Commentary: Countering the Myths About Methadone

Methadone maintenance has been used in the United States for approximately 50 years as an effective treatment for opioid addiction. Yet many myths about its use persist, discouraging patients from using methadone, and leading family members to pressure patients using the treatment to stop.

Dr. Vincent Dole of Rockefeller University in New York, who pioneered the use of methadone as an opioid addiction treatment, found his patients no longer craved heroin. They were able to return to work and school, and participate in family life and community affairs.

As methadone’s use grew, the federal government decided it should only be dispensed in licensed treatment programs, which would provide a whole range of services such as counseling, vocational help and medical and psychiatric treatment.

This creation of the clinic system developed into a double-edged sword. On the one hand, it was advantageous to have many services available in the methadone clinic, but very stringent regulations came along with the clinic concept, including the requirement that patients come to the clinic daily for their methadone. Clinic hours often conflict with patients’ work schedules, and make it very difficult to take a vacation. In some areas of the country, the clinics are few and far between, requiring traveling many miles each day. The biggest and probably most important obstacle has been the stigma associated with being seen entering or exiting a methadone clinic.

In an attempt to reduce that stigma, I present the six most common myths about methadone and explain why they are incorrect.

Myth #1: Methadone is a substitute for heroin or prescription opioids. Methadone is a treatment for opioid addiction, not a substitute for heroin. Methadone is long-acting, requiring one daily dose. Heroin is short-acting, and generally takes at least three to four daily doses to prevent withdrawal symptoms from emerging.

Myth #2: Patients who are on a stable dose of methadone, who are not using any other non-prescribed or illicit medications, are addicted to the methadone. Patients taking methadone are physically dependent on it, but not addicted to it. Methadone does not cause harm, and provides benefits. People with many common chronic illnesses are physically dependent on their medication to keep them well, such as insulin for diabetes, inhalers for asthma and blood pressure pills for hypertension.

Myth #3: Patients who are stable on their methadone dose, who are not using other non-prescribed or illicit drugs, are not able to perform well in many jobs. People who are stable on methadone should be able to do any job they are otherwise qualified to do. A person stabilized on the correct dose is not sedated, in withdrawal or euphoric. The most common description of how a person feels on methadone is “normal.”

Myth #4: Methadone rots teeth and bones. After 50 years of use, methadone remains a safe medication. There are side effects from taking methadone and other opioids, such as constipation and increased sweating. These are usually easily manageable. If patients engage in good dental hygiene, they should not have any dental problems.

Myth #5: Methadone is not advisable in pregnant women. The evidence over the years has shown that a pregnant woman addicted to opioids has the best possible outcome for herself and her fetus if she takes either methadone or buprenorphine. A pregnancy’s outcomes are better for mother and newborn if the mother remains on methadone than if she tapers off and attempts to be abstinent during pregnancy. Methadone does not cause any abnormalities in the fetus and does not appear to cause cognitive or any other abnormalities in these children as they grow up. Babies born to mothers on methadone will experience neonatal abstinence syndrome, which occurs in most newborns whose mothers were taking opioids during pregnancy. This syndrome is treated and managed somewhat easily and outcomes for the newborn are good—it is not a reason for a pregnant woman to avoid methadone treatment. Mothers on methadone should breastfeed unless there is some other contraindication, such as being HIV-positive.

Myth #6: Methadone makes you sterile. This is untrue. Methadone may lower serum testosterone in men, but this problem is easily diagnosed and treated.

These myths, and the stigma of methadone treatment that accompanies them, are pervasive and persistent issues for methadone patients. They are often embarrassed to tell their other physicians, dentists and family members about their treatment. They may feel they are doing something wrong, when in fact they are doing something very positive for themselves and their loved ones. These misperceptions can only be corrected with more education for patients, families, health care providers and the general public.

Dr. Edwin A. Salsitz_Join Together_PhotoEdwin A. Salsitz, MD, FASAM, is Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center in New York.

 

 

PHOTO SOURCE: https://healthy.kaiserpermanente.org

92 Responses to Commentary: Countering the Myths About Methadone

  1. Keith Burns | August 6, 2013 at 12:36 pm

    I hate hearing that Methadone is a treatment for heroin addiction. There is no treatment involved. People dependent on Methadone are extremely difficult to detox, in fact it is harder to detox from than Heroin. As for Methadone not being harmful, in the UK nearly as many people die from Methadone than from Heroin. It is very common for Methadone users to take their morning dose and then go out and score the ‘real stuff’. Not sure why Dr Salsitz wishes to paint this idyllic picture of Methadone but it is rapidly going out of favour in the UK and it is far more preferable to get Heroin users into effective rehab programmes.

