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Since 1971, qualified physicians in the United States have been prescribing narcotic medications such as methadone to treat opioid addiction. But this treatment hasn’t come easy, or without its share of debate.
The Methadone Controversy
Russia is one of several countries where methadone is controversial. Recently, members of a Kremlin youth group launched a protest outside a methadone conference, where a group of physicians and specialists were gathered to discuss methadone treatment for drug addictions. In Russia and other countries struggling over this debate, critics of methadone argue that it traps patients in their addictions for life, leaving them addicted to yet another drug.
Methadone is used as a gradual therapy for recovering heroin users, allowing physicians to relieve their patient’s craving for heroin and block the effects of opiates. With methadone, the gradual and mild onset of the “high” prevents users from gaining the pleasurable effects associated with heroin.
However, opponents argue that methadone treatment substitutes one opioid for another, and fear of methadone being sold on the black market is a big concern. Often patients are left struggling with their addiction to methadone, causing their treatment to be lengthy or fail altogether.
In the United States, methadone treatment has become more regulated and widespread in recent years. An individual’s methadone treatment is often viewed as treatment for a disease rather than a poor moral choice. Therefore, treatment may continue throughout the patient’s life, allowing their bodies to be maintained with methadone and avoiding the symptoms of withdrawal altogether. While not a complete solution for a drug free life, methadone treatment has been found to decrease heroin related deaths and crime, and help individuals achieve greater control of their lives.
Buprenorphine and Suboxone
Today a new opioid medication is making its way into treatment facilities, doctor’s offices, and even homes. Buprenorphine is a partial opioid agonist, which causes it to be less addictive than either heroin or methadone. The “high” produced by buprenorphine is less intense, and the side effects are less dangerous. In general, buprenorphine is safer than methadone, and it is easier for a patient to discontinue buprenorphine than to detox from methadone. The NIDA views buprenorphine as a safer, more acceptable maintenance drug than methadone for the treatment of heroin addiction.
A form of buprenorphine, Suboxone, has been rapidly gaining approval for the treatment of opiates. Suboxone contains buprenorphine and naloxone, an opioid antagonist which is to be taken orally. As long as it is taken by mouth as prescribed, the naloxone causes no side effects. If a user would dissolve the Suboxone and inject it in order to get high, the injected naloxone would cause sever withdrawal symptoms. This special formulation of buprenorphine and naloxone is considered safer than just buprenorphine because it so strongly discourages misuse.
The future of drug addiction treatment with Suboxone looks promising. With the support of the NIDA and the SAMHSA, and with further testing, there is hope that in the future this will be a widespread, successful treatment for drug addiction in the United States and other countries.
1. Schwirtz, Michael, Russia Scorns Methadone for Heroin Addiction The New York Times July 22, 2008
2. Blaine, Jack D., Buprenorphine: An Alternative Treatment for Opioid Dependence NIDA Research Monograph, Number 121, 1992
3. National Institute on Drug Abuse, 1999. Principles of Drug Abuse Treatment: A Research-Based Guide. NIH Publication No. 99-4180.
4. Marion, Ira J., Methadone Treatment at 40 Science and Practice Perspectives December 2005
5. Wunsch, Martha Buprenorphine: Balancing Access with Quality of Care (NIH) February 2008
6. Condon, Timothy P., and Clark, Wesley Buprenorphine in the Treatment of Opioid Addiction: Balancing Medication Access with Quality Care (NIH) February 2008
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zenith — July 24, 2008 @ 9:44 am
But the thing is, Suboxone is not a substitute for methadone. It is a different medication and is intended in general for a different patient population. Articles like this one make it sound as though Hey, this Suboxone is safer, easier to get, and less “addictive”, so goodbye methadone, hello suboxone, yippee!
Howeverm studies show that suboxone is not very effective for patients who require more than 60mg of methadone to stabilize, and since the average methadone patient requires 80-120mg of methadone, you can see that this hardly bodes well for a big switchover.
Another recent study took a cohort of IV heroin users and put them on Suboxone, with the ability to transfer to methadone if they did not do well. About half the patients had to make the switch to methadone.
