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Commentary: Opioid Addiction Treatment and the Criminal Justice System


In the United States today, there are more than two million jail and prison inmates, of whom about 15 percent have histories of heroin dependence. Few inmates receive drug abuse treatment while incarcerated or immediately upon release. Research has shown that this population, once released from incarceration, is at high risk of relapse to heroin use, criminal behavior, HIV infection and of overdose death, resulting in a terrible toll on the individuals, their families and our communities.

The World Health Organization supports the international standard that prisoners have the right to access the health services that would be available to them in the community. Health care in prisons is then a human rights issue and treating drug-dependent prisoners in jail and prison is consistent with the spirit of that standard. However, the correctional systems in the U.S. have been slow to embrace this notion and have shown even less comfort with providing medications to treat addictive disorders.

There are now several FDA-approved medications available in the U.S. to treat opioid dependence. Methadone has been available to treat opiate dependence since the early 1970s. Buprenorphine (Subutex and Suboxone) has been available since 2003. Oral naltrexone, an opioid antagonist, has been available since 1984 and the recently-approved Vivitrol, a long-acting, injectable form of naltrexone, is now available. Unfortunately, these medications are infrequently provided to opioid-dependent adults in U.S. jails and prisons and in the community under parole or probation supervision.

There are multiple barriers impeding the improved treatment of opioid-dependent inmates, probationers and parolees. There is an inherent contradiction between custodial and treatment goals. Moreover, many correctional officials may not be aware of the strong evidence supporting the effectiveness of medications in reducing drug use and criminal activity. They may be philosophically opposed to the use of medications or reluctant to increase their budgets to include medical services for addiction treatment. Moreover, many corrections officials in charge of jails and prisons feel their responsibilities end when the inmate is released from their facility.

The question can then be asked: How can change be affected in the criminal justice system to improve the treatment of opioid-dependent prisoners? The answer may lie in current research, the majority of which is funded by the National Institute on Drug Abuse (NIDA).

Two different approaches are being used. The first is to test medications in opioid-dependent prisoners and those newly released from jail or prison. A recent study by Dr. Timothy Kinlock and colleagues at the Friends Research Institute established that adding methadone to counseling in prison increased the likelihood that a prisoner, upon release, would continue to receive drug abuse treatment in the community, reaping the benefits of this medication; e.g., reduced risk of drug use and of overdose. An ongoing multi-site study led by Dr. Charles O’Brien at the University of Pennsylvania is underway among adult probationers and parolees to evaluate the effectiveness of long-acting naltrexone, which protects from relapse and overdose for one month. The research team at Friends Research Institute is also conducting a study of the effectiveness of Suboxone in prisoners with histories of opioid dependence.

The second approach is to forge better linkages and enhance collaboration between the criminal justice systems and the treatment clinics where effective medications for the treatment of alcohol and/or opioid dependence are available. The Criminal Justice-Drug Abuse Treatment Studies initiative of NIDA is currently funding a multi-city study. Its intent is to improve service coordination between parole and probation agencies and drug treatment clinics that provide medications for addiction treatment through an intervention aimed at improving knowledge and attitudes among community corrections (CC) staff and enhancing inter-organizational relationships. It is anticipated that improved knowledge and attitudes among CC staff will increase the number of criminal justice referrals to the treatment clinics.

Everyone wins by bringing the power of science to bear on the challenges of drug dependence in the criminal justice system. The opioid-dependent individuals reduce their likelihood of relapsing and dying of drug overdose upon release. A reduction in criminal and HIV-risk behavior improves public safety and protects the public health, and avoided episodes of reincarceration save the taxpayers money.

Frank Vocci, PhD, is President of Friends Research Institute, which promotes health and well-being through research, grants administration, education and treatment.

64 Responses to this article

  1. Chris / November 20, 2013 at 4:49 pm

    Methadone should only be used to ease the physical withdrawal process, not as a replacement therapy. All you are doing is replacing one drug for another, and keeping the addict in the cycle of addiction.

    People also seem to forget that the withdrawal from Methadone is significantly worse than from say heroin – it lasts a lot longer, making it even more difficult to become free from drug dependence. Methadone withdrawal is absolutely horrible.

    It is useful in very small doses to help the addict get through the worst of the physical withdrawals, but that is it. The does needs to be cut daily and only used for a few days. Once the physical symptoms subside, then the addict can start to find recovery, and learn how to live without drugs.

    And my opinions are based on personal experience – recovering heroin addict, clean for nearly 8 years now – and from dealing with numerous opioid addicts working withing a rehab facility

  2. Pegasus / September 13, 2013 at 10:23 am

    i have to agree wholeheartedly with Marcia about nutrition, good for you Marcia and all the great work you are doing there. I think that should be also the very first thing that is addressed and funny but it seems to NEVER be addressed at all, no where during the process, before during or after. I am a believer of using diff methods, but it is cruel to have someone kick cold turkey when there are safe means, I think the biggest prob w/ Methadone is simply the trading of one drug / and dependency for another, a less evil but still an evil and still a dependency, and may perhaps be beneficial. There needs to be made avail the combination necessary of therapy , drug or not, for each individual custom around their own desire and input as to what is working. If someone addicted actually really wants to quit they will want to incorporate whatever they need to do so by, all welcomed and none to be soley relied upon or substituted for. all grey not black and white, to each what works and yes to allow patient to decide.
    but wholeheartedly agree with Marcia that it is the most basic and most overlooked I too believe this to be the case for many of those that are labeled from ADHD to bi polar or whatever else growing list of mental disorders that physicians are much too quick to prescribe psychotropic drugs for (many of which are also dependencies and mood altering) as the alternative to firstly nutrition to naturally correct these imbalances and therapy, thus identifying and solving the core problem and root cause, w/o doing so, treating just addiction leaves the addicted soul just a time bomb, either living quite uncomfortably or just a matter of time before they seek the comfort (self medicating) for something that could have very well been treated with food and proper exercise, proper nutrition and food ARE the drugs we need and when we do not get them we are all vulnerable to attempt to self treat, our society is growing ever impatient and to continue to work and be “productive” at the cost of our health and sanity has become normal even admired to do, sad for us. Marcia has nailed the problem at root. we even do this for our domesticated animals, firstly always rule out physical before addressing behavioral issues. your dog is behaving badly and has a malnutrition problem, well that must be treated first and foremost and it has to also become habit, as eating habits for good or bad have to be educated and maintained along with the discipline to do so..she is right. so much could be avoided and PREVENTED should be automatic. I am pretty sure I have nutritional deficiencies that I could alleviate many disorders that I suffer from yet, it has never once even been mentioned by doctors my entire life and I have suffered accordingly…thanks Marcia for opening up my eyes again to this that I know but have such bad habits, I have become accustomed to the bad ones. which goes along w/ self destructive tendencies, so that would have to be addressed for when you are at that level the last thing you will do is feed yourself proper (depression)…

  3. Pegasus / September 13, 2013 at 8:40 am

    Doc Barry I know it is off topic a bit but you are right about the Stigma, it exists also now for anyone that needs pain meds legitimately, it is like saying bomb on an airplane and you are immediately treated like a criminal or addict and you bring up a great point , there should not be stigma w/ addiction and criminalization not only exacberates (sp?) the problem, it feeds that stigma that we need to instead eliminate, quitting is hard and a multi tiered combined w/ the will power and strength of charcter is what is required and if we are going to judge at all it should be for the amount of strength and fortitude, not stigmatizing, funny most who do are the most ignorant of addiction aren’t they?

