The Government Should Get Involved With The

Cure To Opiate Addiction Through The Use Of The Methadone Program In Order To Reduce Crime, Death, Disease, And Drug Use. Essay, Research Paper

Methadone, a long-acting synthetic narcotic analgesic, was first used in the maintenance treatment of drug addiction in the mid-1960s by Drs. Vincent Dole and Marie Nyswander of Rockefeller University. There are now 115,000 methadone maintenance patients in the United States, 40,000 of whom are in New York State and about half that many are in California. Methadone is widely employed throughout the world, and is the most effective known treatment for heroin addiction.

The goal of methadone maintenance treatment (MMT) is to reduce illegal heroin use and the crime, death, and disease associated with heroin addiction. Methadone can be used to detoxify heroin addicts, but most heroin addicts who detox?using methadone or any other method?return to heroin use. Therefore, the goal of MMT is to reduce and even eliminate heroin use among addicts by stabilizing them on methadone for as long as is necessary to help them avoid returning to previous patterns of drug use. The benefits of MMT have been established by hundreds of scientific studies, and there are almost no negative health consequences of long-term methadone treatment, even when it continues for twenty or thirty years.

Methadone maintenance treatment came into being in an unexpected way. By 1963,doctors and public health workers had concluded what objective observers and users alike had known for decades: that there was no treatment known which could cure long term opiate (heroin, morphine, opium etc.) addicts. In fact, there wasn’t even any treatment that could honestly claim to be more successful than no treatment at all! Every imaginable option had been tried, from lobotomies and insulin shock, to psychoanalysis and the threat of lifetime imprisonment. Yet in every case the result was the same: between 70 and 90 percent of these chronic addicts would return to opiates within a short time. In light of such statistics a number of prestigious panels examined the problem and by 1963 had come to the same conclusion: it was time to re-examine nearly fifty years of prohibition and consider allowing doctors to prescribe addicts the opiates they needed. (http://www.methadone.org/origin.html)

At Rockefeller University in New York City, Dr. Vincent Dole, an expert in metabolic disorders and a psychiatrist by the name of Dr. Marie Nyswander, who’d worked at the U.S. Public Health Hospital/Prison for addicts in Lexington, Kentucky, began experiments with several chronic heroin addicts. In attempting to determine if addicts could be maintained on stable doses of pharmaceutical opiates. The volunteers were given access to the spectrum of opiates available to medical practitioners. The researchers tried everything from morphine to dilaudid, but found that it was extremely difficult to stabilize the subjects. The addicts were either over sedated or in mild withdrawal most of the time, and spent their days either “on the nod”, waiting for their next shot, or comparing the relative merits of the drugs used. Reluctantly, Dr. Dole and Dr. Nyswander concluded that the experiment had been a failure, and decided to “detox” the addicts and release them from the hospital. To accomplish the withdrawal, they turned to a synthetic narcotic called methadone. Methadone had first been synthesized by the Germans during World War Two, and after the war it was used to withdraw addicts at Lexington. It had the advantage of being cheap, significantly orally active, and longer lasting than opiates like morphine. For the researchers at Rockefeller, it seemed merely a convenient and humane means of ending the experiment with maintenance. As the addict volunteers had been built up to large doses of narcotics by street standards, they were given relatively large doses of methadone to stabilize their “habits” before beginning the reduction. (http://www.methadone.org/origin.html)

And then something completely unexpected happened. A few days after the subjects had been switched to methadone, and before the “detox” had begun, they began to exhibit very different behavior. Whereas for weeks they had spent their days either feeling the effects of the narcotics or complaining of their need for more narcotics, suddenly the focus of their days turned away from drugs. One subject asked the researchers for supplies so that he might resume his long neglected hobby of painting. Another inquired after the possibility of continuing his interrupted education. In short, the addicts- who when admitted to the hospital had looked and behaved very much alike -now began to differentiate. They began to manifest the potential that each had obscured during years of chasing street narcotics. (http://www.methadone.org/origin.html)

Brecher describes the nineteenth century America as a “dope fiend’s paradise.” explaining

“Opium was on legal sale conveniently and at low prices throughout the century, morphine came into common use during and after the Civil War, and heroin was marketed toward the end of the century.” (Brecher 1972) Methadone is the most effective treatment for heroin addiction. Compared to the other major drug treatment modalities?drug-free outpatient treatment, therapeutic communities, and chemical dependency treatment?

