By Holly Broce, MHA, LCADC
Vice President, Opioid Treatment Program Division, Pinnacle Treatment Centers
Methadone treatment for opioid addiction has a bad rap.
The stigma attached to methadone programs – and to Medication-Assisted Treatment (MAT) for substance use disorders in general – is a significant barrier to treatment and recovery for people who need it most. Public opinion about methadone treatment varies by the individual. However, it usually falls into the following broad categories of assumption and misinformation:
- People use methadone to get high.
- People in methadone programs lack willpower.
- Methadone treatment replaces one addiction with another.
- Methadone treatment is for heroin addicts only.
Some people see methadone treatment for what it really is and the value it truly provides. It’s a legitimate, evidence-based medical treatment for opioid use disorders backed by 50 years of clinical data. Unfortunately, research shows that a majority remain unaware that methadone treatment – along with behavioral therapy and community support within the structure of an individualized treatment plan – is the most effective approach to opioid addiction available.
Data from a 2016 survey conducted on public attitudes toward people in recovery showed that, among more than a thousand respondents, 74% disagreed with the idea that participation in a methadone program represented recovery from a substance use disorder. Additional data from peer-reviewed research published in 2013 and 2017 shows stigma attached to methadone treatment involves prejudice, stereotyping, and discrimination. The most disturbing thing about negative public perception regarding methadone treatment is where it comes from. In some cases, negative stereotyping is espoused by friends and family members of individuals seeking treatment for opioid use disorders; in other cases, it’s present in healthcare workers to whom people in methadone programs go for routine medical reasons; and finally, methadone program participants experience negative stereotyping from coworkers, employers, and potential employers.
All the studies addressing the stigma around methadone programs come to the same two conclusions:
- It keeps people struggling with opioid addiction from seeking a treatment that can change their lives.
- It results in methadone program participants leaving programs before they’re ready.
Both these outcomes increase the likelihood of relapse. They also prevent potential and current patients from receiving and completing a treatment program that gives them the best chance of long-term recovery from opioid use disorders.
Methadone Treatment: A Quick History
Researchers first synthesized the compound that became known as methadone in the early 1940s while searching for a treatment for asthma and other conditions. In the late 1940s, several U.S. pharmaceutical companies produced and sold methadone as an oral cough depressant. In 1947, researchers and regulators noted that similarities between methadone and morphine required classifying the medication as a controlled substance. Shortly thereafter, Dr. J.F. Maddux treated heroin and morphine addicts with oral methadone in a U. S. Public Health Service (USPHS) hospital in Fort Worth, Texas. The positive results of his trials led researchers V.P Dole, Mary Jeanne Kreek, and Marie Nyswander to open the first methadone clinic in New York City in 1964. After nearly a decade of clinical research, the Food and Drug Administration (FDA) approved methadone replacement as a long-term treatment for opioid addiction.
Since then, scores of studies around the world have confirmed methadone as an effective and safe treatment for opioid addiction in general, and the most effective treatment available for heroin addiction in particular.
Methadone and The Disease Model of Addiction
In 1997, the National Institutes of Health (NIH) issued a report that represented a quantum leap forward in the treatment of substance use disorders. While the disease model of addiction was not, at the time, a new concept, a consensus panel on effective medical treatment for opioid addiction recognized that:
“…opioid addiction is a chronic medical disorder that can be treated effectively by a combination of medication and psychosocial services.”
Summarized in the Substance Abuse and Mental Health Services Administration (SAMHSA) publication “Medication-Assisted Treatment (MAT) For Opioid Addiction in Opioid Treatment Programs” the panel also:
- Rejected the notion that addiction is self-induced or a failure of willpower and that efforts to treat it inevitably fail
- Called for a commitment to offer effective treatment of opioid addiction to all who need it
- Advised federal and state agencies to reduce the stigma attached to MAT. They called for increased funding, less restrictive regulation, and efforts to make MAT available in all states
These findings led to a gradual increase in the use of MAT and methadone for the treatment of opioid use disorders. Meanwhile, the prescription opioid crisis struck. Rates of prescription opioid addiction in the U.S. skyrocketed. Between 1999 and 2016, overdose deaths related to prescription opioids increased five-fold. NIH data shows that in 2014 alone, “…over 2.5 million Americans had an opioid use disorder which contributed to 28,000 overdose deaths,” and in 2016, “Opioid overdose caused over 42,000 deaths.”
In 2017, the opioid crisis prompted the Office of the President of the United States to formulate a National Drug Control Strategy which included three key provisions:
- Closing the treatment gap. Of the estimated 20.7 million people in the U.S. who need treatment for a substance use disorder, only one in 10 receive the treatment they need.
- Making MAT the standard of care for opioid addiction.
- Expanding treatment insurance while removing barriers to reimbursement in order to encourage more people to seek treatment.
In 2018, SAMSHA formally recognized that the best practices in treatment for opioid use disorders include a combination of Medication-Assisted Treatment (MAT), evidence-based individualized treatment plans, psychosocial support, community support, and ongoing access to support across a comprehensive continuum of care.
Benefits of MAT and Methadone Treatment
The science is in. Experts agree that for people struggling with opioid use disorders, MAT and methadone treatment programs decrease:
- Opioid use
- Opioid-related overdose deaths
- Criminal activity
- Transmission of infectious diseases
MAT and methadone programs increase:
- Social functioning
- Time in treatment
The best way to understand the effectiveness of MAT for substance use disorders – and to reduce negative stigma around methadone and MAT – is to embrace the fact that substance use disorders are chronic, relapsing diseases just like diabetes or hypertension. Rates of relapse for those diseases are almost the same as rates of relapse for substance use disorders. Effective treatment for diabetes and hypertension involves medication, lifestyle changes, and in some cases, behavioral therapy. Treatment for substance use disorders include medication, lifestyle changes, and in most cases, behavioral therapy. Families and friends of people in treatment need to take these facts to heart in order to support their loved ones in treatment. People in treatment can use this information to counter the attitude they encounter all too often: you aren’t really in recovery if you’re on methadone.
Reducing Stigma, Removing Barriers, Changing Lives for the Better
We don’t stigmatize people with hypertension and diabetes. Instead, we help them get them back on track with their medication and lifestyle changes. We support them as they make significant changes that not only improve, but in many cases save their lives. If we, as a nation, want to address the opioid crisis and help our citizens struggling with opioid use disorders achieve long-term health and well-being, then that’s exactly what we need to do for them: offer the latest medical, behavioral, and social support available, free of the stigma and judgment that are still significant barriers to treatment.