Methadone

Switzerland voters will decide this week whether or not to continue dispensing prescription heroin to addicts deemed “beyond recovery”. The first of its kind, the harm minimization program was developed over a decade ago and has since been tried by the Germans, Dutch, and Canadians. The program was started for those that repeatedly showed no progress in treatment, including methadone maintenance.

Instead of trying to condone or condemn this type of end-of-the-road treatment, I would like instead to pass on a topic that deserves pondering. Is there such a thing as being beyond recovery? Is harm minimization just giving up? Don’t answer too quickly. Remember there are people who fight addictions all their life, only to draw out their own misery while jeopardizing the safety, property, and lives of those around them. Consider also that group of people who administer these types of programs, the ones who have decided they will not give up on those that have been written off by all, including themselves.

Knowing that most in this program will fail, overdose, and harm others- can they in good conscious end it?

I had lunch today with a very smart and successful person that asked about my volunteer work at the “meth clinic”. As an advocate for medically assisted recovery, I was facing double trouble; he was obviously confused and really didn’t know much about it, but that hadn’t stopped him from having a low opinion of such establishments.

It's a common misconception for the general public to confuse methadone with methamphetamines, but when people abbreviate the words down to "meth" even I get confused. I give credit where it’s due though, once this individual was made aware of the differences between the two and the benefits of medically assisted recovery he did express his support.

It comes as no surprise to me that Dr. Nora Volkow, director of National Institute on Drug Abuse and one of my personal idols, stated there has been a “paradigm shift” in substance abuse commenting on a study this month that shows prescription drugs have passed marijuana as the gateway drug choice of our youth.

I have seen the writing on the wall for many years now and nowhere is it more apparent than the ever increasing stream of patients into the local methadone clinic where I volunteer. Over ninety percent of those I see come are not heroin addicts, but instead they are addicted to opioid prescription pain killers Loritab, Vicoden, Oxycontin, and Dilaudid. Go ahead and throw in the benzo's like Xanax and Valium into the mix of problems because that is what most addicts (and alcoholics) con their doctors out of by describing their depression while leaving out the fact they have a raging addiction.

Dr. Volkow mentioned this paradigm shift in abuse and treatment, but I feel there is one more important aspect of this situation she left out.

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The elephant was not on the red planet, but rather on (M)edically (A)ssisted (R)ecovery (S)upport. Taking five times the regular dosage for a human, Xiguang the Asian elephant received daily injections of methadone while in treatment for heroin addiction he developed after being captured by smugglers. This is not the first time I have seen this type of story, apparently the smugglers drug the animals to make them work longer and keep them controlled. Much like human addicts, this system works fine until either the dope or the body gives out.

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Aware of my advocacy efforts with methadone and medically assisted recovery for opioid addiction, JamezD of the Island Recovery Centers asked about my stance on Buprenorphine.

There's certainly some history around this (there always is)
that we're simply not aware of, but our addiction docs
seem to think that "Bup" is a superior approach to dealing
with opioid dependence… ~ Misleading on Methadone

Both drugs are used in treatment of heroin and pain killer addictions. Methadone and Buprenorphine work in a similar fashion but are usually administered and dosed differently to block opioid receptors in the brain to prevent withdrawal symptoms. Neither of the drugs produces the meteoric euphoric high that accompanies heroin and pain killer opioids and in fact cancel out the high of other opioid drugs taken during treatment. I feel Suboxone® is a superior form of Buprenorphine because of the additive naloxone which prevents misuse and abuse by injection and intranasal ingestion (snorting).

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Contrary to my blogging nom de plume, I am most active in meetings and as a sponsor to opioid addicts. They are patients at a methadone maintenance treatment (MMT) clinic where I hold a weekly recovery class. In fact, tomorrow I will testify in a certificate of need hearing for a proposed MMT center for a nearby county. Other than being prepared to answer the questions presented to me truthfully, I really don’t see the need for any preparation but a post on the subject matter certainly seemed timely.

It was in search of a photo to accompany this entry that I ran across this story from USA Today. Yeah it’s a little dated, but it seemed like a good way to concentrate on a singular issue instead of taking on the comprehensive subject. I’m also too lazy tonight to find something more current and this article really serves as a great example of why MMT is often misunderstood. Read the article, notice in particular that every fact and figure on overdoses given in the text is related to prescription methadone prescribed by doctors for pain management. Yet the big pretty picture of methadone offered along with the story is accompanied by this caption:

A plastic cup holds a dose of methadone at the Southern Indiana Treatment Center in Jeffersonville, Ind. Methadone deaths as a percentage of all drug overdose deaths has increased from 4% in 1999 to 13% in 2004, according to the National Center for Health Statistics.

Not exactly a relevant picture is it? I am not sure if the author was biased or just ignorant of the subject matter, it’s misleading regardless.

