Methadone

Treatment with Methadone

The rationale for methadone is that the provision of a legal, stable source of opiate enables the individual patient to cease heroin use and its associated behaviors, such as drug-seeking. During the period of maintenance on methadone, other lifestyle changes can be achieved, such as re-establishing relationships, gaining employment, and making meaningful contributions to the community.

Methadone is used either as a detoxification or a maintenance medication. For detoxification, methadone helps someone withdraw from heroin. It is given daily over a period of a week or longer, progressively at lower and lower doses such that by the end, the person has fully withdrawn from heroin. Research evidence indicates that methadone is more effective as a heroin withdrawal treatment than some other medications (clonidine, lofexidine) mainly because people tend to stay in treatment longer with methadone.

However, the more effective use of methadone is as a maintenance medication, rather than for detoxification. Maintenance treatment means taking the medication daily over many years. Drug addiction is a chronic relapsing condition, not unlike asthma or diabetes, and some people need a stable, constant dose of methadone for many years. Many people resume heroin use after detoxification and it is a less effective treatment.

Effectiveness

Methadone has proven to be a highly effective treatment for heroin dependence. Over 20 years of research has demonstrated that methadone reduces [Page 507]heroin use, reduces criminal behavior, improves health and improves psycho-social functioning. Methadone has been demonstrated to be highly cost-effective relative to other treatments such as detoxification alone or residential rehabilitation. Of the pharmacological treatments available, methadone maintenance is the most cost-effective.

The benefits of methadone maintenance extend beyond the individual patient to society at large. Cost-benefit research has demonstrated that the costs saved by providing methadone maintenance are much greater than the costs spent in providing the treatment. Methadone maintenance treatment saves the community money. However, the standard methadone dose in most U.S. clinics is less than the research-determined optimal dose, which can undermine the treatment's effectiveness.

Despite the evidence, some believe that providing methadone to heroin users is morally problematic. The issue of methadone maintenance treatment is imbedded into debates about harm minimization and zero-tolerance approaches to drug policy.

Buprenorphine

Up until the late 1990s, methadone was the only maintenance medication available to treat heroin dependence. Buprenorphine became available in the United States in 2002 (in the form of the combination buprenorphine-naloxone product, Suboxone), and delivered through office-based care. By way of comparison, buprenorphine became available in Australia in 2000 but in the mono version (buprenorphine alone, Subutex) and was integrated within the existing methadone maintenance treatment service system in Australia. That is, the same prescribers and dispensers were trained and able to provide buprenorphine treatment.

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