In this weeks NY Times, a article discussing the alarming increase in the prescription of methadone as a pain killer almost slipped past me, since like most of us here, I've been caught up with the election.
Methadone Rises as a Painkiller With Big Risks
Suffering from excruciating spinal deterioration, Robby Garvin, 24, of South Carolina, tried many painkillers before his doctor prescribed methadone in June 2006, just before Mr. Garvin and his friend Joey Sutton set off for a weekend at an amusement park.
On Saturday night Mr. Garvin called his mother to say, "Mama, this is the first time I have been pain free, this medicine just might really help me." The next day, though, he felt bad. As directed, he took two more tablets and then he lay down for a nap. It was after 2 p.m. that Joey said he heard a strange sound that must have been Robby’s last breath.
The article continues:
Methadone, once used mainly in addiction treatment centers to replace heroin, is today being given out by family doctors, osteopaths and nurse practitioners for throbbing backs, joint injuries and a host of other severe pains.
A synthetic form of opium, it is cheap and long lasting, a powerful pain reliever that has helped millions. But because it is also abused by thrill seekers and badly prescribed by doctors unfamiliar with its risks, methadone is now the fastest growing cause of narcotic deaths. It is If scientists at the forefront of federal research on drug treatment have their way, methadone and other drugs used to treat heroin addicts will move out of clinics and into doctor's offices and pharmacies. It's possible that buprenorphine, the latest drug for treatment of addiction to heroin and other opiates, will be in pharmacies by this summer, according <to one leading researcher.</p>
"Office-based methadone treatment would represent an enormous step forward in treating heroin addiction," says Alan Leshner, director of the National Institute on Drug Abuse (NIDA), in response to a new report in the Journal of Urban Health: Bulletin of the New York Academy of Medicine. "This study shows that practitioners understand that their addicted patients are suffering from a treatable disease, and they are willing to provide that treatment."
Sharon Hall, a researcher at the University of California at San Francisco whose study on methadone treatment appears in the Journal of the American Medical Association, concurs: "My feeling is anything that moves drug addiction treatment from clinics to physician's offices and pharmacies is a major step. It takes it from a moral issue to a medical issue."
Yes, it's a major step. But I'm not sure this is a step in the right direction. It now increases the amount, of what had been tightly regulated methadone sources. It will also significantly increase the profits of the manufacturers.
The past five years have seen a 25 percent increase in heroin use. There are now an estimated 800,000 heroin addicts in the United States, and only 180,000 of them are being treated with methadone. Drug treatment specialists have been trying for many years to loosen strict federal and state regulations that require methadone to be administered at public clinics. They argue that many more people would undergo treatment for their addictions if it wasn't provided only at clinics. The stigma of going to such clinics often keeps addicts away, as does the requirement to come to the clinic every day to get a methadone dose. "There's a group of addicts who refuse to go to clinics," says Frank Vocci, director of treatment research and development at the NIDA.
Methadone is implicated in more than twice as many deaths as heroin, and is rivaling or surpassing the tolls of painkillers like OxyContin and Vicodin.
"This is a wonderful medicine used appropriately, but an unforgiving medicine used inappropriately," said Dr. Howard A. Heit, a pain specialist t Georgetown University. "Many legitimate patients, following the direction of the doctor, have run into trouble with methadone, including death."
I would like to disagree with the statement by Dr. Heit, about just how "wonderful" methadone is.
Let me be clear. I'm not a medical doctor. I'm a medical anthropologist who has worked in AIDS and drug research, working specifically with heroin and cocaine injecting populations (IVDUs). I have a bias. I am anti-methadone maintenance and have been for years. Just so you know where I am coming from.
For those of you unfamiliar with methadone - it is currently used as government sponsored, and mandated "drug treatment". Programs that dispense this narcotic are labeled "addiction treatment facilities".
Methadone was developed in Nazi Germany in the late 1930s in anticipation of possible shortages of raw opium during the upcoming war and possible blockades by the enemy, which would result in shortages of morphine and other opiates for both the military and civilian populations. It was tested by medical professionals in the German military in 1939-40 but decided that it was too toxic and too likely to become addictive upon repeated use (habituation) for use in the army and other organizations.
