Methadone MythBusters: The Addiction Bait and Switch
By Chris Johnston, MD, Chief Medical Officer, Pinnacle Treatment Centers
In our recent blog Methadone: Changing Attitudes, Saving Lives we discussed the benefits of methadone treatment for people struggling with an opioid use disorder. The purpose of the article was to highlight the advantages of methadone treatment – and Medication-Assisted Treatment (MAT) in general – and begin the work of removing the stigma surrounding both methadone and MAT programs.
This post will dispel a common misconception about methadone treatment, which can be summarized like this:
Methadone treatment is just replacing one addiction with another.
We’re going to take the time to counter this idea. It’s responsible for two negative forces working against people seeking treatment for opioid use disorders:
- It reinforces the stigma around MAT.
- It prevents people with an opioid problem from getting help that can save their lives.
With the opioid crisis raging – quite literally killing people and tearing apart families every day in every corner of the country – we don’t need unnecessary barriers to treatment making the situation worse. Especially barriers that exist because of a lack of big-picture awareness and a misunderstanding of basic facts.
We’re here to raise awareness and share facts. Our endgame: get more people the treatment they need, when and how they need it.
Why Methadone Treatment is Not Trading One Addiction for Another
We’ll start with three helpful definitions published by the U.S. Surgeon General in the report Facing Addiction in America: The Surgeon General’s Spotlight on Opioids:
- Substance Use Disorder: Occurs when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment. Impairments may include health problems, disability, and failure to meet major responsibilities at work, school, or home.
- Addiction: Common name for a severe substance use disorder, associated with compulsive or uncontrolled use of one or more substances. Addiction is a chronic brain disease that has the potential for both recurrence (relapse) and recovery.
- Dependence: A state in which an individual only functions normally in the presence of a substance, experiencing physical disturbance in its absence. A person can be dependent on a substance without being addicted.
We’ll make this very simple.
A person with an opioid use disorder – a heroin addiction, for instance – has what’s defined above as a substance use disorder. When the disorder causes significant impairment and use escalates to a level considered compulsive or uncontrolled, that extreme behavior is characterized as addictive. Addictive behavior – in the context of a heroin addiction – can lead to all sorts of risky behavior, such as petty crime, re-using needles, and doing things that impair an individual’s ability to function as a viable member of society. They lose their ability to be an effective spouse, family member, employee, or citizen – all because of their addiction.
That’s where methadone treatment comes in.
When a person starts taking methadone for their opioid use disorder – a heroin addict, for instance – they stop using heroin. Licensed physicians administer methadone to mitigate the withdrawal symptoms that occur in the absence of heroin. Once the withdrawal symptoms abate, the patient and the physician collaborate. They find a methadone dosage and schedule that blocks the intense cravings that follow. It’s these cravings that lead people with opioid use disorders to engage in the addictive behaviors mentioned above.
In the absence of the cravings, the risky behaviors – damaging to the individual, the family, and society in general – become unnecessary. The individual stops engaging in them, because the drive to do so stops.
What stops the drive?
Harm Reduction: A Return to Stability
A person in methadone treatment does, in fact, become dependent on methadone, according to the definition above. That’s a fact. However, that individual is not addicted to methadone, according to the definition above, because the negative behaviors around seeking, acquiring, and taking methadone are eliminated by the existence of controlled, legal, and safe procedures monitored by licensed physicians experienced in methadone treatment.
When an individual is free from the withdrawal symptoms and the cravings that drive drug-seeking behavior and free of the fog of euphoria/dysphoria caused by using opioids, they can begin participating in life again. They get maximum benefit from the drug counseling and treatment federally mandated for anyone participating in a methadone program. They can become an active parents and/or spouses again, or return to productive employment. In short, people in methadone programs can become a contributing members of society again. This is big: it’s something they were unable to do without methadone.
Methadone treatment reduces the harm they cause to themselves, their families, and their community, and enables them to actively participate in the care they need that will allow them to live a life completely free of illicit drugs.
Now, based on the information above, you can answer the question for yourself: is methadone treatment simply replacing one addiction for another?