  4. Avatar of Pegasus
    Pegasus / September 13, 2013 at 8:36 am

    speaking of addiction, you may become physically addicted to pain medication when you find you are injured and w/o ins and that it takes 3-4 years to receive Medicaid or benefits or even see a dr. to receive treatment for serious health conditions,all the while you wait and you are given pain meds , while you wait since Gov’t is so slow to respond and local will not cover any treatment, you become addicted and enter poverty whilst you wait, because you had ill fortune of getting injured/ill at wrong time. after working your whole life and paying taxes for your benefits. that said addiction could have been PREVENTED, as well as entere DEA war on drugs that has now made it near impossible for people who need legit pain meds cannot get them, enter black market, or what? become homeless? commit suicdie for hte inabilty to tolerate pain that board cert physicians have legally prescribed you meds for? this is a new epidemic going on a few years, yet those unaffected may not hear about this. and meanwhile sure those teens on prescr pills has been reduced but now they have turned to heroin and those o.d have increased accordingly, this is NOT and we all know this regardless the method of treatment, addicts cannot be helped unless they themselves WANT to be. this is first ingredient towards any successful treatment is the desire from the addict.

  5. Doc Barry / March 18, 2013 at 5:41 pm

    I am really pleased to see how much feedback there is on this topic, however misguided much of it is. First of all, as a Heroin addict, I was always in violation of the law, 24/7, so the last place or person that I sought for help would be the CJS. That being said, I take exception to the folks the denigrate Methadone or Suboxone. How Dare People that have not used methadone or suboxone, make judgements about their efficacy? Personally, I have managed MMTP’s, and I know support suboxone out of necessity, for I live in Central New York, and there are very simply, no methadone slots available. If you do not believe me, try to get in to a program from Binghamton, NY to Canton-Potsdam, to Buffalo. A pretty large area. Ironically, a previous writer commented that we have no good treatment for opiate addiction. I have to differ; no, I have to say that is just a lie. I treat more than 100 people,and you can ask those folks if treatment works. Of course, giving someone a medication by itself may be beneficial, however, when you combine that with peer counseling and psychotherapy for those that benefit from it, how can anyone not see that treatment works? By the way, Rokki, you are right on about Stigma. Probably the worst stigma is found in MMTP’s or pharmacies that fill the Rx’s for the medcation. It is pretty pathetic that a person would go to school to become a clinician, and then stigmatize the very person they pretend to help.

  6. Fred B. / February 25, 2013 at 12:29 pm

    I feel that the Commentary that Mr. Vocci wrote has much insight into our justice system. I must bring up that there are legitimate pain patients that do reley on Opioid’s for true severe chronic pain. Yes, many people get into trouble but the fact still remains that there are over 100 million plus people here in the United States that live in some form of chronic pain.

    Fred Brown, Founder

  7. Marcia Kirschbaum / November 30, 2012 at 1:49 pm

    Just paid a re-visit to this article… Great post Doctor Schecter.
    I so agree that legalizing drugs is the big picture answer. I just wish to god the medical community would put a bit more time into studying nutrition to achieve neurotransmitter balance – which is the major, underlying reason behind drug addiction, due to the current state of our toxic food – if some of it qualifies for that title all. Neurotransmitters can only be rebalanced through functional food, but thanks to Big Pharma and AMA, instead it’s always more drugs. Certainly, there are also emotional issues that often need to be addressed, but not always. Lack of nutrition is an “always” when it comes to addiction.

    My own son, now 24, became addicted to pain pills at age 18, after a shoulder surgery and the accompanying bottle of Norco with “take them till you don’t need them anymore” instruction from the surgeon. Well, that day never came.

    In my ignorance, I thought canceling his health insurance was the answer, since he was getting the drugs “legally” with a prescription. Well, of course all I did was turned him into a drug dealer, buying the actual prescriptions for cash from a few doctors and collecting money from other users to pay the hefty $900. For 30 – 80 mg Oxy’s. Ultimately he became a heroin user. The legal issues and felony followed, but it was never a deterrent to stop his use after each release and I was adamant that drug switching was the most asinine thing I’d ever heard of and would never be part of his recovery.

    This is the first article I read, where I connected the dots on what to do and used exercise and nutrition to get him off opiate addiction;

    He’s been clean for over 4 years with no relapses or cravings and I’ve helped a few of his friends get past opiate addiction using nutrition too. The only “trick” is they have to continue to eat a healthy diet. I didn’t know of a particular treatment back then, but Amino Acid IV Therapy is a highly effective and fast road to addiction recovery.

    When will common sense come into place regarding what the human body requires to heal from any chronic illness? None of us has a drug deficiency. The “chemical imbalance” term, so loosely thrown around, is in fact a chemical imbalance, but those chemicals come from what our bodies make from the food we ingest, so if we aren’t getting good nutrition, synthetic drugs cannot replace those chemicals. They cause further depletion and this is why we have not been successful in reining in the nation’s drug abuse problem. We need to teach our children, from a very young age, what real food is and demand Pesticide Corporations stop being in charge of food safety. I’m sure you are aware that many of the Giant Pharma and Pesticide corps are also major investors in the Privatized Prison System. Quite a racket they have going.

    A site you might like to visit or join is GRASP on Facebook.

    Most every member here has lost a child to accidental overdose or drug related suicide and these parents overwhelmingly support ending drug prohibition. Thank you again for the great post that needs much more consideration.

  8. Avatar of Kathleen Huppert
    Kathleen Huppert / September 6, 2012 at 6:05 pm

    I was on methadone for 18 yrs. and the effects to my body are many. I kicked the 18yrs in custody and the cc staff could of cared less. I lost 65lbs in 36days couldn’t eat.Sence then I have been clean and sober for 4 years, that was a eye opener. I dont think methadone is good for anything but 21 day detox’s. other than that it destroys the body. The public p0ays each month for hundreds of p0eople on medical for methadone and it’s not cheep sadly iwas one of them. Please stop methadone use. it’s nothing but a MONEY MAKER for people who buy clinics. The opiate blockers are what is needed.

  9. Avatar of Michaele Plotkin
    Michaele Plotkin / July 16, 2012 at 9:32 am

    Hello, Methadone is used in an effort to reduce harm in substance abuse treatment therapy. If taken properly by the patient, Methadone works as opposed to street drugs…it reduces the harm. I hear that Methadone is very hard on the body and I have to agree with that, but street drugs, I believe are much more harmful, and at any time and for whatever reason the patient could die from something as simple as an overdose. That would not happen with Methadone, assuming the patient is following all guidelines set forth concerning it. Methadone is prescribed for harm reduction. We would hope that the patient follows the guidelines. If he/she does not, then that could lead to much greater problems. If he/she is following the guidelines, taking Methadone far outweighs all the negative impacts that the other people who have left comments in this column are talking about.

  10. Avatar of shannon mchenry
    shannon mchenry / May 31, 2012 at 2:50 pm

    I became addicted to painkillers following being prescribed them after a car accident. I had no criminal record until age 30, and was convicted of prescription fraud several times. I spent one year in prison, living with women who were murderers and child molesters. I learned to tolerate verbal abuse from guards. I now do not just have the stigma of being an addict, but also a felon who has been to prison. I know methadone works for few people- but if it helps two people, its worth it to try. It, also, is an individuals choice!!! I am an addict, not an idiot- I have a right to know every choice for treatment. I am amazed that people who have never lived the life of an opiate addict have all these opinions, based on what they have ” seen”. I base mine on what I have lived. Also, suboxone is used in my states male prisons, but not womens- it makes me so angry that a penis is the determining factor of alternatives for treatment. We have the right to know and be given options, thank goodness I finally found a recovery program that works for ME. It may not work for everyone, but it works in my life. It is easy to forget studies, statistics, and numbers are made up of individual people.

  11. Robert / May 10, 2012 at 10:17 am

    Methodone will rot your teeth right out of your head. If a person wants to quit , they will. 3/4 in jail and rehabs are mandated or are asked to go by their family. They don’t really want to be helped, my knowledge from the halfway house I work at. I see some struggle and want it. They share at meetings and stay busy. Others remain quiet and think that’s the way. There is no one answer.