Methadone was introduced into the United States in 1947 by Eli Lilly and Company as an analgesic (they gave it the trade name Dolophine, which is now registered to Roxane Laboratories). Since then, it has been best known for its use in treating narcotic addiction. A great deal of anecdotal evidence was available "on the street" that methadone might prove effective in treating heroin withdrawal and it had even been used in some hospitals. It was not until studies performed at the Rockefeller University in New York City by Professor Vincent Dole, along with Marie Nyswander and Mary Jeanne Kreek, that methadone was systematically studied as a potential substitution therapy. Their studies introduced a sweeping change in the notion that drug addiction was not necessarily a simple character flaw, but rather a disorder to be treated in the same way as other diseases. To date, methadone maintenance therapy has been the most systematically studied and most successful, and most politically polarizing, of any pharmacotherapy for the treatment of drug addiction patients.
In the United States, methadone maintenance treatment emerged from trials in New York City in 1964 in response to the dramatic and continuing increase of heroin abuse and addiction following World War II.
http://en.wikipedia.org/...
As early as 2003 the NYT printed a warning about methadone:
Published: February 9, 2003
Methadone, a drug long valued for treating heroin addiction and for soothing chronic pain, is increasingly being abused by recreational drug users and is causing an alarming rise in overdoses and deaths, federal and state officials say.
In Florida, methadone-related deaths jumped from 209 in 2000 to 357 in 2001 to 254 in just the first six months of 2002, the latest period for which data are available.
''Out of noplace came methadone,'' said James McDonough, director of the Florida Office of Drug Control. ''It now is the fastest rising killer drug.''
In North Carolina, deaths caused by methadone increased eightfold, to 58 in 2001 from 7 in 1997 -- an ''absolutely amazing'' jump, said Catherine Sanford, a state epidemiologist.
In Maine, methadone was the drug found most frequently in people who died of overdoses from 1997 to 2002. It was found in almost a quarter of the deaths. In the first six months of last year, methadone killed 18 people in Maine, up from 4 in all of 1997. Dr. John H. Burton, medical director for Maine Emergency Medical Services, said hospital emergency rooms were seeing ''a tidal wave'' of methadone-related cases.
http://query.nytimes.com/...
Ironically, the number of methadone related deaths in the US are now far higher than those associated with heroin.
Between 1999 and 2005, deaths that had methadone listed as a contributor increased nearly fivefold, to 4,462, a number that federal statisticians say is understated since states do not always specify the drugs in overdoses. Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003. In most cases it was mixed with other drugs like sedatives that increased the risks.
The rise of methadone is in part because of a major change in medical attitudes in the 1990s, as doctors accepted that debilitating pain was often undertreated. Insurance plans embraced methadone as a generic, cheaper alternative to other long-lasting painkillers like OxyContin, and many doctors switched to prescribing it because it seemed less controversial and perhaps less prone to abuse than OxyContin.
From 1998 to 2006, the number of methadone prescriptions increased by 700 percent, according to Drug Enforcement Administration figures, flooding parts of the country where it had rarely been seen.
http://query.nytimes.com/...
I have two sets of concerns. Methadone, a dangerous drug is now being pushed into the general population. But my primary concern is that for too long the general public has believed the hype - that it is a benign drug that is effective in treating addicts and combating the spread of AIDS. Yes - it can reduce HIV transmission via needle sharing. It does nothing to curtail sexual transmission.
You are all probably aware that HIV can be spread by the sharing of un-sterile syringes. The myth about drug users in "methadone treatment" is that once clients are getting their daily doses of methadone - that they are no longer injecting drugs.
Cocaine, AIDS, and Intravenous Drug Use By Samuel R. Friedman, Douglas S. Lipton along with a host of other books and articles by AIDS and Drug Researchers, make it perfectly clear that many clients in methadone treatment continue to inject drugs - only they switch to injecting cocaine, putting themselves at higher risk for HIV since cocaine injectors shoot up far more frequently per day. And though many studies offer this data - their conclusions are always the same - increase the number of methadone programs.
One study I worked on of active injectors, with a sample size of 1000, found that 56% of those people injecting drugs - were in "methadone treatment". Those people were described as "at less risk" for AIDS, with "statistically significant lowering of injection rates" ignoring the social dynamics of methadone clients, called "methadonians" on the street, who often form sexual relationships at their program, and wind up contracting the virus from unsafe sex. Rather than design additional research to explore options other than methadone, the data was used to justify the benefits, and to completely ignore the perils.
The government has also used methadone over the years as a means of controlling drug using populations. Once addicted to methadone - it is far more difficult to "kick" than the heroin it was supposed to supplant. Once enrolled in a program, you can't just "take a vacation" or travel freely, since you usually need your daily fix and arrangements have to be made to hook you up with a program in the place you want to travel to, if they have methadone.
If you google "myths about methadone" you will get hundreds of hits - from the government and from "treatment facilities" telling you the same bullshit:
Myth: It's harder to kick methadone than it is to kick a dope habit.