    • Perry Kaplan | August 8, 2013 at 1:29 pm

      Not sure where Mr. Burns gets his statistics, but it is nearly impossible for someone stabilized on methadone to overdose–unless they are taking other substances. Statistics taken out of context are meaningless. And while some addicts take methadone and continue to abuse drugs, it is not the methadone that causes the behavior. It’s what addicts do. But it’s the stigma perpetuated by uninformed people like you that keep those whose lives have been transformed by methadone and buprenorphine from coming forward and talking publicly about its benefits. Dr. Salsitz certainly focuses on the benefits, but what he writes is scientifically accurate. Whereas what you and some of your more hysterical (and linguistically-challenged) fellow detractors in this thread put forward is at best misinformed.

    • Dane Lenington | August 9, 2013 at 9:43 am

      I totally agree with you…this article is completely one sided and does not tell the whole story and who cares if it works for restless leg when you can become addicted. Also my experience with many of the clinics is that they give their patient much more Methadone then is recommended and are not receptive to getting people off of the drug!

      • Marie 21 | April 8, 2014 at 4:28 pm

        I have been on methadone for 18 months and I went up to 55mls and I am now at 40mls and let me tell you .. I am not gonna sit here and say that Methadone is good because in my books it isn’t .. I am sick everyday because it is hard on my stomach besides the point that one girls son is doing great on it .. All I have to say is wait until he starts getting to 50 mls and less it is THE HARDEST thing to come off . It will make your life way harder in the way you can’t travel .. You are dependent on another drug .. What happens if you cannot get your dose you end being extremly sick . All though I have every intentions on getting of it and I am going to fight harder then I have ever fought in my life because to me using is not an option anymore I would NOT recommend anyone go on it unless the intend on spending the rest of there life using anyways. I am 21 years old with my whole life ahead of me and all methadone has done for me that is good is make me look way better and made my mind clear. I think better then I have EVER even when I was sober but It is BY far the hardest thing to come off of and I wish I would of just done it cold turkey off of pills cause now I am gonna have my hands full. I can’t work or Go to school on this it because I am sick all the time and coming off it is gonna make me sicker . So for anyone out there that is thinking about it .. Think about how you will never be able to travel without a ton of work , think about what would happen if something happened and you couldn;t make it to the pharmacy .. Think about how your gonna get off of it . Think LONG term . All these people are ” HAPPY” to have their family’s back but guess what they are in for a harder road . So think about it please before you go on it . I haven’t heard of 1 person to come off Methadone .. But I will be able to say I did and I will never be so happy to never have to see that bottle again . If anyone on here knows of anyone who has come off it could you please let me know . I need some encouragement .

    • Edwin A. Salsitz, M.D. | August 12, 2013 at 2:58 pm

      Dear Mr. Burns,
      Your concerns about the abuse and misuse of methadone are valid. However there are many opioid addicted patients who are doing well on opioid agonist therapy–whether with methadone or buprenorphine. My mantra is that all treatments work for some people, and no one treatment works for all. Because of persistent stigma and prejudice, most patients on opioid agonist therapy who are in remission/recovery decide to remain as invisible as possible.

    • nick | November 27, 2013 at 7:00 pm

      It might b easy to w.draw from heroin… but it’s way 3 a diet to go right back to using…and the methadone withdrawal won’t b a problem after a MMT patient has learned about and conquered their mental illness, PTSD, traumatic events or losses that started their addiction in the first place….

    • martin mccclymont | March 18, 2014 at 1:02 pm

      your comment is so true ,!!!!!

    • Alan Fernett | April 17, 2014 at 12:33 am

      I have been taking Mathadone over 35 years for pain I always take it the right way. If you are going to use any drug the wrong way you are going to pay the price. Wake up and know what you are talking about, not all people are looking to get high. What are you thinking of it is the best drug for pain by far out there.

    • Alan Fernett | April 17, 2014 at 12:38 am

      Know what you are talking about Methadone is the best drug out there for pain PERIOD!!!

  2. Billy | August 6, 2013 at 12:59 pm

    Thank you for reporting accurate and unbiased info about Methadone and also the effort to reduce the stigma associated with this medication. Buprenorphine would also fit into the class of meds that are more helpful than harmful.

