Posts Tagged ‘evidence based’

Methadone maintenance is evidence-based medicine

“Prejudices, it is well known, are most difficult to eradicate from the heart whose soil has never been loosened or fertilized by education; they grow there, firm as weeds among stones.”
Charlotte Bronte

During the time I spent working at a methadone clinic, I admitted thousands of opioid addicts into treatment with methadone. For the first few years, I frequently questioned myself: was I doing more harm than good? It was easy to become discouraged. Our clinic was the target of frequent criticism from many sources: local newspapers, state government, families of addicts, and other healthcare professionals. Every time I got discouraged, I recalled the faces of addicts who did find recovery through methadone, and the dramatic changes that were possible not just for them, but for their entire families. It is an honor to be able to witness the miracle of change, and it does happen at methadone clinics.
I read summaries based on forty years of scientific studies regarding methadone’s effectiveness, and then knew that methadone treatment saves lives. “Evidence based” is a catch phrase now popular in all fields of medicine. It means that there is evidence – randomized controlled trials, preferably, as they are the best kinds of studies – that provides proof that a given treatment works. Mountains of evidence from multiple studies show that outcomes for opioid addicts are much better when they are maintained on methadone. So why did our clinics meet such opposition?
I don’t want to get to the end of my career and see that I have based my practice of medicine on inaccurate data, or worse, be blinded by my own prejudice. I often thought of the television clip of the tobacco executives, all in a row, hands raised as they swore tell the truth, and they all said they did not think tobacco was addictive. Why did they do that? Didn’t they feel ridiculous swearing to something that everyone knew was not true? Or worse….did they actually believe what they were saying? Maybe they became so blinded by ideology and economic interests that they believed their own rhetoric.
I don’t wish to make that mistake. I recognize how easy it is to be closed minded to treatment approaches that differ from one’s own. I listened closely to the opinions both for and against medication assisted treatments for opioid addiction. The people opposed to the use of methadone, and presumably buprenorphine, didn’t have facts to back their position, or at least not about methadone prescribed under accepted guidelines with appropriate controls against diversion. Most people who opposed methadone and buprenorphine said it wasn’t “real” recovery, and that they didn’t “believe” in it, as if it were some mythical beast like a unicorn. Addiction specialists who supported medication assisted recovery had evidence-based proof that it worked, and that many addicts could lead healthier and more productive lives.