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Methadone still tugs at emotions

April 3, 2015
by Gary A. Enos, Editor
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Letter From the Editor

Maybe it was because I was days away from preparing to attend the largest national gathering of executives from opioid treatment programs (OTPs), but a mid-March press release about methadone from Novus Medical Detox really caught my eye. The comments from the New Port Richey, Fla., facility certainly stood in sharp contrast to the tone of the discussions I would expect to hear a couple of weeks later, at the American Association for the Treatment of Opioid Dependence (AATOD) meeting.

“Beyond methadone's association with addiction, health risks and potentially fatal overdoses, patients prescribed the drug may also experience discrimination in the workplace,” the March 12 press release reads. “Even with a legitimate prescription, methadone often carries a substance abuse stigma or perceived occupational-safety risk.”

Novus's own website delivers an even sharper message. The heading for the website's description of the Joint Commission-accredited facility's methadone detox services reads, “Methadone Ruins Lives—Get Yours Back.”

I decided to contact Novus executive director Kent Runyon, asking him if he was concerned that this messaging could further stigmatize addiction—as well as the many individuals who have benefited from high-quality methadone treatment services. Runyon replied that he can understand the diverse perspectives that prevail on these topics, but he added that Novus continues to see a considerable number of patients who began a daily course of methadone for opioid addiction but ended up feeling somewhat misled by program professionals.

“They felt inadequately informed and educated about the challenges of methadone, and how difficult it would be to get off methadone,” says Runyon. “I see the ones whose tolerance and use level have increased, and no one seems to have had an interest in or ability to taper them down.”

Business has been brisk at Novus, which recently expanded to a capacity of 31 beds (I visited the Florida facility three years ago when it was a considerably smaller operation). A high percentage of its detox patients are seeking methadone detox (some have been in an OTP, while others may have been taking methadone to treat pain), says Runyon. A typical length of stay for methadone detox is around 12 days, he says.

Runyon points out, “I don't throw every methadone clinic in the same box,” but adds that too often he sees current or former OTP patients and wonders, “How did this person get this high a dose?” He says he now sees a similar pattern emerging with dosing of buprenorphine, which he says also presents a challenging detox.

“I recognize that addiction and dependency are highly complicated,” says Runyon, and he personally sees methadone as having a potentially beneficial harm reduction role for patients who cannot succeed at the outset in abstinence-based treatment. But he adds, “Let's look at methadone maintenance as Plan B. To talk about why you're using the drugs in the first place should be Plan A. I think that too frequently methadone becomes Plan A.”

Methadone has been one of the most highly stigmatized treatments in the addiction toolbox, and comments about methadone-related deaths need to be placed in the proper context because comparatively few of these occur among OTP patients. But where and how do you believe methadone best fits in the treatment equation? Share with us your treatment provider's perspective about methadone.



We in the Substance Use Disorder Treatment field have been saying that Addiction is a "Chronic Disease" for the thirty years that I've been in the field, but our treatment models more closely mirror the Acute Care model and we continue to promote the stigma associated with substance use disorders in our facilities and by our actions. The use of medication is a prime example. When a physician is treating an individual with Hypertension or Type II Diabetes, that physician knows perfectly well that the most effective treatment for those conditions is lifestyle changes with respect to diet and exercise. He also knows that his first responsibility if to keep that person alive. He uses medications to do that and his main goal is not to see how quickly he can get the patient off of the medication but to keep him alive. And please, don't use the worn out canard of "Methadone and Suboxone are Mood Altering Substances". Most providers don't have a problem with caffeine, nicotine, sugar or anti-depressants that are all "mood altering. In Addiction treatment, we steadfastly insist on the 12 Step Model of abstinence based treatment even when, as in the case of opioid use disorders it is a dismal failure and contributes significantly to overdose deaths. We wonder why as a field we are viewed as "less than" by our colleagues in the helping professions when we ignore evidence based treatment modalities in our toolbox and primarily use the tool of "don't drink, go to meetings, read the Big Book and call your sponsor". As healthcare integration moves forward we as a field need to change or we will become irrelevant.

We don't still listen to people claiming that the earth is flat. Why do we, as a profession, still spend time debating with and giving credence to those that refuse to accept science and evidence and continue to exploit sick and desperate people for profit? All the while our children continue to die on the streets as we cycle them through ineffective abstinence based treatment programs and sub-therapeutically dosed maintenance programs with a goal of discontinuing their life saving medication.