    • Edwin A. Salsitz, M.D. | August 12, 2013 at 3:02 pm

      Dear Billy,
      Yes, much of what I said about methadone applies to buprenorphine as well–same concept, different medication. In addition there are pharmacotherapies for alcohol dependence, and tobacco addiction which can be helpful and are generally underutilized.

      • carlos | October 28, 2013 at 10:16 am

        dr. thank you for your insight..I have been on methadone for 4 years and go to a very nice clinic with great councelors…I at one point got up to 90mg of methadone and now am at 42mg by lowering 2-5 mg at a time…I have a few questions however…I have gained a lot of weight,which I factor to my laziness and eating more and it seems the more I lower my dose the sleepier I get…when I was at around 90 I wouldn’t nod off as much as I do now…kinda weird…at least I never noticed it…My one great question is what is a good way to get off? Ive done great tapering and eventually I want to get off for good…how would you recommend doing so?

  3. dominique simon | August 6, 2013 at 1:03 pm

    I appreciate these myth-busters and the importance methadone plays in helping people address opiate addiction. Could the author cite for us the studies demonstrating the effects or lack of effects of long-term methadone use or other opiates on physical and mental health? I work with families whose Loved One may be considering methadone. Studies would help me reassure my families that decades long daily use of methadone has no effects on health.

    • Edwin A. Salsitz, M.D. | August 12, 2013 at 3:09 pm

      Dear Ms. Simon,
      If you email me, I will send you a few such articles. Basically the evidence is that there are no serious or significant toxicities associated long term methadone maintenance. There are some adverse effects which should be addressed, e.g.,constipation, increased sweating in some patients, inappropriate dosing leading to sedation or withdrawal symptoms, and more recently, some concern about an EKG abnormality, particularly at “higher” doses.
      I have the pleasure of treating a few of the original Dole/Nyswander/Kreek patients, who have been on methadone for over 40 years, and do not find any serious or significant long term adverse effects.

      • perryrants | August 12, 2013 at 4:02 pm

        why are they on meth for 40 years?

        • Edwin A. Salsitz, M.D. | August 14, 2013 at 11:48 am

          Dear Perry,
          The duration of treatment with either methadone or buprenorphine varies widely. The goal of treatment is not to see how “fast” a patient can “get off,” but rather to help a patient put a productive and satisfying life together. It is generally agreed that opioid addiction is a chronic disorder, with no cure available at this time. Do you object to patients being on blood pressure, diabetes, or asthma medication for 40 years. Most people would agree that if the patient is doing well on his medication, without serious adverse effects, then treatment should continue. Once again, all treatments work for some people, no one treatment works for all.

          • Brenda Elkins | November 4, 2013 at 12:13 pm

            Dr Salsitz, Thank you for your wisdom on how the methadone works. I have been on methadone for 20 years continuously now and I have lived a very productive life on it. I took my first drug heroin on my 18th birthday, I will be 60 years old next month. Methadone has been the only way I have remained stable. When using I was in the Dept. of Corrections 2 times, three counting the return to prison for a dirty Urine. The last time I was released I went straight to the methadone clinic knowing it could help me stop using drugs which I craved due to the feeling of well being I got from them. Methadone stopped that craving and I have came down in dosage instead of going up. You do not build up a tolerance to the medicine. And we have rules and counseling at these clinics. They take random Urine Analysis monthly. We have to earn priviledges for take homes, we do not run around with no restrictions like some people state that know nothing of the clinics and the treatment. I have managed to get 40 hours of college time and have had no dirty urines in the 20 years. Methadone is a great program for long term opiate addicts. I agree it is not for young users who have just experimented with pills. I pay cash for my methadone and it is financialy draining but I know I need it to live a drug and crime free life. Thank God for methadone for the long term addict.

          • bbp | December 19, 2013 at 2:38 pm

            There are quite a few withdrawal symptoms and side effects missing in this article, about a few dozen….. sounds like someone gets kickbacks to me…. >.>
            They don’t call methadone “liquid handcuffs” for nothing

