We are being told that there’s a heroin epidemic in the United States that is killing scores of young people. The Midwest has become one of the hot spots of heroin use where it’s as easy to order it with your cell phone as it is to order pizza. Part of the reason there’s an increase of opiate use is that for years doctors prescribed painkillers such as Percocet, Vicodin and OxyContin thinking they were non-addictive. When they didn’t work to numb pain, people turned to heroin. And heroin is cheaper than prescription drugs.
It’s time to remove the stigma from heroin use and talk about treatment, specifically methadone maintenance.
We are often told that the use of methadone as a substitute for heroin is just “replacing one addiction with another” and that total abstinence is the preferred course of action. Critics of methadone incorrectly conclude that patients who are in methadone maintenance programs are impaired because both methadone and a newer medication called Suboxone can produce a “high.” However, if an individual is taking the same dose of the medication at the same time daily it no longer produces euphoria or impairment. And if calibrated appropriately, taking heroin “on top” of the methadone or Suboxone won’t work.
Maintenance has been proven to reduce crime, stop the spread of disease caused by intravenous drug use and increase employment as long as the medication is continued without interruption.
According to Maia Szalavitz in the NY Times article, “The War on Methadone,” opioid addiction should not be confused with the general concept of physical dependence. “Opioid addiction. . .is not simply needing a substance to function. . .[it] involves compulsive behavior in the face of negative consequences; obsessively pursuing a drug or experience even though it is ruining your life. Maintenance replaces unhealthy behavior with simple dependence, the need to take a drug to avoid withdrawal.”
The Centers for Disease Control, the Institute on Medicine and the World Health Organization have determined that for opioid addiction—heroin, OxyContin and Vicodin—ongoing maintenance is superior to abstinence. Maintenance is the only treatment known to reduce drug-related mortality, which it cuts by more than 70 percent.
According to Kenneth Anderson, “Maintenance treatment with methadone or Suboxone is the gold standard for treating opioid dependence. Patients on the proper dosage of maintenance medications are neither high nor sick—they are normal and functional.”
Drug courts have been instituted to help defendants get treatment and avoid prison time but only a third allow maintenance use of methadone or Suboxone. Gov. Andrew Cuomo of New York and Gov. Chris Christie of New Jersey are both considering whether to sign bills that have passed their State Legislatures to force all courts to allow this treatment. It’s time to increase the conversation and de-stigmatize methadone treatment.