Friend or Foe: The Role of Methadone in Opiate Addiction Treatment

Methadone is a synthetic opiod analgesic used to relieve pain. It is also used in detoxification and maintenance programs for opiate addicts, particularly heroin users, because it binds to opiate receptors in the brain, relieving cravings and preventing withdrawal symptoms without producing a euphoric response. Although its benefits for managing withdrawal symptoms made methadone an off-label choice for opiate detox since the 1940s, it was not until after Dr. Vincent Dole and Dr. Marie Nyswander released their research on methadone treatment in the 1965 that it became an formally recognized and broadly used weapon in the fight against opiate addiction. The doctors administered oral doses of methadone to 22 heroin addicts and observed significant behavioral changes amongst even severely addicted subjects. Their study notes that “patients have shown marked improvement; they have returned to school, obtained jobs, and have become reconciled with their families.”

The promise of hope for restoring the lives of heroin addicts was tantalizing, and many hailed methadone as a miracle drug. By the time Nixon was in office, methadone detox and maintenance programs were in full swing, with ample federal funding for dedicated clinics that continued to spread throughout the United States. However, methadone was not without its critics. By 1988, President Ronald Regan’s White House Conference for a Drug Free America publicly raised the question of whether “methadone substitutes one addiction for another.” Part of Mayor Rudolph Giuliani’s clean up of New York City in the 1990s included the plan to end methadone treatment in city hospitals, transferring 2,100 heroin addicts into abstinence programs and describing methadone as “an enslaver.” Five months into the program, all but 21 of the addicts were still taking methadone, and of those 21, 5 had gone back to using heroin. Giuliani reversed his policy, stating that it “turned out to be too frightening, too jarring and maybe somewhat unrealistic.”

As psychiatrist Sally Satel, a scholar at the American Enterprise Institute, writes in an extensive and fascinating article on methadone in the Washington Monthly, “in some ways, these rapid shifts tell the story of methadone maintenance: both the government and the treatment community swing back and forth between recognizing its value and shunning it as just another form of drug use.” It also represents the shifting internal dialogue of many opiate addicts seeking to end their destructive dependencies. Whether or not to turn to methadone during detox or for long-term maintenance is a deeply personal decision that requires careful consideration and information regarding the benefits and drawbacks.

Pros of Methadone Use

• Prevents the physical pain of withdrawal.
• Minimizes cravings for illicit opiates.
• Provides a buffer against emotional lows caused by the damage of long-term opiate use on the brain.
• Treatment is affordable.
• Because it is taken orally, users no longer rely on IV-injections and their attendant risks.
• Methadone is a regulated pharmaceutical and you are assured of purity and quality.

Cons of Methadone Use

• The reason you don’t have physical withdrawal pain is that you are still on opiates, which continues to negatively affect brain function.
• While you may avoid withdrawal from your primary opiate, getting off of methadone can be just as hard, causing many people to stay on it for years, or even indefinitely. Because methadone is longer-acting than opiates like heroin, withdrawal is a longer process.
• In order to avoid withdrawal, you must stay on a strictly controlled schedule of methadone, which may involve daily trips to a clinic, interfering with your ability to work, travel, and keep family commitments.
• You may experience side effects from methadone, including impaired emotional and cognitive function, fatigue, weight gain, sexual side effects, and muscle aches.
• Methadone can be dangerous and excessive use can lead to overdose and even death.

For some, methadone is undoubtedly life-saving. The World Health Organization considers methadone maintenance to be the single most effective opiate addiction treatment and the lived experiences of many users starkly illustrate its efficacy. One anonymous writer says, “I’ve been taking this drug since 2010, and what I have to say is this: Methadone saved my life. It took me off the street and allowed me to function as a normal member of society.” Others, however, find that the side effects and practical limitations interfere with their ability to function and that methadone is simply a new addiction that strips them of their authentic self. Cathy M. used methadone for seven years when she decided she had had enough:

[I started] to think of the damage methadone was doing to my entire body and mind. Around this time, my aunt (who I was extremely close to) suddenly died. I wasn’t even able to mourn her in the right way because I could barely feel anything. I was empty. I realized I needed to at least try and detox off methadone. I didn’t want to live my life being chained to the clinic anymore. I was getting married and I wanted to eventually have kids. I didn’t want to be pregnant and standing in line at the methadone clinic.

Methadone also does not solve the problems that drove your addiction in the first place, keeping you locked in a state of emotional dysfunction and reliant on a drug that can cause further psychological damage. Many methadone users feel trapped, unable to truly move forward while still opiate-dependent, but terrified of the pain of withdrawal.

The fact is that unless you plan to stay on methadone for the rest of your life, you will have to go through withdrawal sometime, whether it’s coming off heroin, morphine, fentanyl, or methadone itself. While withdrawal may be a frightening prospect, with the right supports, you can make it through with minimal discomfort and begin your journey toward a drug-free life. As Cathy writes, “If you are on methadone know that it is possible to come off and stay sober—if you want it bad enough.”