Methadone, a synthetic narcotic drug, is similar to heroin and morphine. Unlike short-acting narcotics, methadone has a much longer half-life of between 24 – 55 hours on average. This means it takes considerable time for the body to metabolize and clear the drug from the system. A longer half-life also means a much longer detoxification with withdrawal symptoms present. Even when the drug is tapered down, clients report withdrawal symptoms lasting from 2 – 6 weeks. The average detox for short-acting narcotics, such as heroin and morphine, is 3 – 7 days, and the half-life is approximately 3.8 hours.
Is Methadone Treatment Effective?
Interestingly, clinics report that methadone does not deliver a euphoric effect in “stabilized patients.” Could one not argue the same thing with almost any other drug? If a heroin addict took the same dose at the same time every day, he or she would essentially achieve the same result, avoid getting sick, but nothing more. This is great marketing material for methadone, and a client in a desperate state is none the wiser, believing in its long-term effectiveness. Clinics also claim it is safe. Any opioid taken as medically prescribed could be considered safe. It is true that people on medically-assisted treatment may stop engaging in drug use, but do they stop the behaviors that are common to substance-dependent clients?
Harm Reduction Model of Opiate “Recovery”
In the United States, one treatment model for drug addiction dominates, i.e., the medical model. The model views addiction as a disease and holds that complete abstinence is the only option. In another view, people who favor the harm reduction model believe that addicts cannot quit taking opiates and should be administered narcotics the rest of their lives. The philosophy of the harm reduction model concerning methadone is this: if it can keep your loved ones away from drugs and prevent them from stealing $20 from your wallet or purse, then methadone has done something to help. For a desperate family, that can feel like a solution, and in the short term it probably is.
At this point, the pitfalls of methadone treatment emerge. Oftentimes, families cling to the hope that change has occurred in their loved one, that things are better because their loved one has been on the methadone program, and that the stealing and buying of drugs have stopped. Families cling to this idea even if their loved one still smokes weed and drinks a little. The problem with substance use disorder clients is not the drugs; rather, it is the behaviors and underlying issues of the user. In sum, medically assisted treatment such as methadone may plug the hole in the boat, but the boat still needs to be fixed.
Methadone users call our office to blast us because we do not agree with their view of methadone maintenance. They call to plead their case and to accuse us of being unethical. We have never received calls from sober clients working a 12-step program who scream at us, or write ridiculous reviews pleading their case, or bad mouth us because we prefer cognitive behavioral therapy or counseling, and they do not.
Substance use disorder clients who are either dry or on medically-assisted treatment with no counseling and/or trauma resolution tend to act the same way behaviorally. The difference in dry clients and those on methadone is that methadone clients do receive counseling at the clinic. The problem is this: even a stabilized patient who is not receiving euphoric effects from the drug may not change behaviorally. Studies show it to be impossible to feel and process counseling to its full capacity while on any mind-altering drug. To an extent, emotions and thoughts are still suppressed. Methadone clinics believe that being able to drive a car, go to work, and function on a daily basis indicate a capacity to modify one’s behaviors. Studies show this not to be the case, at least not at the same level as non-methadone clients.
What does this all mean? Nothing at all—if methadone is to become a never-ending way of life. For those wishing to come off methadone, the road ahead includes an unbelievably long detox. They will need to face the unresolved problems and maladaptive coping skills that have still not been resolved.
And then, there is the physical withdrawal that accompanies the detox. Clinics assert that tapering off a drug while being supervised will not cause withdrawal symptoms. In fact, methadone clients will suffer detox and withdrawal symptoms regardless of the taper. They will have the same mindset as when they started using drugs and then went on to methadone. The bottom line is this: methadone, although effective for some, is most often not a long-term option unless one is prepared to stay on it for the remainder of one’s days.