Is the methadone program simply switching one drug addiction for another?
Methadone is considered a Class II drug, which means it has the highest possible likeliness for abuse and dependence. Methadone shares this dubious distinction with such substances as morphine, fentanyl and Oxycodone – drugs which are legal by prescription, but which are also sold on the street and abused for the high they produce. Therefore, it’s only natural that some people would wonder whether taking methadone to ease the withdrawal symptoms from other opiates is something like jumping out of the frying pan and into the fire. Isn’t the methadone program just a medically sanctioned way of switching one drug addiction for another?
Precedent for drug replacement therapies is widely accepted
Perhaps it seems counter-intuitive to use one drug to help stop using another. However, in our medical system, it happens all the time. Consider the success of nicotine replacement therapies like the nicotine patch, lozenges, gum and inhalers for people trying to quit smoking; according to a 2001 research study, all such forms of nicotine replacement therapy were considered effective because they increased quit rates approximately 1.5 to 2-fold regardless of the setting. Though the therapies invariably involve providing the patient with some form of ingestible nicotine, their dependence upon smoking cigarettes can be more easily broken once the body is obtaining a regular dose of the drug.
Replacement therapies, whatever the replacement drug involved, work by keeping unpleasant and sometimes intolerable withdrawal symptoms at bay, so that instead of being tempted by his or her drug of choice, the addict who is participating in the program can feel satiated and can focus their attention on other therapeutic quit methods like group therapy and counselling.
Methadone is less risky than using other street drugs or tapering
If an addict believes that by entering into a methadone treatment program, they are simply going to be switching addictions, they may be reluctant to enter such a program. But the fact is that using street drugs like heroin, which are completely unpredictable when it comes to potency and thus can cause fatal overdose, is a lot riskier than entering a medically managed maintenance program. Addiction to street drugs or even prescription opiates also brings other types of risks to the user, such as:
-Communicable diseases like HIV, which can be contracted from contaminated hypodermic needles
-Damage to all major organs, including the brain, from prolonged use
-Increased risk of contracting diseases associated with living on the street, such as tuberculosis
-Diseases associated with malnutrition, such as chronic infections
-Unwanted pregnancies and birth defects
-Crime (both committing crimes, and being criminally victimized)
-Legal consequences arising from possession of illegal drugs
Compared to using illicit opiate painkillers, methadone is considered a form of harm reduction because the treatment is a strictly controlled and regulated dose that is administered at the same time each day, not an uncontrolled opioid medication taken at random, with unpredictable effects on the body.
Weaning off methadone
For many people, methadone is not intended to be a lifetime drug. This is yet another benefit of the methadone rehab program: while methadone comes with dependence, its dosage is being closely managed by a trained health care professional specializing in treating opiate addicts. When you are ready to step down your dose, your doctor will help you to wean off the methadone in a safe manner so you don’t experience crushing withdrawal symptoms or cave in to the temptation to use other opiates. Depending on how long you are in treatment and how high your methadone dosage is, you may begin to step down during your actual rehab stay – and leave addiction behind for good.
Addiction vs. Dependence
To understand the benefit of methadone and its difference compared with other opioids, it is necessary to understand the difference between these 2 concepts. While methadone comes with dependence, when administered in a controlled way as part a methadone maintenance program, in this manner it does not lead to addictive behaviour and its complications, as described below.
Addiction or compulsive drug use despite harmful is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal).
Physical dependence can happen with the chronic use of many drugs including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it may accompany addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction.
Although sometimes used interchangeably, the terms addiction; and dependence; are clinically thought of as two separate things. The National Institutes of Health says drug addiction is present when a person compulsively uses a drug despite negative and dangerous consequences and effects. A physical drug dependence means a person needs the substance to function and can have intense cravings, according to the organization.
Dependence does not always entail addiction. For example, some blood pressure medications can cause physical dependence but don’t lead to addiction, and drugs like cocaine can be addicting without physical dependence. Withdrawing from cocaine can produce depression and other psychological changes, but don’t leave users with physical problems such as chills and other flu-like symptoms.
The American Academy of Pain Medicine, the American Pain Society and the American Society of Addiction Medicine, in a collaborative effort, have adopted the following definitions: Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Addiction is a chronic disorder with a strong potential for relapse. This means users who are trying to get clean fall back into old patterns of drug use and abuse. Because opiates are so potent, they have a particularly high relapse rate. Strong cravings and other withdrawal symptoms can trigger relapse, even after a period of abstinence.