When a valid form of addiction treatment is criticized by someone who knows next to nothing about it… I nearly always go into a dither. I’m better than I used to be, but not much.
Recently, a patient at one of the methadone clinics where I work said he appeared before a judge for offenses committed prior to entry into treatment at the methadone clinic. The patient says the judge ordered him to get off methadone as part of his sentence, which also included public service, intensive probation, and monetary fines. I’m going to make sure the patient’s report is accurate before I begin my literary assault by letter. But I suspect the judge actually said what my patient reports.
It amazes me a judge would foolishly practice medicine, by dictating what an opioid addict, ill with a disease, can or cannot do to get treatment for their disease.
It’s not like methadone is a flash in the pan. It’s been around for 45 years. It’s one of the heaviest evidence-based treatments in all of medicine. Plus, we have several studies showing opioid addicts who leave methadone treatment have a death rate at least eight times higher than opioid addicts who stay in methadone treatment. (1, 2)
That’s death rates. And dead addicts don’t recover.
If other equally effective options were available to this young man, I wouldn’t be as upset by the judge’s ruling. If the patient could afford to stay in a medical detoxification unit for seven to ten or more days, followed immediately by prolonged inpatient residential drug rehabilitation of thirty to ninety days, I might agree with the judge. But this young man can’t afford that kind of treatment. State funded treatment exists, but usually patients can stay a week in a detox and one, maybe even two weeks in rehab, which is rarely enough for an opioid addict. Outpatient treatment, without replacement medication, results in relapse rates consistently shown to be in the range of 96%.
In my letter to the judge I’m going to try to gently educate, which seems to be the best approach to the law and order type people. In my letter to the judge I’m going to cite several studies, and direct the judge towards an excellent NIDA (National Institute on Drug Abuse) website with all essential information regarding treatment of opioid addiction with methadone: http://international.drugabuse.gov/collaboration/guide_methadone/index.html
This wonderful tool, in a question and answer format, contains valuable information about methadone and its use in the treatment of opioid addiction. It contains references to all of the best and most commonly cited studies about methadone. If you have questions, check it out.
1. Scherbaum N, Specka M, et.al, Does maintenance treatment reduce the mortality rate of opioid addicts? Fortschr Neurol Psychiatr, 2002, 70(9):455-461.
2. Zanis D, Woody G; One-year mortality rates following methadone treatment discharge. Drug and Alcohol Dependence, 1998: vol.52 (3) 257-260.