          • Cheri Johnson | February 27, 2014 at 11:18 am

            I believe everyone, especially the author of this article, is missing the key point here. Also, a bit of misinformation has been put forth about affects on a newborn addicted to methadone. I agree that methadone can/will help an opiate addict get clean from whichever illicit drug they are on, but lets get real for a moment. I attended a clinic and the first set of documents they require you to sign is a release extending your “treatment” past the recommended six months of use. You are coached on what to say on said document, not because methadone can’t work in just six months, but these clinics get state funds around $500 a head (that price was in 2006). Methadone just delays the inevitable: being dope sick. Clinics encourage “lifers” going as far as discouraging stopping usage. Whoever states that methadone has limited effects on newborns, never had to watch they’re baby boy withdrawal for four and a half weeks, knowing that his suffering is due to your CHOICES not an ILLNESS, such as diabetes. The day I left the hospital, I walked into the clinic and let them know that I would no longer be one of their cash hogs. Right on cue, I was told by their professionals (Doctors, councilors, the director herself) that if I quit taking my 90mgs a day methadone prescription, I couldn’t physically or mentally handle the withdrawals, therefor relapse was inevitable. After informing them of my son’s lack of choice to withdrawal (or be born addicted in the first place), I walked out and have been clean ever since. I am not, by any means, saying it was easy, quite the opposite in fact. Four months of flu like symptoms were at times, crippling. But it all comes down to CHOICE. My point here is: addicts need to stabilize, change their lifestyles, then move on. Drug addiction is not a DISEASE, its a choice made by us cowards trying to avoid “paying the price of opiate addiction” and being sick. Any doctor who advises their patients to continue any of these maintenance drugs are doing so for motives other than the patients well being. Remember the oath you took…

        • Brenda | February 6, 2014 at 1:26 pm

          I imagine they are on it for 40 yrs because they remain addicts for 40 years or until they die. You are not grasping the details of the research, sorry

          • Brenda | February 6, 2014 at 1:29 pm

            Just like a diabetic should not stop their insulin. It is not liquid handcuffs to me it is a medicine that changed my life and allowed me to live and raise my children and become a productive citizen.

  4. sally nichols | August 6, 2013 at 3:16 pm

    Opiate dependency is a brain disorder. Medication is as important to the opiate dependent patient as insulin is to a diabetic. Although I feel Buprenorphine is safer and more effective, as it is a partial agonist , the medication MUST be prescribed correctly, monitored and behavioral changes are a must for a successful recovery. Like any medication you must be titrated off the medication correctly . Physicians who prescribe these medications must take the responsibility to assure each patient get’s individualized and proper treatment start to finish. We need to educate the public and other physicians about this opiate addiction epidemic.

    • Edwin A. Salsitz, M.D. | August 12, 2013 at 3:13 pm

      Dear Ms. Nichols,
      I agree. Educating health care providers, patients, and significant others(often neglected), is the key to optimal outcomes.

    • Brenda | February 6, 2014 at 1:32 pm

      Well put Sally Nichols.

  5. kim | August 6, 2013 at 5:52 pm

    what a joke! methadone is a horrible drug. my son was on it and he said it was triple horrible withdrawels than herouin ever was.methadone is not a good idea at all.

    • carole corralejo | August 10, 2013 at 5:25 am

      I just want to let people know that I have been on methadone for nearly 30 years, had 2 children on it and they are very successful. It was the break I needed from heroin to lead a normal life. I don’t think I would be alive if I had kept using, I know I would either be in jail or dead. Methadone to a heroin addict is as insulin is to the diabetic. The main thing the person on maintenance needs to do is let the methadone work for you. Stay away from the people places and things that you had when you were using – including the benzos, They are very dangerous for someone on maintenance to use. I thank God each and every day that I have the freedoms I have now! It does work and I am living proof…

      • perryrants | August 12, 2013 at 4:03 pm

        why 30 years. stopping would have be easier

      • Nan Hucker | August 13, 2013 at 6:08 pm

        You’ve been on methadone for 30 years, so that means you have been addicted to it for 30 years. You cannot stop & be ok. If you do you will be sicker than heroin would ever make you. And because you’ve been on it 30 years, it will take an extremely long time to detox from it. Methadone cannot be compared to medication for other organic diseases. Addiction is a brain & body disease. Diabetes, heart disease and other diseases require medication to live a full life. Methadone is NOT required to live a full life. It is a mind altering & physically addictive DRUG!

        • Dawn | October 30, 2013 at 12:54 pm

          “Methadone cannot be compared to medication for other organic diseases. Addiction is a brain & body disease. Diabetes, heart disease and other diseases require medication to live a full life. Methadone is NOT required to live a full life. It is a mind altering & physically addictive DRUG!”

          Your comment is confusing….when you say methadone cannot be compared to medications for other organic diseases…Why? You state it is a brain and body disease and where meds are needed for diabetes, etc. to live a full life methadone is not. Are you a recovering addict? I am not trying to be arrogant but curious how you can know that methadone is not necessary for some addicts to live a full life? I am a recovering addict and never took methadone but am a nurse who works in a methadone clinic and see miracles in patients who can finally function. Just because I chose not to go on Methadone maintenance dose not give me the right to judge those who do. Some patients have little interest in recovery and are eventually discharged from our program or walk off because they are not able to maintain counseling appointments or other required behaviors to stay on the program. There are good methadone programs providing services such as counseling, HIV/STD testing, education, and other services to help these patients “live full lives”. Less judgement and more understanding and acceptance is needed to decrease the stigma associated with addiction and the different treatments for those who suffer from it.

    • Edwin A. Salsitz, M.D. | August 12, 2013 at 3:17 pm

      Dear Kim,
      I’m sorry to hear about your son’s unfavorable experience with methadone. I hope he is doing well now. Despite his experience, thousands of lives have been saved,and countless infections with the HIV/AIDS virus have been avoided secondary to methadone maintenance treatment. The mantra should be, all treatments work for some patients.

      • Kim | December 26, 2013 at 1:29 pm

        Did you really read what I wrote…it’s my son, my grandson,my granddaughter and her husband! No they are not doing well …the program from my 2- years watching it…has NOT helped. No…they are Not fine! The clinics are blind to the tricks of the on going abuse, of your treatment. When they (the counselors)will take any urine sample given them from known additics the methadone user is abusing your treatment without consequence. They son and family are today shooting up your given Methodone…they take home. I understand it is hard to monitor all the addicts you have. Maybe strictor watching and monitoring the users is needed! I am a mom fighting for her son and family to be FREE!

        • Christine | January 21, 2014 at 12:06 pm

          Kim, it’s really bizarre how you respond so rudely to Dr. Salsitz when you are the one that ONLY mentioned your son in the post in which he replied. He replied to your August 6th post on August 12th, but then you posted another post on December 26th where you mention your other family members. How was he supposed to know about those other family members when you clearly mentioned them only after he responded to your initial post where you only mentioned your son? It sounds like your family members may not be following the program in the way it which it is prescribed.

        • Brenda | February 6, 2014 at 1:37 pm

          Sorry, but sounds like your family members are not ready to quit doing drugs that they like the effect of. Methadone stops cravings for drugs IF used like it supposed to be.

    • voice of reason | August 16, 2013 at 1:50 pm

      @perryants: The problem is your opinion is based on a statistically small sample. The vast majority of addicts, who are in treatment long enough to stabilize their dose, can LEAD NORMAL LIVES. Thank you!

  6. BeBe | August 7, 2013 at 12:35 am

    Trading one addiction for another is not the answer. Get real.

    • Jimmy | August 11, 2013 at 8:52 am

      I agree

      • Michael | February 12, 2014 at 3:52 pm

        The definition of addiction is “the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma.” So yes, it sounds to me like people taking methadone are addicted to it because if they stop they will go through withdrawals. If a diabetic stopped taking insulin they would not go through withdrawals; they would die because your body need insulin to live. Every single living human being is using insulin. You do not however need methadone to live. I am not on methadone and I am living a perfectly healthy life.

    • Edwin A. Salsitz, M.D. | August 14, 2013 at 11:57 am

      Dear BeBe,
      It is simply not scientifically accurate to characterize opioid agonist therapy–whether methadone or buprenorphine–as “trading one addiction for another.” Addiction is always accompanied by harm to the individual, and his/her significant others. If a patient takes either methadone or buprenorphine to treat opioid addiction, and they are not using any illicit or non-prescribed medications, and using their time productively, then I would say they are not “addicted” to methadone or buprenorphine. They are physically dependent, which is not the same as addicted. You are right that if they stop their medication they will develop a withdrawal syndrome. But so will anyone with a chronic disorder who abruptly stops taking effective medications.

    • Brenda | February 6, 2014 at 1:41 pm

      It IS The ANSWER! It is stopping a lot of crime and theft, It is keeping the addict much healthier and better able to lead normal lives. I think that is the better choice or as some of you say The better addiction.

  7. Gagal | August 7, 2013 at 9:30 am

    Another good comparison was left off. People take cholesterol medication to promote their health! And we don’t tell them that they have one year to lose some of that FAT or we will detox them. Many methadone patients are mandated by family/parole/probation to detox after becoming stable.

  8. Linda Pegram | August 7, 2013 at 11:17 am

    Are you aware that methadone is also one of the most effective treatments for restless leg syndrome? Check it out with the Johns Hopkins Center for Restless Leg Research which is nested in their Sleep Clinic.

    It has transformed my dad’s nights!