  12. Dina / March 26, 2012 at 5:42 pm

    None of this would be happening whatsoever if the irrational minds of the medical community and court system did NOT follow the insanity of the 12 Steps. Wilson was a spiritist who was ‘given’ the 12 steps by a demon. How are humans with high degrees rationalizing following a MONSTER??? There is a total 100% solution to what is NOT a disease. I see the healing daily without fail. Has the world gone insane? Are the inmates running the asylem? This is madness!

  13. Dr. Barry Schecter / March 20, 2012 at 5:51 pm

    I thought that I posted to this, but I guess I hadn’t, or I didn’t do the code thing correctly. More to the point; I could never have stopped using Heroin, It was my wife, and it was my life, etc. However, Methadone, took away my need to use Heroin, except for a period of several months when I gave up. I tapered from Methadone three times. Three you ask? The first time I was clean about 18 months. When I say clean, I just mean no dope. Then I ran into two foxy chicks that wanted to shoot dope. I figured, what the hell, what’s one time going to do. Well, I guess you know why there was a second attempt. That one lasted about 18 months again. I fond myself owning a bar, and I heard a customer discussing dealing. Once that thought was planted in my brain, it wasn’t long before he was my best customer, and I was his best customer.
    After about 13 years of Methadone, it beat me. Or, I realized that I should never do an opiate. Anyway, I tapered for the last time in 1983. The next four years were some of the best, and some of the worst. Once I’d have a drink, I would try to make combinations of coke, barbs, valium, of course pot, but that was like the salt and the alcohol was the pepper. The only problem was this mix kept me in a state where I should have passed out, I had already blacked out, but the coke kept my eyes open, so that I was operating in a blackout, with a semblance of presence. I never want to forget those years; all of them. From the first time I saw a friend with a spike in his arm and thought it was disgusting, to the joy of real sobriety. I felt like I was sharing at an AA meeting, but the truth is the light. I would have been dead, if not for methadone. But I’m not. I have been a tour guide for hundreds of people as they too learn that life is a gift. If I died back then, well, just another dead junkie. It will probably still get me, because in the old days, we would say you aint hip, till you had hep. Well, I got hip. Maybe. But I definetly have Hep. In the great scheme of the universe, I will keep my vibrations pure, real and honest, that those that come in contact with me are better for the experience. So long as I do the spirit’s work, and follow that soft voice, I believe I shall et to continue. When I am no longer doing the work, well, may I close by saying nobody gets out of this world alive. So if I don’t meet you in this world, I’ll see you in the next, but don’t be late. Peace and Love

  14. Kris Lootans / March 2, 2012 at 4:18 pm

    In addition, I would like to add that I am not “downing” methadone as a tool for recovery and as I stated previously, NO two cases of addiction are alike. I know of successful recoveries coming out of methadone maintenance, but what I have retrieved from all the resources is that,”methadone is used primarily for harm reduction”, which is very helpful in reducing the sharing of needles, crimes committed to gain access to monies for the support of an addiction, and so much more. I just wanted to be sure I wasn’t totally negative about methadone maintenance. Thanks

  15. Avatar of Jeffrey Quamme
    Jeffrey Quamme / March 2, 2012 at 1:50 pm

    No medication is the “answer” but they can be usefool tools in recovery for some individuals. Methadone is not an “addictive” substance, however there is physiological dependency, as there are with other medications used for the long term. As far as damage to the human body, the withdrawal cycle and lifestyle associated with opioid dependence are far worse. There is over 40 years of research on the efficacy of methadone, and I suggest that it be reviewed before painting it as harmful. People can and DO recover with the assistance of medications, and any path to recovery should be celebrated as opposed to attacked with an anti medication bias not supported by fact.

  16. gloria / February 6, 2012 at 1:58 pm

    Why can’t there be room for all types of teatment. Yes abstinence works for some, 12 step recovery fellowships works for some, 28 day programs works for some, methadone maintenance works for some. I would think that as big as this battle is we would welcome allt he help we could get to fight it.

  17. Sandra, Vancouver, Canada / August 6, 2011 at 11:42 am

    I’ve written several comments in this thread, and I wanted to make clear that I’m an alcoholic and an addict, in recovery for 23 years, clean for 13, with a medical background and I’m a Canadian with an interest in criminal justice policy in North America and the War on Drugs.

    Many Wardens will say privately that they know there are drugs sold in their facility and that they only put a token effort into interdiction of the supply because they feel that without this, violence and risk of rioting would become a problem and the small amount of drugs that get in “keeps a lid on”. Right now, in most institutions, any treatment addicts get is from voluntary organizations like Churches and 12-step groups. Medications are psychoactive drugs: most likely anti-depressants and anti-psychotics. There is no guarantee that inmates will get medical treatment. There is no guarantee addicts will get any treatment when they leave prison–many will leave at the statutory end of their sentence, as a felon and not be on parole, not have any support, and have no access to government assistance because he or she is barred as a felon. He may not be able to go home if his parole conditions bar him from associating with one of his felon relatives–in most inner city neighbourhoods, a young man is more likely to go to prison than to college. She may never be able to vote, if she was sentenced, say, for “theft over” as a juvenile, in some states. Felons are virtually unemployable, especially in this economy, and without a job, re-arrest and re-imprisonment is likely.

  18. Avatar of Chris Baynum
    Chris Baynum / July 26, 2011 at 5:16 pm

    Methadone by NO means is the answer, nor is any other chemical. I am a recovering alcoholic/addict.Vodka and methadone is my drug of choice.When used together they gave me the ultimate high.Abstience is the only solution. It seems that the government feels the need to find excuses on why they use alcohol and drugs to fuel the economy.Alcohol alone generates over 100 billion dollars a year. This does not include the money that is generated through fines for DUI’s, Ai’s and court costs. Abstience would cost the economy billions of dollars!!!!!!!!Now do you understand why they would want you to believe that methadone is the answer to the problem. Methadone is the answer to there problem, not yours!!!!!!! Abstience is the only ANASWER!!!!!!!!!!!!!!!

  19. Bill Poel / July 26, 2011 at 3:32 pm

    Carlos’comments about clinicians and their cognitive limitations or commenting with lots of confidence about their absolute opinion or comments based on experience is quite amazing. My opinions on this topic are definitely based on many years of experience-not on literature or books which, by the way, I have read. I have found that most of the positive comments about methadone comes from clinics or others who have a vested interest in methadone. My personal experience has told me that the theory that methadone is a wonderful treatment facilitator for opiate addiction is not valid. Others may have a different opinion and that’s their perogative.

  20. Bill Poel / July 26, 2011 at 9:30 am

    Rokki comments about stigma and methadone are interesting. I have read all the information there is about methodone and other treatment medications. I based my comments on 35 years of dealing with addicts. I have seen what long term methadone use does to people. An opiate addict using methaone is abolutely not the same as a diabetic and their insulin. You don’t get hammered on insulin. Anyone who thinks one does not get hammered by methadone has their head in the sand. I have had many addicts try the methadone route over the years. for a variety of reasons, I have yet to have even one say that was a good choice. Jane Doe commented about withdrawal – I know all about that. Methadone withdrwal is worse than withdrawing from heroin. I’ve seen both first hand.

  21. Carlos / July 25, 2011 at 6:59 pm

    Methadone is absolutely NOT the answer. It is hugely addictive itself and causes severe damage to the human body.
    The answer should be the patients choice, not ours. The more I look at treatment the less I see the patients participation. Because everything seems to have become “Trust us we am an expert”, we know everything and you know nothing.
    Besides there is a lot of myth out there debunked by research regarding this claim that methadone cause severe damage to severer body. Unless you know some research I am not familiar with, can you please provide the reference so I can look it up. Because I have heard way too much information “based on my experience”, and I tell you we humans are not perfects and we have tremendous amount of cognitive limitations. Based on my experience I think the world is flat and the sun rotates around the earth. If you wonder about my comment about our human cognitive limitations, I suggest “Studying the Clinician” by Dr. Howard Garb for you record

    I do not get a toster if you buy the book, but I get absolutly weird when I hear clinicians talking with lots of confidence about their absolute opinions.

