Methadone Maintenance Therapy

Methadone Maintenance Therapy

Table of contents:
1. Introduction
2. Addiction as a disease
3. Methadone and methadone treatment
4. Side-effects of methadone and risks related to methadone therapy
5. Alternatives to methadone therapy
6. Conclusion
7. References


Introduction
The problem of drug addiction is one of the most serious problems of the modern society. In fact, the drug addiction raises a number of problems related to the use of drugs. In this respect, it is possible to speak not only about the negative effects of the drug use on the health of an addict, but it is also important to remember about the negative effects of drug addiction as a social problem. Anyway, it is obvious that the problem of drug addiction inevitable affects the social environment of drug addicts, including members of their families and people who constantly interact with them, while often absolutely strange people can become victims of antisocial behavior of drug addicts, which are susceptible to aggressive and even delinquent behavior when they need to take drugs.
In such a situation, the question of the effective treatment of drug addiction naturally arises. In this respect, it is important to underline the fact that, at the moment, there is no universal treatment that could solve all the problems of a drug addict. In fact, it is primarily the drug addict who should undertake the first step to overcoming his or her dependence. On the other hand, it is necessary to remember about the fact that drug addiction is a serious health problem, which affects not only psychological and mental state of an individual, but also his physiological state.
In such a context, the external assistance to drug addicts in overcoming their addiction is essential. Hence, the social environment of drug addicts, especially members of their families should assist them in the treatment of their addiction. Moreover, often drug addiction needs the involvement of health care professionals who can help drug addicts to overcome their problems and facilitate the process of recovery from drug addiction. However, the modern science and medicine do not possess efficient tools which can cure drug addicts safely, help them recover and stop taking drugs for the rest of their life. Nevertheless, there are therapies and methods which can be applied to facilitate the process of recovery and minimize the negative impact of drugs on the health of drug addicts.
In this respect, the methadone maintenance therapy is considered to be one of the most efficient treatments which helps drug addicts, which get used to taking such drugs as heroin, to stop taking drugs through their substitution by methadone (Weinrich and Stuart, 2000, 1343). However, the methadone maintenance therapy evokes highly controversial arguments. On the one hand, the methadone maintenance therapy is perceived a true panacea from the drug addiction, which minimizes the risk to patients’ health and increases their chances for recovery from drug addiction (Sadovsky, 2000, 44). On the other hand, the methadone maintenance therapy is believed to be an extremely harmful and ineffective therapy which rather leads to the replacement of one drug, heroin, by another, methadone without freeing patients from their drug addiction (Weinrich and Stuart, 2000, 1344).
Hence, it is obvious that the methadone maintenance therapy is highly controversial, but, at the moment, it is widely spread method of treatment which used to assist patients to recover from drug addiction, when they have already got used to the consumption of “heavy” drugs, such as heroin. Nevertheless, in order to assess the effectiveness of the methadone maintenance therapy, it is necessary to focus on the essence of the drug addiction, the methadone maintenance therapy proper, its side-effects and possible risks drug addicts can face, when they undergo this therapy, and possible alternatives to the methadone maintenance therapy.
Addiction as a disease
Before analyzing the essence and effects of the methadone maintenance therapy, it is necessary to dwell upon the problem of drug addiction as a disease because it will help to understand the mechanism of the recovery of individuals from the addiction as well as it will help to understand the principle of the methadone therapy itself. In actuality, it proves beyond a doubt that drug addiction is a disease, which often makes an individual unable to lead a normal lifestyle. Moreover, the progress of drug addiction destroys an individual’s will and body leading to the overall degradation and death of a drug addict. At the same time, drug addiction develops gradually and people using drugs can be unaware of the fact that they have already become addicts. This is why it is important to understand the mechanism of the development of drug addiction.
First of all, it should be said that the development of drug addiction actually starts from the moment when an individual takes a drug for the first time. In fact, this moment is often considered to be insignificant because people are convinced that they will never be drug addicts if they just try to take some drugs. However, this is a very dangerous moment because drugs may involve an individual. It is very important that an individual could cope with the desire to continue his/her experience of drug consumption because the further consumption of drugs contributes to the development of a habit and an individual takes drugs regularly.
