Methadone Maintenance Treatment - Medicine Essay Example
Methadone Maintenance Treatment
Methadone is the generic name of an artificial narcotic which has been described as a safe and effective medication for pain but is also used in dealing with addiction to opioid substances such as heroin and morphine - Methadone Maintenance Treatment introduction. It prevents patients from experiencing withdrawal symptoms thereby reducing their dependence on such substances. The popular brand names of this medication are “Diskets, Dolophine, [and] Methadose” (Drugs.com, 2007).
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Methadone has been classified as a schedule II substance in the United States. Under the law, a schedule II substance is a controlled substance and could only be directly dispensed by a medical practitioner or through his/her written prescription. The law, however, allows a medical practitioner to orally prescribe the use of Methadone in cases of emergency. Moreover, the law strictly provides that written prescriptions for Methadone could not be refilled (U. S. Drug Enforcement Administration, 2002).
Already in use for over 30 years, methadone serves as a substitute for the opioid substances, occupying that part of the brain which serves as the usual receptor of these substances. By doing so, Methadone triggers a change in the behavior of the patients and later causes them to stop their habit. A daily dose of methadone which is taken orally suppresses the withdrawal symptoms from heroin and morphine for up to 36 hours, thereby lessening the cravings felt by addicts. During treatment, it helps patients from avoiding the “extreme highs and lows that result from the waxing and waning of heroin in blood levels. . . [and frees the patient] from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts” (Broekhuysen, 2006).
The process of treating heroin addiction with the use of methadone is called Methadone Maintenance Treatment (MMT). It is actually a “replacement therapy” where an addict is given regular amounts of methadone to repress the cravings for heroin and prevent addicts from going back to heroin use. It has been found to be rather effective. In fact a study done in California in 1994 revealed that addicts under methadone maintenance programs “achieved greater reductions in illegal drug use” than those in other drug treatment programs. However, the problem with the system was the strict regulations involved in dispensing methadone. For physician or clinics to be allowed to dispense methadone, the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) should first approve their applications. Then the methods and schedules of dosage were to be decided by the Department of Health and Human Services working in tandem with the FDA. For applicants, the process amounted to a mountain of regulations and restrictions established by both the state and federal authorities (The Politics of Methadone, 1998).
This was the main reason why as of 1998, only more than 700 methadone clinics operated in the country. Many states like “Idaho, Mississippi, Montana, North Dakota, South Dakota, West Virginia, Vermont, and New Hampshire” did not permit their operation. The clinics which were allowed in other states, on the other hand, maintained strict hours – usually only in the mornings. That practice made it very difficult for patients to follow the required treatment schedules. Some patients had to drive for several hours everyday to go to their clinic to have their daily dose of methadone, describing their search for a cure as a “white-knuckle experience” especially during winter since clinic hours required them to be there by nine o’clock in the morning (The Politics of Methadone, 1998).
A particularly difficult situation was experienced by addicts living in Athens, Ohio, for instance, who had to travel as far as Columbus, Ohio, which is 74 miles away, just to get their methadone dose for the day. The situation made Betty Woellner, employed by Health Recovery Services, Inc. in Athens, Ohio, as a drug and alcohol counselor, to agree to some proposals that laws governing methadone prescription should be amended if the program was to succeed. She was referring to the recommendation made by Dr. Lewis Judd, then chairman of the Department of Psychiatry of the University of California at San Diego and other National Institute of Health (NIH) officials that in order to make methadone treatment more readily available to heroin addicts who wanted to kick their addiction, the federal government had to get rid of some or even most of the regulations governing methadone use and prescription. Their appeal did not go unheeded. In 1997, the director of the Office of National Drug Control Policy, General Barry McCaffrey, said in a speech that their request would “get a hearing” because he wanted to give methadone a chance. His exact words were: “Dose rates and the execution of the program ought to be a medical challenge and not a programmatic one run from Washington, D.C.” (The Politics of Methadone, 1998).
Perhaps in a reaction to these pressures, the United States Department of Health and Human Services released, in July 1999, a Notice of Proposed Rulemaking (NPRM) for methadone use. After more than three decades of the program, the NPRM proposed that methadone treatment should be considered a valuable clinical tool for treating heroin addiction. As a clinical tool, therefore, the NPRM recommended that methadone maintenance treatment be freed of rigid statutory regulations. Instead, a system should be established which would accredit programs that would assure quality treatment and performance on the part of the methadone clinics and medical practitioners. According to the proposal, the new system would permit more flexibility on the part of the attending doctor and guarantee adequate “clinical management” of the needs of the patients. This policy change would effectively get rid of rigid rules, ensure greater discretion, and establish a standard for the care and treatment of opioid addicts. While future accreditations would be handled by a state or a federal accrediting authority, the DEA would remain as the body which would be primarily responsible for seeing to it that methadone is not used illegally (Broekhuysen, 2006).