  22. Jane Doe / July 25, 2011 at 12:43 pm

    If drugs were just LEGALIZED, there would BE no unfairly jailed ‘users.’ It would considerably free up the prison systems, the drug courts, and the people’s TAX MONEY! Not to mention the fact that there would be no more border drug wars/ cartels. But NO… that wouldn’t make any SENSE or be of any BENEFIT to big government, would it? Live and LET live!

  23. Avatar of Jane Doe
    Jane Doe / July 25, 2011 at 12:37 pm

    I agree with Rick. Methadone is certainly better than the ‘alternative’… (street or prescription drug abuse). You all have obviously never HAD an addiction or been in hellish withdrawal- much LESS been deprived of what your body needs/craves. It is brutal and heartless to leave imprisoned, addicted humans in jail and denied an FDA APPROVED medication that would keep them out of withdrawal!!! Shame on you all- if you ever went through unbearable withdrawal for just ONE HOUR, your “opio-phobic” attitudes would surely change!

  24. Fred C / July 25, 2011 at 10:48 am

    I appreciate this publication’s move to provide more articles like this. Dr. Vocci is right on the money about this. And as far as the money goes, a friend of mine, also involved in prison volunteer work, once calculated that it would be cheaper for the state to put up prisoners in a room at the Hilton and let them order room service three meals a day than to keep them in prison. I agree that methadone is a terrible choice and buprenorphine is not exactly a health food, but remember that the previous prison policy was to just let the addict suffer kicking cold turkey, and in the case of methadone addicts, this often lead to death. After paying for some heavy wrongful death lawsuits, the prison systems grudgingly allowed treatment with methadone. Long-term recovery from heroin addiction has historically been only about 15% the lowest recovery rate of all drugs. I have great hopes for vivitrol and other drugs that may yet be developed, and I hope they do not prove as damaging to the liver as methadone is. I would like to see some information about what is being done in Argentina as Bill Poel mentioned. If it is that successful, an article about it would be very welcome.

  25. notwhatyouthink / July 25, 2011 at 10:39 am

    Hope these research grants Mr Vocci uses are not funded by drug companies because this sounds like a commercial for selling drugs. Vivitrol is about $800 to a thousand a month. Wouldn’t drug companies love that to be a court ordered treatment? I am all for methadone and suboxone treatment, but I believe these should be temporary for most (not all)for some folks opioid replacement is the best we can do. While in jail I says treat them let the addict clear up and allow the body and brain time to heal. Than after jail mandated recovery home treatment. There is no sure fire way to guarantee anyone will stay clean or sober, but I am not convinced using drugs to solve behavioral problems is any more effective than chemical free treatment.

  26. Marcia / July 25, 2011 at 2:23 am

    A good article and I do appreciate you bringing to light the plight of incarcerated addicts, but I will never get behind the drug switching method as being even remotely close to a plausible means of treating drug addiction. Maybe a 1/4 of a Suboxone tablet a time or two a day for the first few days of withdrawal, to decrease the pain, but if the intent is to get these people off drugs, then drug switching is not any kind of answer. Acupuncture was a very successful program for heroin addicts, but of course, since it was working, they blamed the recession and got rid of it. Funny how they still have a budget to keep a huge portion of the inmates on psychotropic drugs. The industrial Prison Complex wants recidivism. How else do you explain why more than 50% of our prisons are filled with drug use arrests or the refractions and violations that follow that original arrest. The only REAL solution for ending this mass incarceration of addicts will happen by legalizing, regulating and taxing drugs and using the revenue to educate and rehabilitating through whole body-mind healing, counseling and exercise.

  27. Avatar of Rbrinn
    Rbrinn / July 23, 2011 at 5:42 pm

    If meth and subOx are chemical jails
    Then post prison fx is just another cell

    Break the cycle with education jobs dignity

    Is nida fri in service to big pharma or addicted

  28. Barry Lessin / July 22, 2011 at 6:07 pm

    Hooray for a step in the right direction but if you acknowledge that health care is a human rights issue for those in prisons and “forging better linkages” and “improving collaboration” between the criminal justice systems and the treatment programs is advocated, then why wait until the person is buried in jail??
    These linkages will be more effective when addiction is viewed as public health issue, not a crime to be punished. Providing access to quality, effective treatment when a person first bumps up against the criminal justice system will increase the chances of people getting connected to the care they need and reduce the monstrous financial burden required to incarcerate untreated addicts.

  29. Avatar of Rokki
    Rokki / July 22, 2011 at 5:15 pm

    Never have I seen and read,in the comment section,so much stigma. I would like to see proof of how methadone mess’s with the body. Can you show me referenced studies? Methadone is a body friendly medication,when prescribed properly and the patient is not adding seroquel or benzo’s,these will heavily sedate the patient not to mention cause all types of nasty side effects. Might I suggest that Every Parole and Probation officer go to the SAMHSA web site Go to publications click there and order a few copies of the “TIP43″. It’s free all day long,even shipping and handling. It’s the Methadone Guidelines and even has a section for Parole Officers and Probabtion Officers who tend to bring their own stigma with them to work and force good patients to get off of a medication so they can die either by HIV/HAV/HBV/HCV/TB and the list goes on and on. Do you make a diabetic get off of Insulin or violate them? How about those who have Thyroid disorders? The medication taken for these is a maintenance medication much like Methadone or Suboxone. It’s not a cure,neither is my thyroid med,but as long as I take it it keeps my disease in check. Do yourself a favor,get the TIP43..Read. Knowledge is power and you just may save someone’s life.

  30. Circus / July 22, 2011 at 4:42 pm

    The public would better support these efforts if the cost of NOT providing treatment for prisoners was better understood. It seems that once an addict gets entangled in the criminal justice system, that person will return again & again if the addiction isn’t treated. The cost to taxpayers is horrifying.

    I was blissfully unaware of such things until a time several years ago when a nephew became a guest of a corrections department in Texas. Now I’m a proponent of meaningful jail- & prison-based addiction treatment, but I would support therapy over substitute meds like methadone.

    Addiction is so misunderstood in our society, and by the time that many addicts end up in prison, they’re alienated from family and former friends. That family may just not be willing to coach the person while they’re incarcerated, and may be unwilling or unable to help the person find treatment upon release. If we were a civilized society, we would detain addicts separately from other types of criminals, and we’d provide meaningful therapies to get them in the proper frame of mind upon their release. What we now do is borderline criminally negligent.

  31. Avatar of w.Price
    w.Price / July 22, 2011 at 4:07 pm

    Frank Vocci’s comments regarding the medical needs of inmates with addiction are well presented. However, the use of suboxone and methadone only prolongs the addiction and these inmates can be safely detoxed in prison. Only the most recalcitrant addicts should be put on a methadone/suboxone maintainence program. This approach in and of itself could well be a life long dependency requiring up to daily clinic vists for the medication. This effectively marginalizes them in society. The vast majority will remain a burden on society requiring wellfare benefits for daily needs as well as medical care. All children of the women will be born addicted and pregnancy is a common event in this population for a multitude of negative reasons.
    Every effort should be made to provide supportive medical and psychologic care. The goal is to give the inmate the tools to deal with those issues that have contributed to the addiction. I would stress that Naltrexone/Vivitrol treatment should be one of the cornerstones of their treatment since this is an opiate blocker that decreases cravings rather than perpetuating their addiction with methadone or suboxone.