Fact: Stopping methadone use is different from kicking a heroin habit. Some people find it harder because the withdrawal lasts longer. Others say that although the withdrawal lasts longer, it is milder than heroin withdrawal.
http://privateclinicmonterey.com/...
The reality is a bit different. Complete and total withdrawal from methadone can take as long as a year, actual "kicking" takes 4 to 6 weeks and in most cases involves severe pain and discomfort for many months. Depending on the dosage one is on (base dosages at clinics are rising not dropping). I had many informants tell me that they were terrified that if they were on the program, and got busted, they would be forced into a horrific 7 day detox in jail. Some who had been through this once, decided to take their risks on the street - continuing to shoot dope.
Am I completely against methadone - no, because it can be used short term for detoxification from heroin. But long term maintenance on methadone is simply the government pushing drugs - that they can make money off of.
Does methadone maintenance work for some people - yes. Can it reduce AIDS transmission - yes, if the person on the program is no longer injecting, or has learned to use sterile syringes. But MTP's do not give their clients clean syringes - since in theory, they aren't injecting.
About 180,000 people in the US are on a program. This number may soon increase. Methadone is also sold as a street drug - tablets or "spitback" (from liguid methadone) can be bought in most neighborhoods where there are clinics. Clients on the program also have high rates of alcohol use, and when combined with the consumption of street prescription drugs the situation is even more deadly.
The War on Drugs is a sham. If heroin were legal - there would be no need for government drugs. The argument for methadone includes that fact that "methadone reduces crime". Yup. It does. If you buy or use heroin - you have committed a crime. If you need money to buy heroin - you many commit crimes. If you take Uncle Sam's legal more powerful drug - you are not a criminal. Am I promoting heroin use - no. But I am interested in discussing government hypocrisy. Do I think that this country will ever legalize drugs - doubtful. Or at least not in my lifetime. The "moral majority" who still sees drug use as a moral failing rather than as a disease, or as criminal behavior, or both, still rules. The prison industry, is growing rather than shrinking. "Rehabilitation" of addicts is a joke, if it is simply the farce of switching those who are not incarcerated onto a "legal" narcotic.
Some grassroots people are now organizing to raise public awareness about methadone - the deaths, and the harm it can cause.
One such organization is HARMD(Helping America Reduce Methadone Deaths)
HARMD has an interesting perspective on methadone. They have a full discussion of the facts we rarely see discussed by either MTP's or government sources, on their website.
THE PROMISE
In summary, switching heroin users to methadone seemed to provide a solution to society’s problems:
· Methadone has a much longer half life than heroin (half-life is the amount of time before half of a drug taken is excreted from the body), so a person can normally be given one dose of methadone and this would last until the next day.
· Methadone doesn’t cost $300 a day but only $300 a month and often this can be paid by a government program.
· Heroin addicts no longer have to participate in illegal activities to obtain their drugs.
· Heroin addicts are no longer using needles to inject heroin and this will reduce the spread of many diseases.
· Heroin addicts can switch to methadone and then reduce their dosage of methadone until they are completely off methadone.
People in society no longer have to feel guilty about not addressing the heroin addiction problem because the methadone advocates promoted the use of methadone as a step toward helping the addict stop taking drugs of any kind.
Those are the promises that we've bought into - and methadone as a solution is now being pushed globally.
HARMD presents the facts behind the promise:
However, what was promised about methadone was not delivered. We now know these facts about methadone:
A 1999 study done at the University of London found that methadone actually increased the cravings for heroin. Many methadone users supplement their "high" with other illegal drugs like prescription narcotics or even heroin. (Illegal drug dealers now can be found around these clinics because business is brisk.)
Most methadone users are forced to come to the methadone clinics and wait in long lines every day or at least once a week.
Because the number of methadone clinics is limited by law, some methadone users have to drive 50-80 miles a day and when they arrive, stand in line for an hour or more to get their methadone dose that will keep them from going into withdrawal, and then they go to work.
The first thing a methadone addict often must do when considering moving is not check on the schools for their children but on the location of the nearest methadone clinic.
Almost all of the people who switched to methadone from heroin have seen the amount of their daily methadone dose increase—to 100 milligrams or even much higher. In most cases the user is now taking a much higher dosage of methadone than the equivalent amount of heroin that they were on.
