Methadone

There's nothing pretty about opiate addiction. Heroin, the U.S.'s most commonly abused opiate, offers a euphoric rush, then drowsy mindlessness that lasts maybe six hours, followed by a crashing craving that lasts maybe forever.

Addicts run the risk of death if they inject a bad dose, or HIV if they share a needle with the wrong junkie. A heroin habit can cost hundreds of dollars a day, a tab that's hard to cover when one is high and wasted. The drug drains society of billions in costs for crime, hospital care, incarceration, foster care, injuries, and death.

In the U.S., some 800,000 people are chronically addicted to heroin, and a growing number are becoming addicted to OxyContin, another synthetic opiate. There are also an unknown number of weekend warriors, trying to get along on the edge of addiction.

In the scheme of national health tragedies, this may not seem like a lot of people, but the pain and hopelessness for addicts, their families, and society cries out for compassion and a national solution.

For 40 years, methadone has offered one such hope, but its power to help addicts has been challenged almost continuously. It is controversial and carries its own dark stigma.

A synthetic opiate, methadone can control the dull roar of pain. It blocks the brain's opiate receptors and can curb craving for heroin or morphine without offering the intense, short-lived blast of euphoria and drowsiness that comes with other opiates.

A narcotic painkiller, methadone was first synthesized by German chemists just before World War II in a search for a nonaddictive painkiller. When used by heroin or morphine addicts, methadone fills the m-opioid receptors in the brain, essentially taking the place of those opiates and negating their influence. Methadone is longer lasting than heroin, allowing 24 to 36 hours before it must be retaken, rather than six hours between a heroin fix. It can be taken orally, breaking an addict's pattern of injection, and it produces a weak "high" that disappears with longer treatment, as does the intense craving for more.

Several of these properties were noticed in the late 1940s, and methadone began being used to help detoxify heroin and morphine addicts who were trying to kick the habit. Withdrawal from methadone is tough but less painful than withdrawal from other opiates.

A series of studies in the mid-1960s at Rockefeller University in New York City, led by Vincent Dole and his colleague and wife, Marie Nyswander, found that methadone could also be a viable maintenance treatment to keep addicts off heroin and give them a fighting chance to function in society. The researchers were looking for a way to curb the growing opiate addiction plaguing New York City.

"They looked at a small group of people with long histories of addiction," says Joycelyn Woods, president of the National Alliance of Methadone Advocates and a neuropsychologist. "They tried treating them with different levels of morphine, but the subjects just sat there day after day watching TV and waiting for their next shot. Nothing happened.

"When everything else failed, they switched the subjects to methadone. They raised the dose higher than that used to detoxify addicts, and after about two weeks, the addicts began to behave differently. One guy had been a tradesman and wanted to rejoin his union and go back to work; another guy suddenly started painting furiously; a third one wanted to get a high school degree. They weren't sitting in front of the TV anymore. It was like they picked up their lives where they left off years ago," Woods says.

But staying heroin-free is not easy. Woods says withdrawal from long-term heroin use--even with methadone to smooth the path--fails most of the time. In all, she estimates that there are about 250,000 U.S. addicts on methadone.

But there is a strong stigma in the U.S. against drug users, especially heroin addicts. Woods ticks off many examples of judges ordering addicts off methadone as part of probation, doctors refusing to treat addicts, and communities blocking clinics from their neighborhoods.

About one-third of addicts have mental health problems, she says, but they are frequently told to get off methadone as a condition for treatment at a mental health facility. "They are given a choice of 'treat my addiction or treat my mental illness.' Heck of a choice for people like these who have been pretty beaten up by life."

Governments should be encouraging medical treatment with methadone, not trying to get people off the drug, says Robert Newman, a physician and international leader in addiction treatment. Such treatment should be done where possible by a private physician and should usually last a patient's lifetime, he says, adding that opiate addiction is a medical condition for which there is no known cure.

At best, he says, heroin addicts in the U.S. are treated in large, government-approved, centralized clinics, and doctors and clinicians face a host of government restrictions.

And 80% of U.S. heroin addicts lack access to methadone treatment facilities, he says.

The U.S., he continues, should follow the U.K., France, Switzerland, Croatia, Australia, Canada, and other countries and ease access to methadone, expand its use by encouraging private physicians to provide medical treatment for opiate addiction, and address addiction as a solvable national problem.

Methadone

Name
◾ 6-(Dimethylamino)-4, 4-diphenyl-3-heptanone

CAS Registry
◾ 76-99-3

Did you know that in 2004 a woman in Tazewell County, Va., had her parole revoked and was sent back to prison because--against judges' orders--she was using physician-prescribed methadone to help control her OxyContin addiction?