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Carol Sholiton, the founder and director of MethadoneSupport.org and the mirror site MethadoneAnonymous.info will be on the Recovery Talk Network on the evening of February 5th, this Tuesday. I have interviewed Carol myself and know first hand the breadth of her knowledge on medically assisted recovery (MARs) and have a deep respect for her commitment to the recovery community, she is an expert in the field.

When it comes to a subject like this, where most people have very strong opinions based mostly on conjecture and misinformation, I can think of no better person to listen to if you are looking for the straight talk when it comes down to methadone and other MARs related topics. I have seen these programs save lives, and I personally know people that are working their way as we speak toward a goal of complete sobriety, but even if you consider yourself an oponent of MARs based treatment I urge you to listen to Carol speak on the subject.

Just in case I haven't done it before, here's a TDA salute to Carol and her caring and helpful organization. Don't miss her "Live" this Tuesday.

A meeting on meetings, yeah sounds kind of crazy doesn’t it? Actually the topic of our recovery meeting this week was why we go and what we get out of our weekly get-together at the methadone clinic. As a recovering alcoholic with a considerable amount of meetings under my belt I had a little more to say on this topic, but I was pleasantly surprised at some of the feedback even from those new to group altogether.

Much like any 12-step or other recovery meetings you have those who say they are there because they have to be, either court or program ordered. A few of the responses including my own hinted at a self-flagellation or atonement, but for the most part that was just good natured banter. A sense of camaraderie and community was mentioned by those more regular to our group. A few even discussed how by listening and watching others it became easier to reflect upon their own actions and thoughts.

There were two main reasons I pressed this topic and they really apply to anyone seeking or already in recovery. First, meetings are a positive step, direct action, on the road to personal recovery. No more crouching in the blocks waiting for the starter’s pistol, regardless if you get anything out of the meeting at all you are moving forward and this can be rewarding both in self esteem and accomplishment. Secondly, it’s about the only place where anyone will have truly have a clue about what you feel or experience. Friends, family, counselors and doctors may lend a sympathetic ear or even earnestly try to understand addiction; however it has been my experience that only an addict or alcoholic will ever truly “get it”. Not to take anything away from these well intentioned people, but they have about as much of chance relating to my story as I do to someone who wakes up to voices in his head telling him to sacrifice amphibians- the context just isn’t there.

Strangely enough, when asked I usually say I’m not a big fan of group meetings… but I host one weekly, strongly recommend them to others, and almost always get something positive out of them. I guess that sounds about as crazy as a meeting about meetings.

While being a very strong advocate for medically assisted recovery, especially methadone maintenance treatment, I still realize there are some major shortcomings in the way these programs are set up. I ran across a term this morning in an article from Ireland about the problems they are facing with their methadone program that describes one of my reservations about the program perfectly: parking.

"There are approximately 9,200 people on methadone maintenance programmes in Dublin city alone and only 23 residential detoxification beds are available in the entire country for those who want to get off drugs completely." Merchant's Quay has voiced concern that too many people are now "parked" on methadone, with no resources available to develop their recovery any further.~ Independent.ie

The methadone programs in Europe tend be more publicly funded as I understand them, but the problem remains the same here. Once in a methadone program, the patient usually shows immediate improvement both in health and lifestyle, but from this point on they are for the most part parked in this position with nowhere else to go with their recovery. Much like the picture of the automated parking garage (cool, click the pic to see it on Gizmodo), there are no stairs or an elevator to get out of the garage and continue the journey… for some people it’s a permanent parking spot. Even worse, many patients become disenchanted with their lack of progress and fall back into their old habits.

By taking heed of the problems other countries are having with their programs we can improve ours. In the States, I see more concern on possible diversion of methadone from the treatment programs. While this does happen, it is considerably minor compared to the diversion of prescription drugs in general. In my humble opinion, we should be emphasizing the role of complete recovery in both the operation and regulation of our methadone programs.

You can’t go to an AA meeting without hearing it, “keep coming back.” It’s a fundamental concept of the program, the more you go the better chances you have of staying sober. The same can be said to be true for those in methadone maintenance treatment (MMT). Building a routine of going to the clinic, attending meetings and counseling sessions, and being exposed to a recovery centered environment helps break the habitual patterns of an addictive lifestyle, but there is a big difference as compared to a traditional 12 step program like AA.

Those that attend AA meetings concentrate on taking life one day at a time, while recovering addicts in MMT, because of the nature of their treatment, have this part covered in a matter of weeks. The real problem with MMT once a patient levels out (healthy, clean, and positive), it is difficult for them to risk losing this new found life by considering tapering off the very substance that brought them back to the real world. Making the task even more difficult, is the fact that those that provide MMT services will play the odds by advising their patients there is no set time limit on how long they can stay in treatment. This practice leads to opponents of MMT to say that the clinics are protecting their investment, but unfortunately they are just being realistic. Those that stay in MMT, usually stay out of trouble, those that don’t fall back into their old habits. Same goes for AA, why else would they say keep coming back?

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