Can I Ever Get Off Methadone?

Dr. Stanton,

I am currently on a methadone clinic which I find counter-productive to the well-being and healing of their clients. Indeed, most patients there remain for decades without ever becoming fully 'clean' which I assume would be the objective. The staff and the patients rarely give or get respect and drugs are sold right outside the doors. The turnover rate for staff is high, I have had 8 counselors in 3 years. I've heard about alternative treatments but can't seem to find much literature on them. Have you heard of 'buprenorphine,' 'apomorphine' or any herbal drugs that work better than methadone? Also, has research been done on the long-term effects of methadone on men and women? And, if methadone is being classified as a 'life-sustaining medication' much like insulin, why can't we pick it up at a pharmacy and take it in the privacy of our own homes without being subjected to humiliating invasions of our privacy and treated like criminals? Is it legal to have your medication withheld?

Dear Friend:

You raise some great questions. I have previously recounted how I originally opposed methadone as simply a replacement addiction in Love and Addiction, but then changed my point of view out of an appreciation of harm reduction techniques.

However, I have always opposed the thinking of Dole and Nyswander in their idea that addiction is a metabolic disease, whether inherited or acquired, such that addicts require perpetual maintenance. I find that view wrong and self-defeating. To maintain an addict for years, or decades, in the environment you describe is truly depressing.

Home maintenance is one solution, and you are right — if methadone is a medication, why can't it be used at home? Some drug reformers advocate for home use of methadone, or at least maintenance with private physicians. Unfortunately, there are black markets for methadone and people die from combining methadone with other drugs. I think maintenance by individual physicians is a more realistic reform.

As for which drug will really succeed in your case, thinking of which drug will enable you to quit addiction is, I fear, never going to lead to release from drug addiction.

I talk with my friend Mike Fitzpatrick, a British physician who treats addicts in London. He shares the views in the last paragraph. However, he notes that, in the U.K., HIV infection due to drug use is practically nonexistent (many people attribute this to widespread needle exchanges in that country), compared with the shift in the U.S. to IV drug use as the major source for new infections. In other words, use of methadone in order to avoid AIDS makes sense here, but has little applicability in Britain.

Yours best,
Stanton

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