenorphine when taken correctly are much safer and have fewer side effects. My main objective has become keeping opiate addicts family members frofurther pain by losing their son, daughter, spouse,

10 Sissy June 3, 2013 at 2:55 pm

This article only talks about long term use of methadone and nothing about weaning off. What would be a better alternative for someone who wants off herion but doesn’t want to stay on methadone for years?? What health effects does methadone have? To me it just sounds like trading one adiction that we all know is dangerous for another adiction that is also horrible but just in a controlled enviornment.

11 recoveryhelpdesk June 4, 2013 at 6:26 pm

Hi Sissy, Some people do wean off methadone. But for many, long term use is the safest and most effective option. Long term use of methadone is generally safe, and safer than the alternative. This is not trading one addiction for another. It is trading addiction for recovery. Thanks, Tom

12 Alicia August 10, 2013 at 8:32 pm

I am going to my local clinic on Monday..I feel like anyone can turn anything into a bad thing…I am doing it not to get high…but to stop waking up wanting/needing something every day just to function…I want help…I need help and I think methadone can help me feel normal again…I dont even remember what it was like to wake up and go through my day without wanting to get something…

Leave a Comment

{ 5 trackbacks }

Previous post:

Next post: