Methadone and Burpenorphine Maintenance
June 30th, 2008 by janI have never agreed with treating opiate addiction by substituting a legal opiate-like drug such as methadone or burpephenorphine for the illegal drug (e.g., heroin). Mostly what these drug treatment programs do is to maintain the patient in a state of physical dependence on the legal drug methadone or buprenorphine. Too often methadone maintenance programs are underfinanced, understaffed, and overly committed, resulting in the patient remaining in the drug culture and frequently addicted to other drugs and alcohol. I understand the public health argument that these programs can reduce i.v. use, crime, and the spread of AIDS and other STDs, and would favor these programs if the goal were at some point to move the patient to abstinence from all drugs (other than the prescribed drug) and alcohol, and to getting off of the methadone or buprenorphine. I worry about buprenorphine treatment where a physician after completing an eight hour training, will now treat opiate addiction out of his/her office; I wonder what addictions treatment and counseling the patient will receive, in addition to the buprenorphine. I favor comprehesive addictions treatment for opiate addition, with abstinence as the goal, and with 12 Step facilitation therapy (NA and AA).
Jan Williams www.alcoholdrugsos.com
Tags: opiate treatment
June 30th, 2008 at 10:23 pm
12 step treatment has a very low effectiveness rate for opiate addiction. The goal of methadone treatment is not to move the patient to abstinence, though that may occur in some cases, and many people misunderstand this. Most people in MMT have failed abstinence based treatment countless times, due to permanent, often irreversible damage to the production of endorphins in the brain. Without these chemicals, the patient is severely depressed, unable to experience happiness or pleasure, anxious, exhausted and lethargic, and has severe cravings. Quite simply, it is similar to diabetes, in which the pancreas shuts down and no longer produces insulin, so the patient requires exogenous insulin supplementation, only in this case it is the brain chemistry that is malfunctioning, requiring exogenous opioid supplementation. Methadone enables the patient with sustained, permanent damage–the type that does not begin to resolve after a period of abstinence–a chance to lead a close to normal life without causing a high or euphoria, by stabilizing the brain chemistry. The patient is not “addicted” to the methadone–they are “dependent” on it. Addiction involves a set of behaviors in addiction to dependence that are not present in a stabilized patient not abusing other drugs. Insisting that these patients be “detoxed” over and over again because society views opiates in a negative light and sees a “drug free state” (often with the marked exception of gallons of coffee and packs of ciggarettes) as the only “real” recovery, leads to stigma, shame, and people leaving treatment in a desperate desire to please others, only to die with a needle in their arm a few months later. All the 12 stepping on earth cannot treat what is, for some, a biochemical brain disorder.
July 1st, 2008 at 3:53 am
Zenith,
With respect, all of what you said is the usual justification presented by methadone advocates to support often permanent treatment of opiate addiction through use of methadone. I am not maligning good methadone recovery. I DO know of good recovery using methadone, meaning a stable life in all areas (job, relationships, no crime, no drug use other than methadone), but that result does not mean that substitution therapy is the only treatment modality for most narcotics addicts. It is clear, as you said, that use of opiates, and many other drugs such as benzodiazepines, cocaine, etc., over time can cause changes in brain chemistry in the reward pathway of the brain that results in strong cravings to use the opiate; and these changes can be persistent. However, it is NOT true that opiate addicts are unable to fully recover without continued use of a legal opiate such as methadone or buprenorphine. There are thousands of members of NA with good, solid recovery. Does the NA experience mean that the recovering addict’s brain chemistry has healed? No one knows for sure. It may very well be that just as the stroke victim can develop alternate pathways to recover, so can the abstinent addict. Research using brain imaging studies show that depressed patients successfully treated with cognitive behavioral therapy (talk therapy) have brain wave changes identical to those of the depressed patient successfully treated with an antidepressant medication. The same changes in the brain may be present in the brain in drug addicts successfully recovering through talk therapy in NA and treatment programs.