  9. Muhammad Saifudin | August 7, 2013 at 4:15 pm

    Assuming that methadone treatment does prevent illicit opiate use and other negative or destructive behaviors (to self and others) then it is far better than failed detoxes and ongoing heroin use (and the actions required to maintain a habit). It is clear that a large percentage of opiate dependent people cannot maintain a state of sobriety so methadone and buprenorphine provide relief for the user and society at large. I do believe that every effort should be made to make methadone as a temporary treatment however that is often not possible.

    • voice of reason | August 16, 2013 at 1:55 pm

      Thank you Muhammad! That is how is works at our clinic, there is a six-month program for getting off methadone for those who are otherwise stable. One can switch to maintenance if deemed truly addicted, but not otherwise!

  10. Doc Barry | August 9, 2013 at 1:06 pm

    Bravo Dr. Salsitz

  11. Linda Warden | August 9, 2013 at 1:33 pm

    I lost my son to substance use disorder and if there had been a treatment that could have saved him, I would have done everything possible to see that he got it. I understand that methadone and buprenorphine have helped many people through opiate or opioid withdrawal. However, I also feel that, as others have stated, methadone use should be strictly medically monitored and its use should be temporary, if at all possible. There are two reasons I feel this way, 1) here is one article from the Centers for Disease Control and Prevention about the increase (467%) in poisoning and methadone-related deaths between 1999 and 2005 and 2) my son was one of those deaths. Since my son was over age 18, I do not know if he was taking methadone as a treatment or if he was abusing the drug. He did take the drug with alcohol, valium, and marijuana, and that combination took his life. Methadone is a treatment, but it is also a very dangerous drug that has taken many lives. People on this drug should be repeatedly informed of the real dangers of drug interactions before and during the time they take this drug. They should also be told to always inform their physician of their methadone use before they begin to take any other medication, and to stay away from alcohol and illicit drugs.

    BTW, we all come to this forum because of knowledge or personal experience with methadone. All views should be respected, not criticized or belittled. Efforts to support more evidence-based research on this topic are a more helpful way to move forward

    • Phillip Smith | December 3, 2013 at 3:42 am

      I liked your “btw” ending…Reading this thread, I am full of mixed feelings. I’ve struggled on methadone for the past 2 and 1/2 years. My methadone program has had a few periods of stability, but also riddled with chronic relapses (especially on benzos), misuse or abuse of my carries/takehomes, and 2 failed detoxes. Also, almost a year ago I was with one of my best friends, Clint, when he overdosed on heroin and died. Reading these comments is difficult, as I am approaching day 6 of my third attempted detox. I’ve jumped off from a lower dose of 70 as compared to 125mg. I tried detoxing in a hospital (mental/behavioral health) and at a good friend’s house, and now at my mom’s apt. The withdrawls are terribly painful, yet I seemed to fail over and over again with several chances on the methadone program, unable to stablize. I’ve been abusing benzos with the methadone, taking sometimes over 10mg of alprozalam(xanax) and entering a blackout, in which my behavior was erratic and I also would go all over the city and shoplift while on this combination. For some reason, I don’t think “titrating” off the medicine over a period of months would work for me. I’ve yet to make it over 2 weeks without going back to the clinic. Many people say they never feel right without it. I’ve not felt right with it. I’ve been researching it, and everyone is different. The HBO documentary “Methadonia” was almost impossible to watch, although I did several times. I’ts become quite the love/hate relationship. Day 6 this morning and I’m crawling out of my skin, feel like a train hit me, with intense muscle and bone pain. I’m deterimined to get through this and have talked to and know several people who successfully detoxed. A period of months is likely, but that seems worth it in exchange for the rest of my life, at age 33–I’ve had a period of complete sobriety, without methadone or any other medications or mind-altering substances, for almost 3 years. It was the best time in my life. I was working, going to school, and caring for my toddler son with autism. I even bought a car. I’ve since lost all those things, and have been homeless now for tha past year. The doctor at my clinic expressed deep concerns about the use of benzos affecting ekg, and also diagnosed me with resperatory problems, including asthma, and restless leg syndrome. I don’t know what to do at this point, but I know I just want to be free, free from all substances, and live a normal life.