This stage is consistently worse compared to the previous one because the regular consumption of drugs is the indicator of drug addiction. In actuality, this means that an individual develops a physiological dependence on drugs. As a rule, people start from light drugs that do not produce a profound impact on their psychological, physical and mental health. At the beginning, people using drugs can have the feeling of euphoria that stimulates the further consumption of drugs. Gradually, people become dependent on the drug consumption. However, in the course of time, drugs do not produce the desirable effect that forces drug addicts to experiment and consume new drugs and increase their dose. Naturally, such experiments produce a destructive impact on their health and undermine not only physical but also psychological and mental state of a drug addict.
Eventually, the drug consumption does not bring the desirable euphoria. Instead, it becomes a physiological necessity to consume drugs and increases the dosage. In such a way, a drug addict turns to be in a kind of vicious circle since he/she may be willing to stop taking drugs but he/she cannot do it because of the profound physiological changes and the lack of moral and spiritual power to give up taking drugs. In such a situation, an individual apparently needs psychological and even medical help in order to overcome drug addiction that implies the change of the lifestyle of the individual.
In this respect, it should be said that the change of the lifestyle is an essential condition of the solution of the problem of drug addiction because this problem affects dramatically the behavior of people. To put it more precisely, at the early stages of the consumption of drugs, the behavior of an individual starts to change. Basically, the change occurs under the impact of drugs that stimulates self-assurance of an individual and makes his/her behavior more aggressive and challenging. In fact, an individual can hardly control his/her actions, especially in the state of intoxication. Gradually, the behavior of an individual becomes more and more unpredictable.
At the same time, the longer an individual takes drug the more dramatic are the changes in his/her behavior. To put it more precisely, at the beginning of drug addiction, some elements of anti-social or illogical behavior may be observed basically when an individual is in the state of intoxication. However, as he/she becomes more dependent on drug consumption, the need in drugs increases. This means that the individual needs to take drugs more often and in larger doses. This stimulates the aggressiveness of an individual provoked by the lack of drugs and physiological need in drugs. As a result, the behavior of an individual becomes not only extremely aggressive but also unpredictable.
Furthermore, it should be said that the social behavior of an individual is characterized by the growing isolation of the drug addict from his social environment. As the matter of fact, unpredictable and aggressive behavior naturally leads to the destruction of the traditional social links an individual had before the development of drug addiction. In this respect, it is not only friends and colleagues of a drug addict that suffer from negative changes in his/her behavior but it is primarily his/her family that becomes the first victim of drug addiction. Many specialists (Leavitt, 2003) point out that often drug addiction leads to the destruction of families, increases divorce rates and provokes conflicts within families. Naturally, a drug addict can potentially be left alone with his/her problem.
At the same time, isolation of a drug addict is only a part of his/her problem. The growing need in drugs naturally stimulates the individual to spend more money on the acquisition of drugs. Gradually, this burden becomes financially unaffordable for a drug addict that forces him/her to commit crimes in order to gain more money and get another dose of drugs (Wolf, 2002, p.152). In such a way, a drug addict gradually transforms in an anti-social personality that represents a serious threat not only to his/her social environment but to him-/herself as well because cases of suicide among drug addicts are not rare.
Thus, it is obvious that the drug addiction is a serious health problem which leads to a dramatic change in the physiological and mental state of an individual, provoking him to anti-social behavior. At the same time, the growing dependence of an individual on drugs at the physiological level proves that the assistance of health care professionals is needed, including the use of medication treatment to facilitate the recovery at the physiological level. In such a way, it is possible to justify the use of the methadone maintenance therapy.
Methadone and methadone treatment
In fact, methadone maintenance therapy was developed to facilitate the recovery of drug addicts who used to consume heroine. In terms of this therapy, methadone is used as a substitute of heroine since its effects on human health is consistently less harmful than those of heroine. In this respect, it should be said that methadone is a long-acting opioid and, in its essence, it is a drug, which is used in medication treatment of drug addiction. At the same time, unlike heroine, methadone is a legal drug which is used as substitute of heroine.
