This is my first attempt at public writing so please accept my apologies in advance. My wish is to impart some of my knowledge, observations and opinions garnered from years of working as Medical Director in small Methadone clinics (120 or so clients), in a small U.S. cities.
Also, please pardon any apparent randomness in the flow of these discussions until I’m able to develop a logical, coherent information presentation system. Please feel free to communicate any topics which you would like to be discussed/have commentary/opinion on and I’ll try to do so in a timely fashion. Remember and be aware that what I say or claim here may not be so or applicable at another or your clinic. All Opioid Treatment Programs (OTPs) (Methadone clinics) adhere to the same Federal guidelines but State and Local guidelines and ordinances vary and as in all aspects of medicine, practices vary, especially in clinical areas where there are no convincing or accepted scientific or clinical studies to indicate one clear clinical pathway. Always confirm what you read here by doing your own personal research.
Methadone Maintenance Therapy (MMT) for Opioid Use Disorder (OUD) (opiate addiction) has been around (approved) and practiced since the 1970’s, in this country (USA), and has the longest track record of any widely used medication-assisted therapy (MAT) for OUD. It is still somewhat stigmatized for various fallacious reasons. I hope that this effort can pull back the veil and shed more light on this magnificent, life-affirming treatment option.
MMT combines a type of pharmacotherapy called, “Opioid-Agonist therapy” (OAT) or Replacement Therapy, so called because it consists of using Methadone (a long-acting opiate agonist), to replace the client’s illicit daily opioid use with a legally sanctioned (replacement) opioid, in order to prevent the onset of acute opiate “withdrawal” (the “Abstinence syndrome”) and so maintain a feeling of wellness while counseling/behavioral/psychological techniques are simultaneously applied, in addition to drug use monitoring. All in an effort to induce favorable behavior changes, primarily, abstinence from illicit drug (opioid) use/abuse, the maintenance of sobriety (remission) and to promote the development of a new lifestyle of “Recovery” from the addiction.
Other (non-methadone) pharmacotherapeutic options for medication-assisted treatment of OUD do exist. These include using an alternate opiate-agonist called Buprenorphine (generic name) or employing an opiate-antagonist medication instead, such as Naltrexone (generic name). Only medications which have been approved by the FDA (Food and Drug Administration) for this specific purpose (OUD treatment) are allowed to be used. Agonist and Antagonist medications cannot be used simultaneously. Remember that while in/on opiate-agonist MAT the client/patient is still opiate-dependent, that means that their body still requires daily exposure to opiates in order to function as “normal”, in other words, for them not to go into “withdrawal”. Antagonist MAT can only be considered after someone (the opiate user) has been free of opiates for an extended period of days to weeks.
In my opinion, what makes MAT in the OTP (clinic) setting so successful in breaking the cycle of opiate addiction is it’s completeness. The avoidance of the pain of “withdrawal” from acute/immediate “detoxification” (forced, complete, abstinence from all opioid exposure) combined with the strict rules/restrictiveness (witnessed treatment drug administration)/personal accountability through in-house (one-stop) counseling and frequent drug-use monitoring, are all crucial aspects of these programs. The program provides a stepping stone/training wheels, in the form of professional assistance on the path to ultimately achieving total abstinence from illicit opioid use and opiate independency (after the weaning (medically-supervised withdrawal) process of getting off the treatment opioid), gradually, after several months or years of re-building one’s life, while in the program. This establishes an extended period of monitored sobriety in a new Recovery lifestyle before embarking on the lifelong journey of maintaining this sobriety unaided by opioid medication.
Keep in mind that this therapy, as with many other treatments/techniques for managing chronic medical illnesses, may need to be reapplied (voluntarily), in the event of imminent or established relapse (a return to active illicit opioid drug use). OUD is a chronic, relapsing, progressive brain disease with no known cure and so relapse is to be planned for and accepted, however, it is to be avoided, if at all possible, by seeking treatment immediately, such as readmission into MAT, in a clinic (OTP-methadone) or office setting (Buprenorphine), especially following incarceration, or in-patient services/therapy. Some client/patients may choose to be on MAT indefinitely, if they’ve failed multiple attempts at medication-free sobriety but are able to manage their addiction favorably while on MAT-clinic or office and prefer it’s relative safety.
That’s all for now. As you can see this is an extensive subject with many areas of controversy but what isn’t controversial is that this treatment option has been validated to be effective (for some) and has saved and rehabilitated countless numbers of lives . I’ll try to post soon on another aspect of MMT life. Thanks for reading and your feedback is appreciated!
PS: Here’s a link to an informative post on Methadone treatment for opioid addiction: https://www.thefix.com/7-things-you-need-know-about-methadone-treatment
Stu (Dr. P)
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