There is no reason to constantly feed this “competition” between methadone and sub with all these blogs and articles about which is better, safer, etc–they are apples and oranges, with a little bit of overlap in the middle.
me — September 6, 2008 @ 11:31 am
As a 110 millligram prescribed a day Methadone-maintenance paitient, I am troubled by the stat that says anyone 60mg of methadone and over have basically a 50/50 shot at the drug being effective to qwell cravings. Withdrawing from forced detox from 4 successful years of methadone maintenance – and withdrawing HARD – all because of a poor choice to use benzodiazapines while on methadone within the last two months (anxiety problems). Don’t want to go through this ever again.
Suboxone/buprenorphine/subutex/naltrexone and the likes have been an interest of mine simply to not have to go through such a long period taper to get off medically-assisted opiate treatment, for whatever reason. Swithching to Suboxone puts me in fear I will crave, and succumb to those cravings. OR, go through the lengthy process of being forced to have no suboxone in my system simply to be able to be switched back onto methadone. Meaning: more cravings, less stabilty in my life, long periods of having nothing in my system at all to help quiet the massive, 10-year I.V.-herion addiction cravings I go through withought medical help. So right now, it’s back on methadone in two weeks at a new clinic, or suboxone. Don’t know which to choose, looking for “experienced” advice, someone who’s been through a similar situation.
Zenith,
Congratulations on your continued success at staying clean. Detox is a big fear and a very uncomfortable process. What you are doing seems to be working for you, you need to discuss your concerns and your questions about switching with your doctor and possibly with a different doctor as well. It is always best to get as many opinions as possible. Doing your research as you are here will help you make an informed decision and with that knowledge the facts will become more clear and your fear will fade.
George Clarke — January 8, 2009 @ 2:58 pm
The reason that Suboxone will not be able to help everyone is that it no longer functions beyond a 32mg dose due to its inherrent agonist/antagonist ceiling. Methadone is a full agonist so it will work when the Suboxone will not. This information is needed by the new patient who comes in to try Suboxone Treatment. Suboxone is an excellent medication for opiate/opioid abuse for those who have no problems at up to 32 mg.
Below are two items in the flow chart about this.
See Fig 4.3 in SAMHSA TIP 40 http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.72564
“Continued illicit opioid use despite maximum dose?
(Then: my word)
Maintain on buprenorphine/naloxone dose. Increase intensity of nonpharmacological interventions. Consider referral to OTP or other more intense level of treatment.”
OTP is Opioid Treatment Program (Methadone)
George Clarke — January 12, 2009 @ 9:27 am
Why do people post the glowing report and not mention the simple drawback which is it will not work for everyone and that methadone is a good answer for those who need more medication than the buprenorphine can ever provide. I am not against buprenorphine at all. Where it works is of great importance to me as an advocate for recovery through medicine.
I am for methadone clinics being able to provide buprenorphine with the same restrictions as an approved buprenorphine MD. I am for working relationships between Merthadone clinics and Bup MD’s so that a person can be transferred easily to the right program for them.
George Clarke ARM-CT
Lynnea — January 26, 2009 @ 9:41 am
Do you have statistics on how many heroin addicts are successful with and without the use of medication? In other words the success rate of addicts who are treated with methadone or Suboxone compared to those who just get behavioral modification and therapy.
I would appreciate this info if you have it available.
Hi Lynnea, that’s a great question. I don’t have any readily available. However I have asked our editor to look into it for an upcoming article. Thanks for your comment.
George Clarke — February 6, 2009 @ 3:23 pm
I too am looking for some more definitive information as to who will do OK when switching from methadone maintenance to Suboxone maintenance. I am also very hopefull that clinics may soon be able to compete directly with the suboxone authorized doctors. The differences between both concerning take home medication should be eliminated.
I do hope that the Suboxone MD’s will set up a relationship with clinics for those patients for whome suboxone is not enough.
Maybe, one day, the Suboxone MD’s will also be authorized for Methadone. That would be great.
George