In actuality, specialists (Sadovsky, 2000, 45) point out that methadone can help to stabilize the state of patent suffering from drug addiction. Originally, this drug has been introduced in drug treatment programs since the 1960s. Basically, methadone, being a synthetic opiate is primarily used for detoxification and maintenance in patients who are dependent on opiates, such as heroine. It is worth mentioning the fact that in the USA, physicians can prescribe methadone for analgesia as a schedule II drug. However, its use as a treatment for drug addiction is restricted to practitioners, clinics and pharmacies licensed by the US Food and Drug Administration for this purpose (Sadovsky, 2000, 45).
Methadone is a medication that is taken orally. Basically, it is diluted with a juice, such as orange juice. It should be said that methadone is part of a long-term maintenance treatment for people who are dependent on heroin and other opiates. The mechanism of its action is well-known. Its pharmacology accounts for its analgesic and antitussive properties, along with various adverse effects. As a rule, methadone is prescribed as maintenance therapy for heroin addicts because its long-half life delays the abstinence syndrome, making its effects less severe compared to heroin, and because it blocks the euphoric effects of and cravings for heroin (Sees et al., 2000, 1304). In such a way, it is obvious that one of the major advantages of methadone is its consistently less harmful effect compared to effects of heroine, while the lack of euphoric effects of the drug prevents patients from growing dependent on methadone.
In addition, methadone use is linked to decrease in illicit heroin use and in the incidence of infectious diseases among addicts. The methadone maintenance therapy is usually started at 10 to 20 mg of methadone (5 mg of parenteral is approximately equal to 20 mg of oral methadone) and is increased in 10 mg increments until withdrawal symptoms are controlled. Patients often require 80 – 100 mg daily to minimize the illicit intravenous heroin use. Detoxification involves tapering the dosage with the goal of achieving a drug-free state (Weinrich and Stuart, 2000, 1345). However, it is important to underline that withdrawal symptoms should be carefully controlled by health care professional during the detoxification.
In such a way, the methadone maintenance therapy facilitates the withdrawal and increases the chance of the recovery of patients with drug addiction. However, some specialists warn that the recidivism rate after detoxification remains high that means that the use of methadone does not necessarily lead to the recovery of patients, but rather facilitates this process.
Furthermore, it should be said that effects of methadone last for one or two days only that means that the drug should be taken regularly according to the dosage prescribed by health care professionals. At the same time, such an effect of methadone allows drug addicts to stop using heroin or other drugs they get used to take many times a day. But it is necessary to remember that the methadone maintenance therapy works best when combined with other services. In actuality, the main goal of the methadone maintenance therapy is to stabilize patients’ body physically so they could start to change their life for better and recover from their drug addiction.
At the same time, it is important to remember about the fact that methadone is mainly oriented on the physiological recovery of the body, while the problem of drug addiction is complex and involves not only physiological but also psychological and mental aspects. Therefore, the treatment of drug addiction should be complex too, though the role of the methadone maintenance therapy can hardly be underestimated because it contributes to the formation of the physiological stabilization which may be viewed as a foundation on which the complex drug addiction treatment program can be implemented successfully.
In fact, it is possible to single out a number of positive effects of the methadone maintenance therapy, which are related not only to the health of patients proper but also to their environment. In this respect, it should be said that the methadone maintenance therapy decreases the risk of the spread of infectious disease among drug addicts because they take methadone instead of heroin and, what is more, they take this drug orally, instead of injections which may contribute to the spread of such infectious disease as AIDS. In addition, the methadone maintenance therapy occurs under the supervision and control of health care professionals, who are able to define precisely the dosage patients need at the moment and they can observe changes in the state of the health of patients and respond adequately to these changes. In such a situation, the risk of lethal outcomes caused by the overdose, for instance, decreases dramatically. Hence, it is possible to estimate that the methadone maintenance therapy decreases numerous risks and threats to the life and health of drug addicts.