  32. Bill Poel / July 22, 2011 at 2:09 pm

    Methadone is absolutely NOT the answer. It is hugely addictive itself and causes severe damage to the human body. It is cheaper per dose than the other drugs mentioned but at what cost? The other drugs are also iffy at best. I have had many probationers use all the mentioned approaches. None have worked very well with Methadone being the worst. The system in the US for dealing with opiate addiction does not work. Tremendous success has been achieved in Argentina treating all forms of addiction including opiate addiction.

  33. Bill Poel / July 22, 2011 at 3:07 pm

    Methadone is not the answer for opiate addiction issues. It is very addictive and does horrible damage to the human body. The other treatments listed are suspect at best. Opiate addiction treatment in the US does not work.

  34. Avatar of Rick Eash
    Rick Eash / July 25, 2011 at 7:58 am

    Iran has also had tremendous success in treating addicts.
    They execute them. 0% relapse rate
    “methadone … does horrible damage to the human body”
    Are you serious?
    Compared to adulterated heroin, HIV, HEPc, blown out veins or severe liver damage from high doses of tylenol in hydrocodone how does methadone stack up?

  35. Avatar of Penny Hall
    Penny Hall / July 25, 2011 at 8:55 am

    It is amazing that after all of the research that has been done to PROVE without a shadow of a doubt how effective methadone treatment is there are still people who refuse to believe the PROVEN facts. Methadone saves lives!! The only horrible thing that it does to a person’s health is PROLONG their life. Methadone has been proven to have one harmful health effect and that is to prolong the QT wave. This effect is shared by MANY other drugs and is not found in all patients.
    Methadone does not work for everyone unfortunately. There are just some people who refuse to give up their desire to get high. But it works in the majority of those who enroll in programs and saves their lives! It gives them back a sense of hope to be anything they want to be.
    Methadone is the most researched of all the addiction treatment modalities and consistently comes out with positive results.

  36. Avatar of Kris Lootans
    Kris Lootans / March 2, 2012 at 4:11 pm

    Being in active, successful recovery, myself, for about 1-1/2 years, I totally agree with the statement regarding, “methadone is the worst treatment for opiate addiction”. Methadone is beneficial in being utilized for “harm reduction”, but for assisting an individual overcome withdrawal, craving, and other effects, the use of buprenorphine (Suboxone) has been very successful for me. I am aware that all cases are not the same, but in my case, the craving to use (near the end) was out of fear of withdrawal! I have decreased my dose of suboxone gradually since first introduced and today, I am able to take 4mg. a day with the ability to sporadically skip a day. In my opinion, this is huge! I started at 32mg. and currently have no desire to use any type of narcotic and my life is on the right path again. I have been enrolled in college courses to earn my AAS in Human Services, with current GPA of 3.5. Just wanted to share my view of methadone, it was the worst attempt at recovery I ever tried!!!!

  37. DrJJMD / January 29, 2013 at 6:16 pm

    Unfortunately, despite over 40 years of definitive research and large scale statistically significant studies, providing overwhelming evidence to ALL that Dole & Nyswinder’s utilization of methadone maintenance was and IS a legitimate recovery modality for the effective treatment of persons dependent on heroin, there continues to be large scale myths and mis-educated patients, individuals and even PHYSICIANS that accept and propagate stigma regarding opioid agonist therapy. Furthermore, the fallacies (with regards to this treatment) remain deeply entrenched within the psyche of Americans. Research has demonstrated that methadone maintenance treatment is an effective treatment for heroin and prescription narcotic addiction when measured by 1)Reduction in the use of illicit drugs
    2)Reduction in criminal activity 3)Reduction in needle sharing 4)Reduction in HIV infection rates and transmission 5)Cost-effectiveness 6)Reduction in commercial sex work 7)Reduction in the number of reports of multiple sex partners 8)Improvements in social health and productivity 9)Improvements in health conditions 10)Retention in addiction treatment 11)Reduction in suicide
    12)Reduction in lethal overdose. Furthermore, meta-analyses have supported the efficacy of methadone for the treatment of opioid dependence. These studies have demonstrated across countries and populations that methadone is effective in improving treatment retention, criminal activity, and heroin use. In addition, Amato et al, in their 2005 meta analyses provided, “…an overview of 5 meta-analyses and systematic reviews, summarizing results from 52 studies and 12,075 opioid-dependent participants, [it was] found that when methadone maintenance treatment was compared with a) methadone detoxification treatment, b) no treatment, c) different dosages of methadone, d) buprenorphine maintenance treatment, c) heroin maintenance treatment, and d)L-a-acetylmethadol (LAAM) maintenance treatment, [that] methadone maintenance treatment was more effective than 1) detoxification, 2) no treatment, 3) buprenorphine, 4) LAAM, and 5) heroin plus methadone. [Also], high doses of methadone are more effective than medium and low doses.” Also, a systematic review conducted on 28 studies involving 7,900 patients has demonstrated significant reductions in HIV risk behaviors in patients receiving methadone maintenance. In a 2.5-year followup study of 150 opioid-dependent patients, participation in methadone maintenance treatment resulted in a substantial improvement along several relatively independent dimensions, including medical, social, psychological, legal, and employment problems. I can site literally dozens of other statistics regarding the benefits of opioid agonist therapy but I would rather share my personal experience treating patients with substance abuse problems related to opioids. First off let me begin by stating that as a psychiatrist practicing addiction medicine, it was my hope and desire that all patients who presented to me could successfully weaned off of the opioid being abused and that they’d remain clean (and I do have a number of highly motivated patients 5-8%) who do accomplish this task. However, I also have patients that truly NEED the added help of some agonist medication to get through life. Why this happens is a different conversation, however, when opioid addicted patients are incarcerated, they should be offered all of the treatment modalities that are offered on the outside; particularly if they are prisoners that will be released back into society!

  38. Marcia / July 25, 2011 at 1:38 am

    Bill I so agree with you! Drug switching is craziness. Methadone is beyond even that. More people die from Methadone overdose than heroin overdose and drug switching in general just continues the “I need a drug to get through life” mentality. I will preach till the day I die that functional food nutrition is the answer, along with a consistent exercise program – a body can make use of that combination. Exercise can become an addiction in it’s own right and superior, living food (raw and organic) based nutrition will balance the depleted and unbalanced neurotransmitters – not the best job security for drug counselors or big Pharma, but if getting addiction to be over with is truly the goal , it has a much better outcome than drug switching. Ultimately drugs can never work because they are synthetic and the body rejects them as a foreign substance. Nutrition is how I got my own son free from Oxy addiction almost 3 years ago and 4 of his friends since. I recommend reading End Your Addiction Now and then you’ll understand another way.

  39. Avatar of Joe McNair
    Joe McNair / June 22, 2012 at 7:04 pm

    Glad to see there is some sense left out there. For crying out loud! Wanna know what people get high on? Find out what dealers are being busted with! Ask clients what they are abusing. The abuse of drugs and alcohol is THE SYMPTOM-not the problem. Why not just give pain meds to someone with an amputated leg but don’t work on the wound. Every time the medical community thinks they have found the answer clients end up abusing. I have 16 years clean and a masters and a few licensures. I treat addicts. They work on healing. Not just keeping from a few days of being dope sick. Some need to be rehabilitated-others need to be habilitated. Taking these substances is a stop gap for many. I’m sure for some it “worked”. However, if all the medical community is a hammer, everything looks like a nail. Stop this silliness.