    • Phillip Smith | December 3, 2013 at 3:54 am

      I’ve had a lot of experience with methadone. Been on methadone for almost 3 years now, with chronic relapses on benzos and 2 failed attempts at detoxing cold turkey. I am definitely an addict, and never have felt right without opiates in particular. The methadone pretty much stopped my use of opiates and alcohol, however the benzo addiction with the methadone has been out of control…I also have PTSD from seeing my best friend die from an overdose, and have restless leg syndrome. I’m about 6 days in to my 3rd attempt at detoxing, this time from a dose of 70mg compared to the 125mg before. Something just keeps telling me to get off it, get away from the clinic and the people, surroundings, involved that keep me relapsing. I hope I can endure this pain and come out the other side of what’s been a long, foggy tunnel or bridge that was going nowhere. I believe all the opinions are just how people feel and what their experience had shown them, whether a doctor or an addict, or whoever! Don’t know what to say but I could write a book about this stuff. I hope to make it. I’m held up in my mom’s apartment in hidious pain and suffering. Determined to make it off this drug.

  12. Dan D. | August 9, 2013 at 2:09 pm

    Sorry, can’t buy all of this. Point #1 & 2 are refutable, strikes me as a ‘spin’ to justify his stance on the use of methadone.

  13. Leo Vickerman | August 10, 2013 at 8:08 am

    I worked in a methadone clinic for 18 months. It was a very popular clinic and had hundreds of patients. Although it was gratifying to see people kick their illegal drug habit, it was disheartening to have patients that have been on the methadone program for almost their entire life. Comparing methadone to insulin or inhalers is an unfair comparison. People need those medications or they might die. People won’t die if they are properly tapered off of methadone. The goal of methadone treatment should be to get the patient to stop opioid use and then to taper the patient off of the methadone.

    • Edwin A. Salsitz, M.D. | August 14, 2013 at 12:09 pm

      Dear Mr. Vickerman,
      Methadone can do only so much in the treatment of opioid addiction–namely eliminate illicit and non-prescribed opioids from the patients’ lives. The process of rehabilitation is difficult for many patients. Hopefully resources available in OTPs can be helpful–counseling, vocational guidance, treatments for other drug use such as alcohol and cocaine. For some patients methadone treatment may fall into a “harm reduction paradigm.” Those patients who have been on “methadone their entire lives,” might not be alive if their opioid addiction had continued unchecked. Untreated opioid addicted people have significantly higher mortality rates, than patients in OTPs.

      • Manipulated mother | November 5, 2013 at 4:41 am

        Sadly I was told to continue trying to conceive whilst on a fentanyl patch. When I injured myself falling during my pregnancy, I was hospitalised and threatened that if I did not start methadone I would be placing my unborn baby at risk. I have not yet given birth and am miserable, unheard, judged, and before having to take maternity leave, I was a happy, highly qualified health practitioner; I’m now a mentally foggy, depressed prisoner, and 9 months I have looked forward to my entire life have been destroyed. I was bullied into starting the medication, and not one person will help me reduce it (despite discharging me from hospital on too high a dose) and post birth, dose reduction appears to be lengthy, with my prescriber laughing when I tell her I would like to be medication free within a year, so I can enjoy some of my child’s infancy, plus return to work without the daily hassle of doses and stigma. An opioid is an opioid. Patients need to be treated as intelligent consumers; despite being a colleague to these prescribers, I feel now I was bullied, and like most pregnant women, would do anything if any registered medical professional told me if I didn’t, my child would suffer. It is not a solution, for my “care team” it was a quick fix, sheep following protocol, when my chosen maternity provider was out of the country which makes me incredibly sad.

        • Christine | March 13, 2014 at 6:54 pm

          Since you say you were “bullied” into treatment, it makes me wonder if you are just really only missing the high that you obtained through you Fentanyl patch. After all, as long as you are in methadone treatment, you will never be able to feel the euphoric effects like with your patch.

    • Brenda Elkins | November 4, 2013 at 12:37 pm

      Sorry to say for some drug users it is not that they do not get off the methadone, it is that they can not live life with using the opiates afterward. They can come off the methadone many times but they can not live afterwards without relapsing due to whatever is going on in their brains to make them feel they need the opiates to feel any pleasure or safety. Addiction is a mental illness as well. Our brains are not quite normal when it comes to craving opiates. Opiates are a feel good feeling that is the only way some of our brains can function normally. We want those feelings just like most people feel pleasure and warmth normally. So Maybe it is trading one drug for another but the way we function like regular people and not have to commit crimes is the best choice I would think.

