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Profile:  Methadone Maintenance
 The "Invisible " Success Story

A client receives counseling along with her                                                     medication  at Beth Israel's methadone clinics.


- - - - Every day some 115,000 Americans take the prescribed drug methadone, a synthetic opiate, used as maintenance treatment for heroin addiction.  - Studies find that two-thirds of methadone patients show dramatically decreased drug use, decreased criminal involvement, and improved life circumstances.

Heroin is one of the hardest addictive drugs to "kick" for good. It provides a euphoric rush, and chronic users can experience intense cravings for more of the drug even years after last use.
 

Methadone can help with these problems. It is also an opiate, but because it is taken orally, it does not provide a euphoric rush. It is long-acting, so the patient no longer experiences the extreme ups and downs that accompanied the wax-ing and waning of heroin blood levels.

 Furthermore, because methadone actually blocks the "high" from any heroin use, a patient on it has little motivation to use heroin again.   - - Essentially, the patient remains physically dependent on an opiate,  - - - - - but is freed from the compulsive, uncontrolled, and disruptive use seen in heroin addiction.

Still, misconceptions abound and continue to limit methadone's availability. Neighborhood groups often oppose a new clinic because they assume it will lead to higher rates of drug use and crime (studies show these rates actually    go down).  And those favoring a "drug-free" approach often dismiss methadone maintenance as merely "substituting one drug for another."


Despite such skepticism, Beth Israel Medical Center in New York has prescribed methadone for 33 years, serving some 8,000 patients in 22 clinics throughout the city. Patients receive not only their prescribed methadone, but a comprehensive range of medical care, drug and health education, and counseling.

- - - -  Those enrolled at Beth Israel's program are racially diverse and include lawyers, bankers, homemakers, graduate students, and musicians, as well as some long-term unemployed. - - - Peter Vanderkloot, 33, a patient and now a counselor in the program, notes that, despite this diversity,  - - -a stereotype of methadone patients persists because most successful methadone patients are "invisible."

"The better someone does in treatment, the more successful he or she becomes in life, the more secretive he or she is about being on methadone," says Vanderkloot. "We're simply not who people think we are." 


Methadone treatment has long been hampered by government regulations that require most patients to come to the clinic five to seven days a week. - - - This requirement works against patients' efforts to maintain employment, as they must often leave work and travel some distance to keep appointments.

Recently, U.S. drug "czar" Barry McCaffrey recommended making methadone more readily available by allowing doctors to prescribe it - - - - like any other medication (as is already done in Great Britain, the Netherlands, Germany, Australia, and elsewhere).

Beth Israel has been experimenting with this approach for some time. A special "medical maintenance" program allows long-standing patients to take home a four-week supply of methadone to self-administer. - - -  Edwin A. Salsitz, M.D., director of the program, likens the prescribing of methadone for addicts to pre-scribing insulin for diabetics.  - -  -In either case, he says, "It's simply a medical treatment for a medical condition."

For further information about admission, call: (212) 420-2389.

For other program information, contact Marie Marciano, Administrator, at: (212) 387-3930.

-Donna Boundy

 Profile: Methadone
 Maintenance at
 Beth Israel .
             


- - -  Treatment for addiction usually consists of behavioral-oriented strategies,     such as psychotherapy, group counseling or family therapy, designed to help  the addicted person change.  - -  Medications designed to suppress withdrawal symptoms and drug craving, or to block the "high" produced by the drug, may help by making abstinence easier.

Although the general area of pharmacotherapy for drug addiction is still a brave new frontier, there are several well-tested methods, particularly for opiate and alcohol addiction/dependence, that are known to be effective.  (But even those who support pharmacological treatment believe it must be done in conjunction with counseling and other therapy.  Research shows that medication alone has success rates that are no greater than if a placebo was used.)


- - -  Methadone, a substitute opiate medication that quells heroin withdrawal and craving, is the most successful proven treatment for heroin addiction in terms of reducing heroin use and improving social functioning. Hundreds of studies have shown that methadone patients have significantly reduced heroin use, particularly if they remain in treatment for long periods; that they commit fewer crimes; and that they are better-functioning.

Taken orally in pill or liquid form, methadone is a weak-acting synthetic opiate agonist (a medication that has pharmacological actions that are similar to the abused drug). While it imitates the action of opiates like heroin, thereby stabilizing the level of opiates in the bloodstream (and preventing withdrawal and craving), it doesn't produce a comparable euphoria or high.

So convinced are members of the medical and scientific establishment about the effectiveness of methadone that a National Institutes of Health expert panel in November 1997 urged the government to widen its availability so that more heroin addicts can
benefit from it.   -  - -  - Despite its proven effectiveness, however, the medication has become increasingly difficult to obtain. There are an estimated 600,000 heroin addicts in the U.S. But, because of limited access, only 115,000 of them receive methadone treatment.  (See Policy: The Politics of Methadone.)