By 2001, the proposal for a new accrediting system was adopted. It was jointly announced by the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration (SAMHSA) that the existing regulations being enforced by the FDA were being superseded by a “Final Rule” governing “the use of narcotic drugs in maintenance and detoxification treatment of opioid addiction.” To take effect March 19, 2001, the “Final Rule,” which transferred the oversight and the administrative functions to the SAMHSA from the FDA, established a new system of regulating methadone providers based on a standard of accreditation. This new system, which was arrived at after a public hearing which was conducted on January 31, 2000 and another on May 10, 2000 in Rockville, Maryland, was aimed at permitting greater medical judgment in the treatment of opioid addiction. Under the provisions of the Final Rule, SAMHSA would create and/or approve applications for accreditation bodies. These bodies will, in turn, accept applications for accreditation, review said applications, and finally grant the accreditation certification to qualified treatment programs (Addiction Treatment Watchdog, 2003).
As a result of this new system, the number of methadone treatment centers ballooned from their previous number of more than 700 in 1998 to over 10,000 today. They could be found in forty-four states of the country. According to the Methadone Treatment Directory (2007), in the state of New York alone, 278 Methadone Centers could be found, i.e.:
Albany – 3 centers Manhasset – 2
Amityville – 2 Mount Vernon – 1
Amsterdam – 2 New Rochelle – 1
Bay Shore – 1 New York – 57
Binghamton – 1 Newburg – 1
Bronx – 76 Niagara Falls – 2
Brooklyn – 77 North Babylon – 1
Buffalo – 4 Pomona – 2
Clinton – 2 Port Chester – 1
East Meadow – 3 Poughkeepsie – 1
Elmhurst – 1 Rhinebeck – 1
Far Rockaway – 1 Richmond Hill – 2
Flushing – 1 Riverhead – 2
Glen Cove – 1 Rochester – 3
Glen Oaks – 1 Schenectady – 2
Greenport – 1 Staten Island – 4
Hauppauge – 1 Suffern – 2
Jamaica – 3 Syracuse – 1
Kingston – 1 Tully – 3
Long Beach – 1 White Plains – 1
Long Island City – 1 Yonkers – 4
However, even the experts in the treatment of drug addiction are not one in endorsing Methadone as a primary cure for heroin addiction. They feared that the substance could just as easily be abused like heroin when not properly regulated. Paul Farley, an addiction specialist who has a treatment center near Atlanta said that while Methadone “has a clear place” in combating heroin addiction, his belief is that it is in fact addicting and more difficult to quit than heroin. According to Farley, methadone could very well develop into another coping mechanism just like heroin. He argued that “For the right people widening availability is the right thing…but it is not the cure for everything.” Another skeptic was Dr. Herbert Kleber, a former Bush advisor for drug policy and the executive vice-president and medical director of the National Center for Addiction and Substance Abuse at Columbia University, stated that different people feel differently about methadone and because of this mixed feelings, he was not so sure if it could still be “expanded into the medical dispensing system” (Politics of Methadone, 1998).
Supporters of methadone want to assuage such fears, however. While they admit that it could be subject to abuse being a controlled substance, they reiterate that it is safe as long as it is used as prescribed and administered under the careful supervision of properly accredited providers. In fact according to them, even if used on a long-term basis, methadone cannot cause damage to the vital organs such as the liver, the lungs, the heart, the brain and even the bones. They maintain that the only slightly-troubling effects being experienced by some patients are minor symptoms like excessive sweating, constipation, drowsiness, and rashes on the skin which, according to them, immediately subside after tolerance to the substance has been increased (Office of National Drug Control Policy, 2000).
The testimonies of some methadone users, however, tell a different story and in fact serve as deterrent to other would-be users. One methadone user from Staten Island, New York, said that she developed juvenile diabetes while using methadone. She claimed that she got addicted to heroin when she was 18 years old. The following year, she was already on methadone. She said that after suffering from several overdoses, she decided to quit methadone abruptly because she thought that it would be that easy. During her first week of withdrawal, she recounted that she felt as if she was in hell, burning but with cold sweats. She spent the entire week almost without sleep. On her second week, she made two visits to the emergency room. More than a month after she quit methadone, she said that she woke up in the hospital and was told that she had spent the last three days in a diabetic coma. According to her story, she spent two weeks in the hospital and another eight months more to recover fully from the effects of methadone (Inspirational story of ex-junkie/methadone user, 2006).
Another methadone user claimed that withdrawal after heavy doses and long-term use had not only been longer compared to other opiates, but more painful as well. This particular user claimed that during only the first day of withdrawal, the user gets “flu-like symptoms” and bodily pain, insomnia, diarrhea, anxiety, and sneezing. On the second and third days, the same symptoms get worse in addition to hypertension, severe pain in the muscles and bones, and the user becomes “intolerant of life [and develop] feelings of suicide along with wanting to jump out of [his/her] skin” (Methadone, The Hidden Help, n.d.).
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