Side-effects of methadone and risks related to methadone therapy
In spite of obvious positive effects of the methadone maintenance therapy and its contribution to the treatment of drug addiction, this therapy has still a number of opponents who criticize severely the wide use of methadone in the treatment of drug addicts. In actuality, the main argument of the opponents of the methadone maintenance therapy is the idea that methadone is a opiate, synthetic drug that means that the mechanism of impact of methadone can be similar to that of other drugs (Sadovsky, 2000, 46). In other words, the regular use of methadone can lead to the formation of a dependence of patients on this medicament and, therefore, health care professionals using the methadone maintenance therapy simply change the drug their patients get used to since, instead of heroin or other opiates drug addicts used to consume, they start to take methadone, though under the supervision of health care professionals.
The supporters of the methadone maintenance therapy argue that methadone is a very tolerated medication (Weinrich and Stuart, 2000, 1347). Nevertheless, methadone can have side-effects which can produce a negative impact on patients’ health. At the same time, it should be said that the observations of patients and studies conducted in relation to the effects of the methadone maintenance therapy on patients, reveal the fact that, as a rule, side-effects are relatively few. As a rule, side-effects of the methadone maintenance therapy are distressful but they are rarely extremely dangerous and, what is more, they diminish in the course of time (Sadovsky, 2000, 46). Among the most widely spread side-effects of methadone, it is possible to name sweating, but this side-effect can appear when the methadone dose is too high or too low and, as a rule, in a clinical environment, this problem does not occur to patients taking methadone medication.
Furthermore, in some cases patients taking methadone can suffer from constipation. At the same time, specialists (Weinrich and Stuart, 2000, 1346) argue that this problem can be solved by means of increasing fiber in the patients diet and regular physical exercises and drinking more fluids. Also, patients using methadone can have sexual difficulties. For instance, some patients can have a reduced sexual desire, while others can show an increased desire associated with a better life (Weinrich and Stuart, 2000, 1348). In addition, patients taking methadone medication can suffer from sleepiness and drowsiness. This problem is common and may be caused by the consumption of large amount of methadone. Therefore, dosage of the medicament proves to be very important to the minimization of the risk of having side-effects. In some cases, the methadone maintenance therapy can lead to the weight change in patients. In fact, patients using methadone can sometimes put on weight, but some specialists argue that this change can occur because patients are eating properly and grow healthier as their drug addiction reduces. At the same time, it is important to remember about the fact that methadone should be used only under the control of health care professionals. Otherwise, methadone can be extremely dangerous if used inappropriately.
On analyzing possible problems that arise in the course of the methadone maintenance therapy, it is worth mentioning the fact that methadone crosses the placenta and can cause fetal dependence. This means that the use of methadone by pregnant women should be limited to those with opioid dependence (Sees et al., 2000, 1306). In fact, detoxification is not recommended during pregnancy because fetal distress can occur. On the other hand, women who are dependent on opioids do better with methadone than with no treatment at all. Moreover, without such a treatment, these women are exposed to the risk of the ongoing consumption of heroin and other opioids that increases risks to the health of both the women and fetal. The advantages of the methadone maintenance therapy in such a situation include longer gestational periods and higher birth weights, as well as more moderate abstinence syndrome in the neonate (Weinrich and Stuart, 2000, 1347).
Furthermore, specialists (Weinrich and Stuart, 2000, 1348) argue that potential difficulties with methadone therapy include the need for longer observation periods following overdose because of its longer half-life and variations in pharmacokinetics in infants and in elderly. The most serious adverse effect of the methadone maintenance therapy is the potential for apnea, respiratory failure and hypoxia, leading to coma or death of a patient, but such cases are very seldom (Sees et al., 2000, 1307). Other side-effects associated with long-term use of methadone include abnormal menses, urinal retention, blurred vision, biliary pain, insomnia, gynecomastia and hepatotoxicity (Weinrich and Stuart, 2000, 1346).