- -Finding a treatment for heroin is becoming even more imperative given that the face of the heroin user is getting younger. In 1995, 141,000 people tried heroin for the first time; 25 percent of those people were teenagers.    - - - Federal data show that there was a rise in heroin use among 8th, 10th, and 12th graders between 1991 and 1995.   In 1994, nearly 60 percent of hospital emergency room admissions for heroin-related illnesses was among teenagers under age 18.  In Boston, treatment agencies reported a surge in young heroin users in 1995 and early 1996.  - -  (The increased use of heroin may be due to the fact that it is now available in much purer forms, thus making it easier to "snort" rather than inject.)

One of the most promising new treatments for heroin addiction is levo-alpha-acetyl methadol, or LAAM.  - - - Approved by the FDA in 1993, LAAM was the first new medication for heroin addiction approved in more than 20 years. Like methadone, LAAM blocks cravings for heroin and eliminates the high if heroin is taken.  - - Its advantage is that it is longer-acting than methadone -- a big plus when patients must report to a clinic for each dose, as most methadone programs in this country currently require.

Another promising medication for opiate addiction is called buprenorphine, which does not appear to produce the same level of physical dependence as methadone. Discontinuing it is easier than stopping methadone treatment, because there are fewer withdrawal symptoms.    -  -  - It is not yet approved for treatment of opioid addiction and is still being studied by the National Institute on Drug Abuse.


- - - - - There are no effective pharmacological ways to treat cocaine addiction yet available.   - - Most cocaine users are treated via psycho-social avenues, with an abstinence approach. But there are promising prospects being tested on animals. One is GBR 12909, a compound first tested in Europe as a potential antidepressant. - - - In 1995, federal researchers studied the effects of GBR 12909 on cocaine use by monkeys and found that under the right conditions it could completely eliminate cocaine-seeking behavior for a couple of hours. One researcher who has examined the drug's effects on rats - - has said GBR 12909 might even reverse the process of cocaine addiction.  - - The drug and some related compounds are being tested for possible use with humans.


- - -Nicotine is one of the most addicting drugs of abuse, and one of the hardest to kick for good.  - - - - -  According to Charles O'Brien, M.D., Ph.D., Director of the Addictions -Research - Center at the University of Pennsylvania Medical Center in Philadelphia, - - - - - some 70 to 80 percent of people formally treated for nicotine dependence resume smoking by the end of a year.  However, aids like the nicotine patch and gum have been developed to help some of those who want to quit.

- - Most recently, an antidepressant called buproprion has also been shown to help people quit smoking. It's been on the market for this use since the summer of 1997 (under the brand name Zyban) and is the first FDA-approved non-nicotine product design-ed to help smokers quit. 

-Researchers think it works by helping to normalize neurotransmitter levels in the brain.


- - - Some recovering alcoholics take a medication called disulfiram, or Antabuse, which supports abstinence by making them very ill if they drink alcohol.

- - - - Another medication, called naltrexone, was developed to prevent relapse to opiates such as heroin by blocking the receptors for those drugs in the brain. 

-- But heroin addicts tend to resist taking it because it can cause dysphoria, or low mood, in those patients and does not eliminate craving for heroin. -  -  Naltrexone has also shown more promise, however, in the treatment of alcoholism, by reduc-ing cravings for alcohol and blocking some of the drug's "high."   It lowers relapse rates in recovering alcoholics - - and tends to stem minor relapses from becoming full-blown binges.

University of Pennsylvania researcher A. Thomas McLellan, Ph.D., estimates that adding naltrexone to psychosocial treatments for alcoholism produces at least 30 percent more benefit than treatments without it.


Because many addicted people also suffer from co-existing psychiatric problems, such as depression or anxiety, that may interfere with recovery, treating those conditions can be very valuable in helping them maintain sobriety, experts say. Researchers are examining questions such as whether giving antidepressants such as Prozac increases sobriety rates. Some studies have been promising.

One recovering alcoholic, who asked not to be named, comments, "I really wanted to quit drinking - - - I checked myself in for three weeks of inpatient treatment and then joined AA --- - but I couldn't manage a lasting sobriety until I got my chronic depression and attention - deficit  - disorder diagnosed and appropriately treated, which in my case was with medication. It's really hard to stay sober when you feel lousy all the time -- eventually you just want relief.  - I knew that if I drank again, I might die; - - -  but how much of a deterrent is that when you're suicidal anyway?"

-- Janet Firshein

Editor: Deborah Shrira                          Updated:  19 February 2008

Profile Of A Methadone Maintenance Program

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