methadone is the most rigorously studied and has yielded the best results. Methadone is effective HIV/AIDS prevention. (Ward J, Mattick R, Hall W. Key Issues in Methadone Maintenance Treatment. New South Wales, Australia: New South Wales University Press; 1992:46-61) MMT reduces the frequency of injecting and of needle sharing. Methadone treatment is also an important point of contact with service providers and supplies an opportunity to teach drug users harm reduction techniques such as how to prevent HIV/AIDS, hepatitis, and other health problems that endanger drug users. Methadone treatment reduces criminal behavior. (Drug Abuse Treatment Evaluation: Strategies, Progress, and Prospects. NIDA Research Monograph 51. Rockville, MD: U.S. Department of Health and Human Services; 1984:42-68.)Drug-offense arrests decline because MMT patients reduce or stop buying and using illegal drugs. Arrests for predatory crimes decline because MMT patients no longer need to finance a costly heroin addiction, and because treatment allows many patients to stabilize their lives and obtain legitimate employment. Methadone drastically reduces, and often eliminates, heroin use among addicts. (Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995:22.)The Treatment Outcome Prospective Study (TOPS)?the largest contemporary controlled study of drug treatment?found that patients drastically reduced their heroin use while in treatment, with less than 10% using heroin weekly or daily after just three months in treatment.(Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment. New York: Springer-Verlag; 1991:160-175) After two or more years, heroin use among MMT patients declines, on average, to 15% of pretreatment levels. (Fairbank A, Dunteman GH, Condelli WS. Do methadone patients substitute other drugs for heroin? Predicting substance use at 1-year follow-up. American Journal of Drug and Alcohol Abuse. 1993;19:465-474.) Often, use of other drugs?including cocaine, sedatives, and even alcohol ? also declines when an opiate addict enters methadone treatment, even though methadone has no direct pharmacological effect on non-opiate drug craving. (Institute of Medicine. Treating Drug Problems, vol. 1: A Study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems) Methadone is cost effective. MMT, which costs on average about $4,000 per patient per year, reduces the criminal behavior associated with illegal drug use, promotes health, and improves social productivity, all of which serve to reduce the societal costs of drug addiction. Cost benefit analyses indicate savings of $4 to $5 in health and social costs for every dollar spent on MMT. Incarceration costs $20,000 to $40,000 per year.( Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995:162) Residential drug treatment programs are significantly more expensive than MMT, at a cost of $13,000 to $20,000 per year, though it should be noted that treatment stays are typically no more than one year in these programs. (Yancovitz SR, Des Jarlais DC, Peyser NP, et al. A randomized trial of an interim methadone maintenance clinic. American Journal of Public Health. 1991;81:1185-1191)Finally, given that only 5 to 10% of the cost of MMT actually pays for the medication itself, methadone could be prescribed and delivered even less expensively, through physicians in general medical practice, low-service clinics, and pharmacies. MMT as part of general medical practice is increasingly common throughout Europe, Australia, New Zealand, and Canada, but is severely restricted in the U.S. A few “medical maintenance” experiments in the United States, which permitted some long-term methadone recipients to transfer from traditional methadone clinics to office-based physicians, have achieved excellent treatment results. Medical maintenance is also cost-effective, and patients often prefer it over traditional methadone clinics. (Drucker E. Harm reduction: A public health strategy. Current Issues in Public Health. 1995;1:64-70) I n maintenance treatment, in proper doses, methadone does not create euphoria, sedation, or analgesia. Methadone has no adverse effects on motor skills, mental capacity, or employability.

Bibliography

1. Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995:22.

2. Institute of Medicine. Treating Drug Problems, vol. 1: A Study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems

3. Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment. New York: Springer-Verlag; 1991:160-175

4. Institute of Medicine. Federal Regulation of Methadone Treatment. Washington, DC: National Academy Press; 1995:162

5. http://www.methadone.org/origin.html

6. Drucker E. Harm reduction: A public health strategy. Current Issues in Public Health. 1995;1:64-70

7. Ward J, Mattick R, Hall W. Key Issues in Methadone Maintenance Treatment. New South Wales, Australia: New South Wales University Press; 1992:46-61

8. Yancovitz SR, Des Jarlais DC, Peyser NP, et al. A randomized trial of an interim methadone maintenance clinic. American Journal of Public Health. 1991;81:1185-1191