I have a difficult relationship with Methadone. I see what it can do positively for a person: decreasing drug-seeking behavior, reducing or eliminating sharp withdrawal symptoms, providing comfort and reducing the criminal or anti-social behavior that continuous illegal drug use requires. I also see that it provides a very helpful service to the community and society: reducing drug-related crime, providing long-term treatment at a low cost/dose and, possibly most importantly, pacifying a population of time-consuming patients that would otherwise require intense (expensive) treatment to rid themselves of the need for opiates or opiate substitutes.
I dislike methadone for about the same number and quality of reasons: Instead of freeing a person from an opiate addiction, it moves them to a less-problematic opiate addiction; it is too freely given by doctors that are not specialized in opiate use cessation, it is provided without the proper education; it is given by doctors who are not ready to put in the time to properly titrate a patient off of it; I'm going to say this again because it is important, methadone is often given by doctors as if it is a long-term medication for heart disease, leaving the patient with the conclusion that this is as good as their life will get.
But why? Methadone is fully addictive physiologically, is prone to abuse and can lead to withdrawal because it shares much of its qualities with short-acting opioids like heroin and oxycodone. There is something to the common belief that methadone treatment is simply a trade from one addiction to another, even if it is a much less destructive addiction. Along with being abused and overdosed, methadone is given to patients over a duration that prolongs the addiction recovery process.
Counseling interventions, the development of social supports, skill practice and trigger awareness are part of recovery planning for those with acute problems with alcohol and drug use, but with methadone these interventions can be put off, ignored or minimized since the majority of pressing addiction symptoms are reduced or eliminated with the daily dose. Can you seen the problem here? My car has a hole in the gas tank and I figure out that if I only fill it past 1/8 of a tank it doesn't leak (much), so I don't fix the hole. I can't visit anyone that is farther than 30 miles from a gas station, don't really want to drive more than I need to, and am not confident taking my family on trips, but the solution is working: just don't fill the tank.
Many people on methadone maintenance therapy are being told this same thing: just don't fill your life up with things that you like doing or make you feel productive and you will be able to maintain the treatment protocol that is easiest for the doctor.
Oh, I didn't mention the side effects of methadone as yet.
Chronic fatigue, Sweating, Vomiting, Diarrhea, Perspiration, and Blurred Vision are some of the physical ones. Insomnia, Weight gain, Decreased or absent libido, anxiety, Cognitive impairment, Memory loss, Cognitive impairment, and Mood change are some of the psychological ones. This isn't just a list though, it's a picture of what someone's life will be for the years they are on methadone. But unlike the rare occurrences that some other medications have of their associated side effects, every methadone client I have worked with reported having some or all of these to some degree.
So the person, supposedly given a prescription to help them regain control of their life, is given a medication that makes them almost unable to live it to any real degree. The flattened affect and lethargy are some of the most dramatic side effects because they present to a degree usually found in severely depressed clients. The patient has almost no motivation and if they do accomplish something the enjoyment from doing it is reduced or eliminated.
There has to be a better way.