Why the Bias Surrounding Methadone Needs to End Now
The opioid crisis — the staggering number of individuals battling Opioid Use Disorder and dying from opioid-related overdoses — has persisted through two decades. Until recently, it was considered the worst public health tragedy to affect Americans since the AIDS epidemic of the 1980s. That was, of course, before Covid-19, which has already claimed over 200,000 lives in the US alone.
Although current events may have decreased the public’s focus on opioid addiction, it nonetheless continues to take lives and shows no signs of slowing down anytime soon. According to preliminary data from the Centers for Disease Control and Prevention, deaths in the United States resulting from drug overdoses increased by 4.6% from 2018 to 2019, with two-thirds of these deaths being opioid-related.
With this increase in opioid addiction comes an increased interest in the many forms of drug rehabilitation and substance abuse treatments currently available. One option which has become more and more popular is MAT (or Medication-Assisted Treatment). MAT involves the utilization of certain prescription drugs in the treatment of substance use disorder. There are three medications currently approved to treat opioid addiction in the US: buprenorphine (Suboxone), Vivitrol, and methadone.
The Benefits of Methadone
Although treatment for opioid addiction with buprenorphine and Vivitrol began relatively recently (the FDA approved them for this purpose in 2006 and 2010, respectively), the use of methadone started successfully in the 1960s. A synthetic opiate itself, methadone works by mimicking certain neurotransmitters (a type of chemical used to communicate messages in the brain) and acting on the same receptors that opiates like heroin and morphine do.
Methadone has a long history of being misunderstood and is often criticized by those who don’t understand it and view its use in treating opioid addiction as simply switching out one high with another. According to the National Institute of Drug Abuse, this is not the case. Methadone has a gradual onset, unlike heroin, which produces a rapid rush of euphoria but quickly ends with a “crash.” Methadone activates the brain’s receptors at a much slower rate, so it doesn’t produce the same euphoric high that other opiates do but instead eliminates withdrawal symptoms and drug cravings. Methadone can effectively block the euphoric effect of other opioids, were they to also be taken during treatment.
The therapeutic value of using methadone in the treatment of opioid addiction is well- documented. Patients using MAT are twice as likely to remain in treatment than those who do not. Methadone, in particular, has been shown to reduce a patient’s intravenous drug use (thereby also reducing transmission of HIV infections among opiate abusers) as well as the amount of criminal activity committed by opiate addicts.
A Treatment Rising in Popularity
Although methadone has been the drug of choice in treating opioid addiction for the past 60 years, its popularity has grown dramatically in the past five years. According to Mark Parrino, President of the American Association for the Treatment of Opioid Dependence, the methadone treatment industry grew more between 2014 and 2018 then it did over the past two decades.
There were over 254 new methadone clinics and OTPs (or opioid treatment programs) built in the US during that time. These highly regulated facilities are the only places where methadone can be prescribed for opioid addiction. Many states loosened previous building requirements and requested that the treatment industry build new facilities to meet the demand.
Barriers to Treatment
Even with all the new clinics that have opened their doors in recent years, many addicts still do not have access to methadone treatment. Due to extremely stringent regulations, the prevalence of clinics varies significantly by location, and many rural and suburban areas are immensely underserved. Some states have laws that curtail building new clinics, even though many addicts in those states live too far away from any clinic to commute.
The long associated stigma surrounding methadone treatment has also been one of the biggest barriers to treatment. Despite its proven benefits, the drug continues to be scrutinized by political groups and community members. Although not an official policy of Narcotics Anonymous, many members of the popular 12-step organization look down on its use and criticize members using methadone and other forms of MAT in their recovery.
The Future of the Epidemic
The opioid epidemic continues to cause ruin and take the lives of thousands of individuals each year. Reports have shown that Covid-19 has caused an even more significant rise in mortality rates from opioid overdoses, making the need for effective types of treatment more important than ever. Methadone has long been the preferred drug of choice in treating opioid addiction, and it continues to grow in popularity. Hopefully, by raising awareness and educating the public about its vital role in treating opioid use disorder, the stigma surrounding methadone will be replaced by improved access, support, and advocacy.