Background Information
Methadone is a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and
dependence. For more than 30 years this synthetic narcotic has been used to treat opioid addiction. Heroin releases an
excess of dopamine in the body and causes users to need an opiate continuously occupying the opioid receptor in the brain.
Methadone occupies this receptor and is the stabilizing factor that permits addicts on methadone to change their behavior
and to discontinue heroin use.
Taken orally once a day, methadone suppresses narcotic withdrawal for between 24 and 36 hours. Because methadone is
effective in eliminating withdrawal symptoms, it is used in detoxifying opiate addicts. It is, however, only effective in
cases of addiction to heroin, morphine, and other opioid drugs, and it is not an effective treatment for other drugs of
abuse. Methadone reduces the cravings associated with heroin use and blocks the high from heroin, but it does not provide
the euphoric rush. Consequently, methadone patients do not experience the extreme highs and lows that result from the
waxing and waning of heroin in blood levels. Ultimately, the patient remains physically dependent on the opioid, but is
freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts.
Withdrawal from methadone is much slower than that from heroin. As a result, it is possible to maintain an addict on
methadone without harsh side effects. Many MMT patients require continuous treatment, sometimes over a period of years.
Methadone maintenance treatment provides the heroin addict with individualized health care and medically prescribed
methadone to relieve withdrawal symptoms, reduces the opiate craving, and brings about a biochemical balance in the body.
Important elements in heroin treatment include comprehensive social and rehabilitation services.
Availability of Treatment
About 20% of the estimated 810,000 heroin addicts in the United States receive MMT (American Methadone Treatment
Association, 1999). At present, the operating practices of clinics and hospitals are bound by Federal regulations that
restrict the use and availability of methadone. These regulations are explicitly stated in detailed protocols established
by the U.S. Food and Drug Administration (FDA). Additionally, most States have laws that control and closely monitor the
distribution of this medication.
In July 1999 the U.S. Department of Health and Human Services released a Notice of Proposed Rulemaking (NPRM) for the
use of methadone. For the first time in more than 30 years, the NPRM proposes that this medication take its rightful place
as a clinical tool in the treatment of the heroin addict. Instead of its use being mandated by regulations, programs will
establish quality assurance guidelines and have to be accredited. The proposed new system will allow greater flexibility
by the treating physician and ensure appropriate clinical management of the patient's needs. This proposed change in policy
would eliminate most of the current regulations and allow greater clinical discretion for treatment by the physician.
Accreditation establishes a clinical standard of care for the treatment of medical conditions. In the foreseeable future,
clinic and hospital programs would be accredited by a national and/or State accrediting body. Responsibility for preventing
the diversion of methadone to illicit use will remain with the Drug Enforcement Administration.
Is It Safe?
Research and clinical studies suggest that long-term MMT is medically safe (COMPA, 1997). When methadone is taken under
medical supervision, long-term maintenance causes no adverse effects to the heart, lungs, liver, kidneys, bones, blood,
brain, or other vital body organs. Methadone produces no serious side effects, although some patients experience minor
symptoms such as constipation, water retention, drowsiness, skin rash, excessive sweating, and changes in libido. Once
methadone dosage is adjusted and stabilized or tolerance increases, these symptoms usually subside.
Methadone is a legal medication produced by licensed and approved pharmaceutical companies using quality control standards.
Under a physician's supervision, it is administered orally on a daily basis with strict program conditions and guidelines.
Methadone does not impair cognitive functions. It has no adverse effects on mental capability, intelligence, or employability.
It is not sedating or intoxicating, nor does it interfere with ordinary activities such as driving a car or operating machinery.
Patients are able to feel pain and experience emotional reactions. Most importantly, methadone relieves the craving associated
with opiate addiction. For methadone patients, typical street doses of heroin are ineffective at producing euphoria, making
the use of heroin less desirable.
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