Editor’s Note: Today brings the second in our guest series by Grey Ryder of aboutmethadone.org. His first piece gave a brief overview of methadone’s history, with an eye to its bad reputation among the public at large. Today: a look at the drug’s beneficent clinical and social effects.
The tools for treating opiate addiction are sparse. The front line treatments are rehab and twelve step groups. Most of the pharmacological treatments are still in their experimental stages, and there don’t appear to be any silver bullets on the horizon. However, there is one treatment that offers real hope. Over the past fifty years, researchers studying methadone have determined that it is one of the most effective treatments for drug addiction ever created. While it is a far cry from a cure-all – some patients don’t respond to it at all, and some continue using drugs during treatment– it is a godsend for many addicts.
Defining success is of critical importance when assessing any treatment’s effectiveness. The simplistic view looks at whether a treatment stops an addict from using their drug of choice. This absolutist approach is problematic for a number of reasons.For how long do you measure abstinence before you call a treatment effective? What about reduction in drug use, instead of full stoppage? What about measuring not just drug use, but the ancillary negative behaviors associated with it?
A better approach to assessing success entails identifying a number of different negative behaviors associated with drug abuse, and measuring how much a certain treatment reduces those factors or behaviors. When looking at methadone’s effectiveness at treating heroin addiction, we should focus on criminal behavior, the spread of H.I.V./A.I.D.S., and the rate of continued drug use following treatment.
Heroin isn’t cheap. Most addicts don’t have full time jobs with enough disposable income to support their habit. As a result, many users turn to property crimes such as theft and burglary to support their addiction. All major studies show a very strong links between illegal opiate use and criminal behavior. One of methadone’s biggest strengths is reducing this criminal behavior. The vast majority of research shows a marked decrease in crime following methadone treatment. One particularly large study, involving over 600 patients, showed a 70.8 percent decline in “crime days” – a 24 hour period in which an individual commits one or more crimes – during the first 4 months of methadone maintenance treatment. Those declines continued as patients continued in treatment. There have been numerous cost/benefit studies on heroin addiction and methadone maintenance. One major study showed that for every $1 spent on treatment, crime and costs to the criminal justice system were reduced by $4-$7.
Perhaps heroin addiction’s greatest horror is its contribution to the A.I.D.S. epidemic. Sharing dirty needles is a leading cause of H.I.V. transmission. More than 36% of new A.I.D.S. cases are attributed to intravenous drug abuse. Methadone significantly reduces injecting use and the sharing of needles. As a result, new H.I.V. infections decline with treatment. Studies show that more than 1/3 of intravenous heroin addicts share needles. Even though methadone does not stop some addicts from continuing IV drug abuse, it reduces that needle share rate to 1/5. In addition to reducing H.I.V. infections, methadone reduces prostitution by addicts, another major cause of new infections.
When measuring whether a treatment is effective or not, the primary concern is whether addicts stop or use fewer drugs than before they started treatment. Methadone succeeds in this regard. Drug use declines dramatically in those who undergo treatment, and it continues to decline as addicts spend more time in treatment. Relatively new research shows that addicts who receive higher doses (measured as 80-100 milligrams) use even fewer opiates than the traditional treatment population, who are usually maintained on a sub-optimal dose. There are many reasons for this, but it makes sense intuitively. When an addict takes more methadone, their need for heroin lessens dramatically.
All studies show that the more time a patient spends in treatment, the fewer negative drug-related behaviors they engage in. However, there is a push within society and the clinics in particular to end methadone maintenance treatment as soon as possible. Society’s view – and this is echoed by many within the treatment community – is that patients should discontinue methadone as soon as they are stabilized. Unfortunately, this is just when the benefits really start to accrue. Studies show that the first 12 months of methadone treatment are critical to success. However, the majority of patients drop out within a year.
Nearly 40 percent of patients drop out of methadone programs during their first year of treatment due to incarceration. They are sent to jails or prisons where they don’t receive methadone maintenance. This tends to undo the benefits they’ve achieved while working a methadone maintenance program. Another large segment of patients are dismissed from their programs for not paying the program fees. Medicaid covers a significant number of methadone patients, but for those patients whose states don’t cover methadone, or for those who earn too much for Medicaid, paying the $12-$14 a day for treatment can prove to be financially impossible.
Methadone treatment, as all studies show, reduces drug use, crime and disease among opiate addicts. Unfortunately, patients typically don’t stay in treatment as long as they need, for a variety of reasons.
Easing societal pressure on methadone patients and increasing funding for more treatment would go a long way in alleviating this problem. However, current policy is going in the other direction. Even in the face of such problems, methadone remains the best choice for treating opiate addiction, and those lucky enough to have access to it see vast improvements in their lives. Despite the evidence showing significant benefits to methadone use, politicians have been working to limit treatment. The final piece in this series explores these tactics and their long-term consequences.