Methadone Maintenance Treatment

Methadone maintenance treatment (MMT) has been the primary form of treatment for heroin addiction for many years and has been recognized as the most effective treatment for this condition by the Institute of Medicine and the National Institutes of Health. As a treatment for opioid dependence, MMT involves the daily administration of the oral opioid agonist methadone, a long-acting, orally administered drug, to replace the shorter acting heroin that is usually injected. As a maintenance medication, methadone has distinct advantages. When administered in adequate oral doses, a single dose lasts between 24 and 36 hours. Methadone is dispensed orally in different forms, which include tablets (also called diskettes), powder, and liquid. Most importantly, methadone relieves the persistent narcotic craving or hunger that is believed to be the major reason for relapse to heroin. MMT involves providing drug abusers with methadone in a clinical setting, a methadone maintenance treatment program (MMTP). In the United States alone, there are more than 1,200 MMTPs, with an estimated staff of 20,000 serving more than 220,000 patients annually. MMT is intended to do three things for patients who participate: (1) keep the patient from going into withdrawal, (2) keep the patient comfortable and free from craving street opioids, and (3) block the effects of street opioids.

The operations of a MMTP are regulated by federal and state regulations. MMTPs are staffed by physicians, physician assistants, nurses, social workers, addiction counselors, case managers, vocational counselors, HIV counselors, and administrative supervisors. The methadone dose is determined by the physician, who adjusts it according to the patient's [Page 537]need, withdrawal, and craving symptoms. Daily dispensing and observation of methadone, supervised urine drug screens, and other medical treatments (i.e., HIV/AIDS and hepatitis screening) are provided by nurses and physicians assistants. Clinical staff members provide individual and group counseling, case management, cognitive and behavioral treatments, and psychotherapy. The ability to provide all of these treatments in one location has made MMT the most effective treatment for opiate dependence to date.