Almost none of these former heroin addicts have been able to wean themselves off methadone. (Some complain that the methadone clinics don’t help their clients wean off. Apparently many clinics tell the methadone addict who is trying to taper down but experiences some withdrawal symptoms that if they are experiencing any discomfort, then the dose should be increased back to where it was. Some clinics will not taper the methadone addict down to lower dosages even if the addict wants to. They apparently tell people that "They are addicts and will always have to take methadone. But this is not too surprising—the methadone clinics only stay in business if their clients remain addicted.)
Even if the methadone addict who is now taking 40 to 240 milligrams of methadone decides that he or she has to stop, there are few rehabilitation centers that will accept people on more than 40 milligrams per day, so the person has to either face serious withdrawal pains, find one of the few medical detox centers that will accept high dosage methadone users, or stay on methadone.
The real truth is that switching an addict to a different addiction never really made sense. The real solution was and will always be to help the addict become drug-free.
They describe the Catch-22 of switching from heroin addiction to Methadone as THE TRAP:
In a classic example of "the end justifies the means", the FDA was persuaded that even though heroin was illegal, it was ok for methadone, a drug that is more addictive and creates many of the same effects, to be legal. Instead of rewarding criminals who smuggled heroin into the country, the FDA chose to reward drug manufacturers and people who run methadone clinics so that the same people could continue to be addicted.
There is a heated political debate over whether we should legalize drugs and take the profits away from the criminals. Yet we have already cut out the illegal dealers by giving the profits to drug companies and to methadone clinics—which are limited in number and thus assures their profitability. The advocates of substituting methadone for heroin are now aware that methadone is often more addictive than heroin.
No responsible person can dispute the fact that as the doses of opioids like methadone or oxycodone increase, people’s cognitive abilities and their reaction times are adversely affected more and more. They can also experience other side effects such as being more susceptible to illnesses.
Perhaps the saddest part of the methadone experiment is that our society encourages these former heroin addicts to take more and more methadone, since it costs the same if the dose is 10 milligrams or 200 milligrams.
Every time a methadone addict gets clean, the only groups that lose are the drug companies that produce methadone and the methadone clinics who lose money. The rest of society wins and the former methadone user wins most of all.
There are other solutions to addiction in our society - and "changing seats on the Titanic", switching from heroin to another opioid does not have to be the only option.
THE SOLUTION—MEDICAL DETOX AND REHAB
Regardless of the reason that someone began using methadone, there are few reasons why methadone users would not benefit if they could stop having to use methadone and not have the cravings to use opioids. There are many effective rehabilitation facilities that are successful in helping people become drug-free. These rehabilitation facilities are located all over the world. However, despite the desire of these rehabilitation facilities to help, few if any will accept someone on a dose of methadone over 40 milligrams per day. Most require that the methadone user go to a medical detox center to get off methadone completely before they will accept them.
Unfortunately, there are very few medical detox facilities that will accept a methadone patient taking over 40 milligrams a day of methadone. Some facilities that do accept the patients simply put them in a room and give them some drugs that help alleviate some of the pain, but the patient has some very difficult withdrawal symptoms and often leaves the detox center before completing their withdrawal. Then they go back to the methadone clinic and the despair grows even more.
Most methadone users who have decided to seek help have tried to withdraw or at least cut down their dose of methadone in the past. Almost all of these people were unsuccessful because they began experiencing painful withdrawal symptoms and stopped their taper. Many of the methadone users ended up taking more methadone than they were taking when they started trying to withdraw, and their despair of ever being free of their methadone habit increased. The solution is to locate a medical detox center that will assist a person on a high daily dose of methadone to complete their withdrawal comfortably, safely and more quickly from the drug.
Quite a few of my good friends work at Methadone programs as drug counselors. They have privately discussed the pressure they are put under by supervisors to discourage assisting patients/clients in lowering their dosages - and they are not supposed to encourage clients to work towards becoming drug free.
I realize that the opinions I've expressed here run counter to government documents, drug research data (which is tied to the funding of more methadone), but I submit this for your discussion, because I believe that it's time to cut through the lies, and begin to explore other options for those who suffer from the disease of addiction. Creating a class of permanent addicts is not a solution. It's a dodge.
If you are one of the lucky few who is a methadone patient, and has successfully gotten your life back together, are meaningfully employed, and are not a poly-drug abuser, I salute you. Unfortunately, most of the hundreds and hundreds of poor, urban, inner city addicts that I worked with, shared a neighborhood with, grew up with, and in a few cases who are members of my family, have either died from AIDS, or have never been able to hold a job, or get clean. They spend their lives going to and from the clinic, on crutches and in wheelchairs, copping drugs, drinking, and waiting to die.
The good news is that thousands of others have avoided this cycle, and have gotten clean - one day at a time, in programs that don't cost a dime.