  40. Avatar of RON
    RON / December 16, 2012 at 2:13 pm

    Buprenorphine doesn’t cause deaths like Methadone, but for some Methadone works. A multi-pronged approach is the key and in the US, barriers like these uneducated people spouting off how bad for the body these drugs are fail to look at evidence based practice, but go off the criminality concept that causes the social strife we have. France is treating HALF of their addicts with success. They have jobs, support families and don’t go to jail! Our system is idiotic because of uneducated people failing to look at the evidence, spouting off from emotions. Treatment works. Addiction is a disease not a moral deficiency. If abstinence doesn’t work, maintenance does at a stunning rate. If we opened the doors allowing ALL practitioners to prescribe buprenorphine (NP’s, PA’s, MD’s, DO’s) we would see our economy shift in a substantial way like France’s.

  41. Marcia / July 25, 2011 at 1:48 am

    Of course – good luck getting anything even close to that in the prison system… How would the the Prison Guard Union explain to their investors that the recidivism rates are down because they actually rehabilitated the drug addicts and they’re out leading a ( productive life? At least partially productive – you can only undo the addiction – the stigma of being a felon has no cure.

  42. Carlos / July 26, 2011 at 10:49 am

    You are teasing these guys aren’t you? You devil you!!
    Here is a bit of how our arch enemy the Iranians treats their local junkies,

    Hopefully,they get real clear. Most people who talk about methadone, know little about it. They are truly operating from their emotional and not from rational approach.

  43. Carlos / July 26, 2011 at 11:02 am

    It does not have to be the way you think it should be. Most of the problems you delineate have to do with current political policies, and lack of understanding of the consensus found based on research. I have found that a significant number of the people
    Who post here; do not seem to be very familiar with the science of substance abuse. I have a little suggestion that we start learning science. Because the direction in Substance Abuse is to evidence base <it means research, "not you expert testimony").
    Chances are that if we do not start doing this. We are likely to see patients starting to legally suit the treatment facility they enter for malpractice. Some have already been started; they are not being so much informed by the media. Just a suggestion!!
    We are going to have to start getting over the fact that some of us flunked high
    School science, and start giving it a good college try at science again. Many are
    Beginning to stop listening to use make up rubbish and call it assessment and treatment
    When there is no evidence or bases for its accuracy.

  44. Sandra, Vancouver, Canada / August 6, 2011 at 11:06 am

    Drug use in prison happens, even though Marco has said that it is less than commonly thought. It varies, depending on the prison, but drugs are 100 to 1000 times more expensive in prison, and of course this is a great way for organized crime–the gangs–to make money and power. Depending on the institution, they have to rely primarily on the guards to bring in the drugs, so you know how compromised security is.

    Addiction must be worse in prison. It stands to reason that when you are at your most miserable, lonely, afraid, angry, and (the worst for a human being) bored and sensory deprived, your addiction/withdrawl symptoms and all your body’s agonies are all you can concentrate on. Of course w.Price says “these inmates can be safely detoxed in prison”!!! There is no physical danger in opiate withdrawl–the physical and mental anguish is no danger to the body whatsoever! Why would prisoners who are addicts not do anything to get drugs in prison? They probably will. Being imprisoned in the US puts you at high risk for being HIV+. And despite the fact that the rate of using and selling drugs is remarkably similar across racial and ethnic demographics (white teens are a bit higher), Black and Latino/a inmates far outnumber whites in every institution.

  45. Jeanine / May 22, 2012 at 10:39 am

    but after returning so many times to prison/jails for the same repetitive drug use, one can easily yield to the argument that all addicts will detox and remain clean while incarcerated. The real problem, hence the question, how do we keep them clean, how do we stop the repetitive behavior…once the addict is released into society. It’s very obvious and apparent, that we are loosing the war on that front. The one drug that has consistent favorable results at keeping drug addicts off of heroin/opiates is Methadone. It’s been successful for years, it’s only drawback seems to be that doctors that have absolutely no training giving prescriptions of Methadone to people that do not need it, then not explaining just how dangerous a drug it is. The unfortunate outcome of this is there are so many deaths from abuse and from the people that have no idea what it does, how it does it, how lethal it is, that it is unlike any other pain medicine, it will kill you and anyone else that gets a hold of it in your home that is not authorized to use it. This is not a drug that should be prescribed casually. I absolutely think that Methadone is trivialized by doctors pain clinics will give it to just about anyone that asks…providing they have good insurance coverage.
    Like many other things, it seems that we don’t blame the people that actually pick up these pills/liquid, or go out and seek to buy them without a prescription, nope…when something bad happens to those that make bad choices with Methadone, whe blame the drug, not the idiot that was most likely not following the doctors orders or didn’t have doctors orders. So as a direct result of that it makes it expensive and very hard for the people that this drug actually saves, and it does save them, just ask their children, their mothers, fathers, sisters, brothers, etc.

  46. Avatar of Marco
    Marco / July 28, 2011 at 5:13 pm

    You are absolutely right. I personally did 12 years in ther Federal System, I personally did not see much drug use in the system regardless to other BS reports. My problem is getting a Job out here. My background was medicine, smuggled some marijuana from Colombia back in the early 80′, and I received a “LIFE” sentence because I cannot practice or be around patients/clients whom I have always loved to help. Once you are released and you go back to the neighberhoods, you are exposed to too many triggers. Hopefully one day I can assist addicted individuals, but as an ex-felon I threw away my career for the lure of large amounts of money. What a fool. I could have done and will try to do good to other people. Mental health and Addiction are a big problem in prison populations once released.

  47. Michael Velardo / February 21, 2013 at 3:53 pm

    You certainly hit that nail on the head Marcia. The stigma of being a felon has no cure, and is often a huge trigger for relapsing since getting a job is near impossible depending on the conviction/s. You can get all the training, and education in the world, and there will always be a line of folks a mile long “without” felony convictions just as qualified, and even less qualified who will get the job first. Substance abuse tx in prison, if offered, is often attended for reasons other than remaining drug free. It’s to fulfill recommendations, and requirements for positive parole consideration. If the prisoner is indeed motivated to change, and remain drug free, “disclosure” in the SA therapy groups, NA/AA, and other programs geared to give the inmate insight into his/her behavior as it relates to drug abuse/addiction, is severely impeded because of where these people are. Disclosure is more like opening yourself up to vulnerability and attacks outside the group setting initiated by other inmates who could, and do use that information for nefarious purposes. Providing drugs to prisoners would only be good if it was for detox purposes, and believe at the very least that this should be done when a person is first incarcerated in the county jail. While in prison, inmates often sell their medication and do so with impunity. During med-line calls it’s like a circus in there, at least in the Michigan prison system, especially at those facilities that house prisoners who need medical care frequently. I know for a fact this happens more often than not. Been there, did that. Not buy drugs in prison, but observe it happening, and knowing people who did it. I was in prison for a total of 21 years, and spent 36 years addicted to heroin, methadone, and morphine on and off. However, I am clean, and crime free now for 9 years. I am also a former SA counselor, and paralegal. I am writer now about substance abuse.

  48. Sandra, Vancouver, Canada / August 6, 2011 at 11:13 am

    Drug courts are being used more and more, but sometimes people are just not ready to get clean today, and drug courts can be very hard line with them–no three strikes, just one mistake, and it’s years in prison. Drug courts save money, but on the whole, addiction is a medical problem, not a crime.,8599,1893946,00.html
    I hope that link worked, it’s to Time magazine’s story on how Portugal’s decriminalization of use of illegal drugs has worked well since 2001.

  49. Sandra, Vancouver, Canada / August 6, 2011 at 11:23 am

    Anecdotal evidence suggests that methadone withdrawl is worse than heroin withdrawl. Why not use heroin maintenance therapy for those who are not ready to quit? Because of puritanical American attitudes. It’s been used in Europe successfully, with addicts resuming successful lives. That said, we’re talking about prisoners, and not about post-prison life. You must suit the therapy to the patient, not to your preference, experience, or worldview.