Anyway, it is necessary to underline that the risk of side-effects and deterioration of the health of patients is minimal when the methadone maintenance therapy is conducted by health care professionals, under their supervision and control and when the consumption of heroin and similar drugs is eliminated.


Alternatives to the methadone therapy
Nevertheless, the existence of possible side-effects evokes a strong opposition to the methadone maintenance therapy. In this respect, it is necessary to take into consideration possible alternatives to the methadone maintenance therapy. However, it is important to underline the fact that, at the moment, there are no effective medication alternatives to methadone and alternative therapies mainly involve psychological, but not physiological assistance to drug addicts.
On analyzing possible alternatives to the methadone maintenance therapy, it is possible to mention such methods as individual or group counseling as well as case management. As the matter of fact, individual and group counseling can be very helpful for patients since they encourage them to change their lifestyle. Individual counseling is oriented on the change of the personal philosophy of a drug addict since he needs to understand that he can lead a normal life without taking drugs. At the same time, group counseling is even important because it stimulates the socialization of drug addicts. When they discuss their problems together they are more likely to understand what their problems actually are and how important the solution of these problems is. In addition, they can learn a positive experience of other drug addicts who have already recovered from the addiction and stopped taking drugs.
As for case management, this approach includes crisis intervention, as well as help for social problems concerning housing or food, and legal and financial concerns (Sees et al., 2000, 1308). In this respect, it is important to underline that the provision of psychosocial treatment and social programs should enhance the methadone maintenance therapy.


Conclusion
Thus, in conclusion, it should be said that the methadone maintenance therapy is very important since it has proved to be an efficient treatment which facilitates the recovery of patients from the drug addiction, especially in relation to drug addicts consuming heroin and other opiates. At the same time, it is important to use methadone under the supervision and control of health care professionals in order to avoid possible side-effects. In addition, it is important to understand the fact that the methadone maintenance therapy is not a panacea from drug addiction, but it is an essential element of a complex program of patients’ recovery, which should include not only medication, i.e. the methadone maintenance therapy, but also psychological assistance and provision of social services to patients.

References:
Addiction Research Foundation. (1997). Co-occurring Mental Disorders and Addictions: Scientific Evidence on Epidemiology and Treatment Outcomes. Toronto : Addiction Research Foundation.
Beaudoin, C. (1997). A Comparison of In-treatment Female Alcoholics and Female Alcoholics from the General Population. Faculty of Medicine, University of Manitoba.
Blood, L. (1995). Choices Program: A Treatment Outcome Study: Preliminary Results. Nova Scotia Department of Health, Drug Dependency Services.
Haden, M. (1997). Program Evaluation Report: The Central Clinic. Alcohol and Drug Services, Ministry for Children and Families, Province of British Columbia.
Harvey-Jensen, Z.A. (1995). Adolescent Treatment: Excellence Through Evaluation. Alberta Alcohol and Drug Abuse Commission.
Koob, G.F. (1997). “The Neurobiology of Drug Addiction.” J Neuropsychiatry Clin Neurosci; 9:482-497 [1]
Nestler, E. and Malenka, R. (Mar. 2004). "The Addicted Brain". Scientific American, pg. 78-83.
Leavitt, F. (2003). The Real Drug Abusers. New York: Rowman & Littlefield.
Sadovsky, R. (2000). “Use of methadone.” West J Med January. 172:43-6.
Sees, K.L. et al. (2000, Mar 8). “Methadone maintenance vs 180-day psychosocially enriched detoxification for the treatment of opioid dependence.” JAMA 283 1303-1310.
Weinrich, M. and Stuart, M. (2000, Mar 8) “Provision of methadone treatment in primary care medical practices.” JAMA 283 1343-1348.
Wilbur, B.D. (1997). Health Standards: Edition 1. Public Health Services and Drug D ependency Services. Nova Scotia Department of Health.
Wolf, M. (2002). “Addiction: Making the Connection Between Behavioral Changes and Neuronal Plasticity.” in Specific Pathways Molecular Interventions, 2:146-157.