What is Methadone Maintenance Treatment?
Methadone maintenance treatment remains the most widely used form of treatment for people who are dependent on opioids.
Methadone itself is a long-acting synthetic opioid agonist, which is prescribed as a treatment for opioid dependence/addiction. People who are dependent on opioids may be dependent on either oral or injectable forms of opioids. Some individuals may also snort or smoke opioids.
There is no universal definition of what a methadone maintenance treatment “program” is–although the common thread is clearly the use of methadone. Program components and policies vary widely around the world, and within Canada. A comprehensive approach to methadone maintenance treatment, however, generally includes a number of key components–which can be delivered in a variety of ways and at varying levels of intensity–including:
- methadone dose;
- medical care;
- other substance use treatment;
- counselling and support;
- mental health services;
- health promotion, disease prevention and education;
- linkages with other community-based supports and services; and
- outreach and advocacy.
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Isn’t Detox Better Than MMT?
Detoxification from opioids focuses on managing withdrawal symptoms as a person abruptly stops using opioids. While often seen as the first step in addressing opioid addiction, detox alone is generally ineffective, with over 90% of patients relapsing. This high failure rate is because detox only addresses physical withdrawal symptoms, ignoring the mental and emotional aspects of addiction, such as dependence on opioids for mood regulation. Detox may work for a minority of patients who have a purely physical dependence, such as those using opioids for pain relief without seeking euphoria or stress relief. However, for most opioid-addicted individuals, a maintenance program involving methadone or Suboxone offers better long-term stability, allowing the brain to adapt to a new chemical balance before potentially tapering off the medication.
As discussed, “opioid-addicted” patients (those with any history of seeking mood alteration from the opioids) are usually not good candidates for a detox program. If chosen by the patient to enter the maintenance program, he or she can be stabilized on an appropriate dose of methadone or Suboxone. While on a stable dose, the patient then can go back to fixing the tolls that addiction took on their lives. A stable dose in maintenance allows the patient to feel just normal, alert and functional without feeling any of the highs and lows that come with the abuse of the short-acting opioids such as oxycodone (OxyContin or Percocet), fentanyl, hydromorphone (Dilaudid), heroin, morphine, codeine, etc. This stability also allows the patient’s brain to slowly adapt to a new chemical balance. Once a patient has been stable in this way, and avoided all abused drugs for a considerable duration, then an attempt could possibly be made in tapering the dose of methadone very slowly while carefully monitoring for signs of relapse. To lower the chance of relapse, the process should take at least one year from the last date of problematic drug use, but could take much longer for many opioid-addicted patients.
Who is MMT for?
If you’ve been using opioid drugs such as heroin, OxyContin, codeine, Dilaudid, Percocet and others, and you’ve come to a point where you know you can’t go on using, but you can’t seem to stop either, methadone maintenance treatment (MMT) may be right for you. A physician consultation and examination is required who is a candidate for MMT. MMT is generally useful for those over 18 who meet a diagnosis of opioid use disorder based on the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders).
Opioid Use Disorder (OUD) in the DSM-5 is diagnosed when an individual exhibits at least two of the following within a 12-month period: taking opioids in larger amounts or over a longer time than intended; unsuccessful attempts to reduce use; spending excessive time obtaining, using, or recovering from opioids; experiencing cravings; failing to fulfill major obligations due to use; continuing use despite social or interpersonal problems; giving up important activities; using opioids in hazardous situations; continuing use despite physical or psychological harm; developing tolerance; and experiencing withdrawal symptoms.
How long is MMT?
This is a very common question. Even after about 40 years of international experience with MMT, there is still no one answer to this question. The best possible answer is that most people who are successful coming off methadone show three important characteristics:
1- Their lives have been stabilized after they’ve been on methadone maintenance treatment for more than a year.
2- The decision to stop taking methadone is made with their doctor, who gradually decreases the dose while providing support.
3-They’ve made changes in their lives that show they’re stable. For example, they may have a stable family life, support from the non-drug-using community, steady satisfying employment and fewer financial or legal difficulties.
What is the Goal of MMT?
Methadone maintenance is a long-term treatment for addiction to opioids. Once a patient is stabilized on a stable dose of methadone, the negative thoughts, associated with addiction, often diminish and go away. The patient’s life tends to normalize and functioning increases, which can include caring for their families, working, achieving educational goals, addressing both mental and physical health co-occurring disorders and enjoying an active, healthy lifestyle. Achieving a healthier, normal life through methadone maintenance is a valid form of recovery from opioid addiction. Improvement in all areas of health and social integration increase with the length of time in treatment. The greatest positive change comes in the first year of treatment.
Isn’t Detox Better Than MMT?
Similar to the medicines prescribed for diabetes, asthma, high blood pressure, depression, or other chronic medical problems, methadone is not a magic treatment. No single medication or behavioral intervention can be a magic bullet for all patients seeking help for opioid addiction and the medical, psychiatric or social problems which may co-exist with it Methadone maintenance treatment has proven to be the most effective way to treat opioid addiction. Research shows that life expectancy, health and vocational and educational achievement are much improved while substance abuse and criminal activity are greatly reduced for patients in MMT. Proper use of medication eliminates withdrawal symptoms and the craving for heroin, oxycodone, hydromorphone or other opioids and the structure and counseling required and offered provides an opportunity for patients to address problems and issues related to their addiction.
How is Methadone Taken?
A Your doctor will provide the pharmacy with a prescription for your methadone. This prescription must be renewed periodically by your doctor. He or she will determine how often you come for appointments, depending on your needs and progress. Methadone is a medication that is taken orally. It is diluted with juice such as orange juice. When you first start on methadone, you will be asked to go to your pharmacy each day to drink the medication. As you progress in your treatment, you may be eligible to take home some doses. These are called “carries.” Your carries must be stored safely to make sure the medication is not taken by anyone else, especially a child. Carries should be refrigerated.
Is MMT a Cure?
It depends on how one defines cure. Methadone in MMT is a medication that will control your addiction, so you can get back to normal functioning in life. If one defines cure as absolute abstinence from all opioids, there is no medication or technique that has been shown to achieve that. However if one defines cure as getting back to normal functioning, work and family life, then methadone maintenance can be viewed as an effective cure since it has been shown more than any other medication or method to achieve these goals.
How do I get off MMT?
MMT is voluntary, so you can stop it at any time. However, studies have shown to successfully stop methadone without a very high chance of relapse to abusing other opioids, one has to be in the program at least 1 year (preferably 2) from the last use of illicit hard drugs. A successful taper of methadone can be tried very gradually over a 3-6 month period, while carefully monitoring for signs of relapse to illicit drug use.