  50. MJB / December 1, 2012 at 6:48 pm

    Bill – I would bet every dime that I have that you would have absolutely no idea that I was on a relatively high dose of methadone and fentanyl. I don’t act “hammered,” my eyes aren’t pinned; I’m not nodding. The kind of effects that you are referring to happen because the person is also taking other meds – and mind you, they might not even be abusing them, but the side effects potentiate the other drugs side effects. Or, in many cases, the person IS abusing another substance and THAT is what is causing them to appear “hammered.” If you add Seroquel or any benzo to methadone, you will most often get someone who looks and may well be high. But, please do not say that everyone on methadone is this or that!

    In any case, my challenge stands. Not one of the commenters here who have been blasting methadone would be able to tell that I was taking it. Not. One. So, if I’m walking around with a good job and all that goes with it, how many other people like me do you think are out there? Many! But since you can’t see us, there is no way for ignorant people to know that it is not the methadone that is the problem!

  51. Carlos / August 10, 2011 at 11:27 am

    Is not only amazing, but it is also accurate, and it not even my opinion. I don’t think you have read it, or else you would have learn that there is vast amount of studies going back to1950s. Indicating that our Clinical Judgment for the most part is exceptionally fallible. I have 7 years (1974) more than you and I have learned that for the most part what we call our clinical opinion is our personal opinion fringe with psychobabble. Some how I do not get you have read everything there is about methadone. You have probable read “Methadonia” and perhaps a few others like “Inside the Methadone Clinic Industry”. Most things written about methadone (synthesize in 1934 Germany) is from the last 40 plus years of research is in scientific journals and some how I do not get you read many of those. You probably skip “The State Methadone Treatment Guidelines”, which was a review of the literature until the mid 90s. Was published by Substance Abuse Mental Health Service Administration, they spend millions of dollars in creating a consensus of researcher, outstanding results clinicians and patients advocates for publishing the guidelines. Which was ignored by most Methadone Treatment facilities, because treatment staff believe that their hunches, intuition and speculations were better than the vast research that was available. Substance Abuse treatment is the only profession that I know that ignore research, and gets away with it (I predict not for long, we will start getting malpractice suite if we do not straighten out) The State Methadone Treatment Guidelines is now out of print and has been updated with a few new TIPs. In science one improves and refines treatment protocol based on new valid and reliable research findings.

  52. Avatar of mary
    mary / August 15, 2011 at 1:25 am

    reply to carlos , yes you hit the nail on the head. I to beleive that methodone is seen as good thearpy to replace herion first hand. managed care would not allow detox etc only methodone to addict. Human rights are ingored by the very same people who are there for these souls. Our goverment has put a price on the heads of every addicted person due to the drug policies in our country. Prisons now private and nida and cjs are working together to make prison a hospital 90 percent of the population are substance abuser many chronically. Get it together nida we are talking prison you know where people go that commit murder and serious crimes, not non violent drug abusers who where so addicted that even seeing the po didn;t matter isn;t that called dependent in the dsm. Money is the business of the day who gets to keep a job,which agency get the grant,our own goverment is about to make a deal with mexico and guess who else the drug cartels. Prison and the cost is big business in these times aren’t we trying to budget our money. 8 million people ages 12 and over reported by cjs using or have used and the percent of going to detox was low,wonder why.Oh sure its the addicts fault it wouldn;t be that some staff have little respect for the pt or that managed care told them what treatment this person would get. I loved my country until I experienced being poor because our loved one was so badly addicted and to watch his body terrible and cry like a baby, when managed care refused him treatment and made him beg yes I helped ease his pain, and then he try on his own but it didn;t work, until we had no money and nothing in our home the anger and the monster wouldn;t go away. To those who think the drug policy in this counrty is on target hope that you never lose your job and you lose your home and you learn that your child is using drugs, just pray that you don;t have to go to the state for assistance pray that you child doen;t get arrested for posession get placed on probation and because she or he may be so dependent that the monthly visit to the po doesnt matter and this sweet child that you know your child is ends up in prison instead of a hospital remember it was your choice. not that of a sweet child that due to this horrible disease can only hear the cries of the body for more while others insist on jail.

  53. Carlos / August 15, 2011 at 2:16 pm

    If they will only be getting treatment, because the 12 Step is not treatment, it does not meet the standard of treatment. There is only a tiny amount of research on 12 Step program, two were only found to be valid and reliable both with the inmate population, both show to be ineffective. The twelve steps was not design to be treatment, it was design as a fellowship. It has too small research based and none of it is compelling to call effective, because it is simply not effective as treatment. Bob and Bill were right. Twelve Step treatment violates the 6th, 8th and 11th tradition. If you know how to read, look at the traditions and read it them again, because it does not seem like many people think much about the traditions anymore given that we violate them all the time. What part of anonymity we do not seem to understand?

  54. Avatar of James
    James / December 3, 2011 at 1:49 am

    Methadone in fact does have a longer and a bit nastier withdrawal experience since it is a longer acting opioid analgesic and has a “stepping/stacking” effect. That means that a patient won’t really feel the dose they took this morning (for example) until 48 to 72 hours later. It is meant to be a long-term solution for a long-term problem. The 28 day detox which is what the state of California requires for 1st time patients is ridiculously unrealistic and likely fails nearly every time, unless the patient was not physically dependent on an opioid in the 1st place. I personally agree that a shorter acting opioid should be used for detoxing. There is the (nearly) cold-turkey option as well, which involves checking into a hospital with a detox unit for 5 days where you go through hell on earth, but receive a tiny smidgen of relieve in the form of anti-nausea, anti-diarrhea meds, NSAIDS and if you have the luck of having a Nurse with a heart (with a doctor who will write the order) some Chloral Hydrate to mercifully knock you unconscious to spare you the pain that is bad enough to make even the toughest person commit suicide (if they can find a way).

  55. gloria / February 6, 2012 at 1:45 pm

    Penny thank you for your comments it still amazes me that there are so many misconceptions about methadone, due to not taking the time to educate oneself. methadone is one of the most researched drug out there and has been proven over and over again to work with opiate addiction when nothing else has. It amazes me that we have no qualms about prescribing oxycotin and other opiates like crazy till is now become a national epidemic, but something safe proven over and over again is still considered horrible, I would encourage anyone to look at the research regarding methadone and make informed decisions.
    LOok at the lives it has saved, the money it has saved the criminal justice system, the families it has restored, don’t let a small percent of indivdiuals that methadone does not work for cloud all the postives it has done.

  56. Avatar of Alice Mixon
    Alice Mixon / April 25, 2012 at 1:31 pm

    I work at a local methadone clinic as an addiction counselor for over 6 years and have seen methadone work for a lot of people. I have seen it change peoples lives. People able to function in the work force, reunite families. Methadone is for people who have a desire to stop using illicit substances and change their life style and I have seen people who are still searching for that “high” and continue to use other substances and live that “addictive life style”. Those are the people who give methadone that bad name. Those are the ones the community hear about, Not the ones that have that positive change in their lives. You only hear about the overdoses of people who continue to use illicit substances along with methadone. At the clinic where I work we care about our clients and those who continue to test positive esp. BZP are discharged or only allowed to go only so high on their dose. So please for those of you that hear only the bad there is good with MMT.

  57. sugerdog / June 30, 2012 at 6:00 am

    All these actualization’s of methadone been a bad drug and it does bad things to the human body is incorrect period ! see people can talk about things and say bad things about drugs that they don’t take, they just go on about what they here and it’s all wrong . Methadone has no side affects NONE ! AND IT’S SAVE LIFE’S THAT WANT TO BE SAVED FROM OPIADS OR PAIN KILLERS (OXYCODONE) . DOCTORS GET YOU A PRESCRIPTION FOR PAIN MEDICATION FOR YOU ARE IN TITLED TOO FOR YOUR CONDITION BACK OR NECK PAIN AND ONCE YOU GET USED TO TAKING THEM EVERYDAY THE DOCTOR WANTS TO CUT YOU BACK OR TAKE YOU OFF THEM AND THAT’S CRAZY SO HERE YOU ARE ADDICTED TO THE PAIN MEDICATION THAT HE HAD YOU TAKING BECAUSE THE MEDIA HAS GOT ALL THESE KIDS THAT DIED FROM AN OVERDOSE ON THE LOCAL NEWS . THERE’S GOING TO ALWAYS BE IRRESPONSIBLE PEOPLE OUT THERE AND ITS NO NEED TO INFLUENCE A DOCTORS TREATMENT ON ANY PATIENT. ANYWAY BACK TO SUBJECT AND THAT WAS Methadone and it is a safe medication for one that really needs it !and that’s why they are thousands of Methadone clinics out there in every city on the planet because Methadone saves life’s period !

  58. gloria / July 25, 2012 at 12:26 pm

    Thank goodness a voice of reason, Did you know that methadone is the most research drug there is and continues to be a safe drug for addicts to take, of course it doesn’t work for everyone what does, it is sad to see there are so many people suffereing when there is a solution.

  59. Dr. Barry Schecter / March 20, 2012 at 6:24 pm

    I appreciate your comments, and feel your pain. That not just bs trying to social work you, it is real. You see, there is no Drug Policy in this country. Think about this. Where are all the people that were getting high in the 50′s, 60′s, 70′, isn’t that a large majority of the adult population in this country? So why, can’t we have a group of people that want to govern us, because they were right next to us smoking that joint or dropping that acid. You know, and I know, that most kids are getting high by the time they’re in high school. An awful high percentage go on to college and continue to get high. If not one drug, it is another. Alcohol is not Iced Tea or Lemonade; it is just another type of syringe to get the drug, Alcohol, into one’s body. What pisses me off the most, is that the drugs that we make legal, like nicotine, kills more people than every other substance combined by about ten fold. We lost about 3,00 good, innocent people during 9-11. That caused the country to go wild. We’re still in war over that. We gave away so many of our rights, for “Homeland Security.” I don’t know about you, but I don’t feel so secure. Listen, please don’t misinterpret my words, those people dying was terrible. But get this visual; because our government taxes the crap out of cigarettes, Imagine say 5 or 6 747′s bound for Hawaii, loaded with four or five hundred people each, crashing everyday, no survivors. Do you think that people would stop flying? What do you think the government would do? Well, under prohibition, which is the name for the policy that we now live under, you can count on those planes crashing everyday. Now, simple question, how many people do you know that died as a result of smoking pot? I don’t know any, but I know quite a few that went to jail for it. If you worked second shift, and you had to drive home at about 1:00AM, would you rather know that in the oncoming traffic was, someone high on pot, someone that used heroin, someone that used cocaine, someone who smoked cigarettes, or someone who was drinking alcohol? I can give my answer in a heartbeat. The smokers could cause an accident, theoretically if they were burning one and the flaming part fell in their lap and caused burns and instead of pulling off the road, they tried to extinguish the fire, but while they were doing that they came into your lane, end of story. But how rare is that? The heroin addict, no real worries, unless he just usedright before he started the car, there might be a shaky picture for a few minutes. The one that is drinking alcohol? Oh, by the way, the government atxes the crap out of that. They also make a fortune as legal bookmakers. But, Making Drugs legal? Faggetaboutit! Why should the government turn a losing venture, prison, trials, catching, on and on, into a money making proposition. Then, there is no criminal issue, and those that need medical care, can legitimately get medical care, without fear of getting busted. And, maybe, one of the Americans that remembers preparing for nuclear war while in public elememtary school, might get elected, and instead of punishing “those damn addicts” with a bigger club, maybe we can figure out cause, and come up with solution, wouldn’t that be new for this country? Justice, Liberty, isn’t that in the pledge of allegiance?

  60. Jeanine / May 22, 2012 at 10:45 am

    OMG Thank you so much for that

  61. MJB / December 1, 2012 at 6:29 pm

    Thank you, Rokki, for making the most logical comment I have read so far. I spent almost 5 years in a NYC chemical dependency outpatient clinic that had a MMTP component. Everyday I would hear the comments about how bad methadone was and how the “methadonians” were lazy, shiftless addicts who were all abusing their meds. All the while I had to bite my tongue because little did anyone know that I was on methadone for the management of severe and chronic pain.

    There were so many times when I just wanted to scream at my colleagues, who I liked to believe were smart, caring clinicians – but when it came to methadone, they became as bad as any group that has always ostracized and stigmatized drug addicts. Oh and let me add, I’m one of those, too. I’ve been clean for 17 years and on methadone for my pain problem for a third of that time. There are countless people who would claim that I wasn’t sober at all. I have only shared that I’m on methadone with a few select people who believe as you do that methadone is medication like insulin or any other safe and effective medication for a chronic condition. And even though I was never a heroin addict, my pain problem pushed me towards abusing the short acting opioid narcotics. I’ll also add that I’ve been on fentanyl patches for as long as the methadone and even though I am on 2 incredibly powerful medications, I have a prestigious job at a world renowned rehab and I have the respect of my colleagues and peers. But I don’t kid myself. If my employers knew what meds I was taking, especially methadone, they would figure out a way to fire me as quickly as possible. Of course it couldn’t be because of the meds, but they would find a way to get me out of my position.

    After 5 years at a clinic that I thought couldn’t be any less tolerant about methadone, I landed an even better job at a clinic that looks ta methadone as the lowest form of treatment. It truly saddens me that I have reached a point in my career that I have always dreamed of and I must carefully guard this big secret. In fact, I do not use their health insurance to buy my medications because I do not trust that my records will be kept safe. I can’t expalin why without giving away where I work, but suffice it say that I find myself “hiding in plain sight” like so many other recovering addicts. I don’t doubt for a minute that I would be looked at in the same way by my colleagues if they were to find out what meds I was taking! It is very disappointing but just another indication that we have a very long way to go in de-stigmatizing addiction and an even longer way to go – if even possible – to de-stigmatize methadone use regardless of the illness.

  62. Avatar of Howard
    Howard / June 29, 2012 at 1:41 pm

    In the US, unlike other countries, when one is an addict..that is the reason they were incarcerated in the first place.

  63. MJB / December 1, 2012 at 6:38 pm

    I completely agree with you, Jane and Marcia’s comment that it would be ok to give someone in withdrawal a 1/4 tablet of something to help them has clearly never suffered the soul crushing reality that is opiate withdrawal. You are so right in saying that most people would never be able to tolerate the pain for an hour let alone days if you did not have medical intervention. Jails used to have prisoners kick cold turkey, because since it wouldn’t kill them, maybe they should just suffer instead. And suffering it is. Be very grateful that you have never had to kick without help!

  64. Doc Barry / March 18, 2013 at 6:04 pm

    Kathlen, I am sorry you had to endure such suffering. Methadone Treatment is not about money, especially at Not For Profit Clinics. Yes, there is money, but very little if you understand the way clinics are reimbursed. All too often I heard people telling me that methadone was rotting my bones and teeth. What they never asked was when was the last time I saw a dentist? Living on Hostess Cupcakes and Grape Nehi, not having a home to clean up at, might have contributed more to my problems than methadone. Please, do not misconstrue my words; Tapering from Methadone is no fun, however, with the right support, it can be done. However, let me pose a question. Why do people with this chronic disorder want so badly to stop their medication? Could you imagine someone that was in pain from Hypertension, at risk for stroke, but they did not know that. They go to see their physician, he diagnosis Hypertension, prescribes a beta-blocker, and voila, the person feels better. When will they stop taking their medicine?
    In closing, the worst thing that a clinician or provider could do is subject someone to a 21 day detox. I can predict that outcome with relative certainty.

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