    • Kim | December 26, 2013 at 1:46 pm

      I agree…I have been sober off drugs alcohol for 35 years now. It can be done…when you want freedom bad enough you can do anything with Gods help! This new kind of treatment centers does not bring real freedom! There needs to be a progressive getting them off altogether. Tools to assist them for a full life…real life…if they have other problems, then address them. I just want people to really be FREE! I have not yet seen this happen with this program…

  14. Mavis | August 12, 2013 at 4:30 am

    In my 25 years studying research and reality, I have learned to spot blatant deception. Anyone can look up the stories, the rates of abuse, harm and complications from Methadone. The warning packet alone is a mile long.
    I notice the author did not disclose his funding sources!

  15. Carrie Ann | August 12, 2013 at 4:35 am

    I agree!
    It is one thing to honestly state that Methadone seems to be a safer compromise FOR SOME people; it is another thing to actually deny its high rate of abuse! It’s no myth that compliance is limited or that Methadone is the most addictive drug we have! I’ve seen what people have to go through – it takes months of agony to get Methadone out of their systems!

  16. perryrants | August 12, 2013 at 3:59 pm

    the good dr is a funny guy. he throws out his out when he says that those “who are not using any other non-prescribed or illicit medications”. what methadone users does not abuse benzos, alcohol or other illicit meds (drugs)?

    • Sean McKinnon | October 19, 2013 at 2:00 pm

      Wow. There is a lot of ignorant prejudice here even from medical providers.

      I am a methadone patient who does not drink or use any illicit substances. When I entered MMT I had tried multiple detox’s, hospitals and residential programs with no success. The reason for this is opioid addiction is a medical problem that is chronic and if left untreated fatal in most cases. Once I started getting medical treatment for a medical problem instead of moral or spiritual treatment I was able to stop all illicit substance use and regain a normal life. I went from being homeless to owning a business that employs over 50 people with revenues I’m excess of 2 million dollars a year.

      Fact is that addicts in methadone treatment for greater than 2 years have a “success” rate of 98% for obstaining from illicit opioids versus 16% for abstainence based therapies. Why should 82% of opiate addicts continue to suffer or die from ineffective “treatments” because “you” have a moral objection to this treatment?

      My heart goes out to anyone who loses a loved one for any reason but to blame the increase in methadone deaths on MMT is disingenuous. It is clear that it is due to the huge jump in methadone prescriptions for pain. Methadone from clinics is dispensed in liquid form the illicit methadone found on the street in almost all cases are tablets dispensed from a pharmacy for pain from an OTP.

      I personally believe that I was born with an endorphin deficiency which made me predisposed to opioid addiction which was triggered when I was prescribed opioids after surgery. I believe it is much like a diabetic who suffers from an insulin deficiency and is dependent on insulin to live a normal life. I am dependent on methadone, I live a normal life, I have gained success, love, wealth, and happiness while on MMT.

      As a closing note I think the biggest problem is that people (even some in the field) assume the goal of MMT is abstinence from methadone. It is not and has never been. Dole and Nyswander designed the treatment as a maintenance treatment. Successful MMT should be determined by the absence of illicit substance use, absence of criminal behavior, and the ability to work and live as a normal productive member of society.

    • Brenda Elkins | November 4, 2013 at 12:45 pm

      This methadone user. One who has 20 years of clean urines with no other illegal drugs. They are always bad apples in everything, please do not consider us all as the same as a few people who do not understand they just have to do what it takes to stay off illegal drugs and defeating behaviors even if it takes drinking a dose of medicine every day. Just like a heart pill, or blood pressure.

  17. DrAJJMD | August 13, 2013 at 11:16 pm

    Dr. Nora Volkow, MD, director of the national institute of drug abuse or NIDA has said in many of her public statements that, “…methadone continues to be the gold standard for the treatment of heroin addiction.” The irony is that research supports her statements in a statistically significant way via the myriad of studies, which over the years have provided 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. Yet the misconceptions and myths abound on large scales and are primarily the result of mis-educated patients, individuals and PHYSICIANS that Blindly accept societies general ingorance and rather than stay quite, add to the problem by “adding their misinformed 2 cents,” 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, when administered correctly 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!

    • perryrants | August 15, 2013 at 1:44 pm

      it’s not that meth does not work, it is the fallacy that it works.

    • CH-LCAS | August 27, 2013 at 9:45 am

      Thanks for the excellent research summary, DrAJJ. I saw these results in the time I worked adjunctively with a Methadone (not “meth”, Perry) clinic in the 1990s. The patients in that clinic were VERY CAREFULLY monitored; those who “made it” performed as the data suggests. However, we saw a HUGE problem with those who were unable to recover, relapsed to street drugs, “got kicked off the program” (unfortunate, but as the overdose stories in this blog affirm, mixing methadone with other depressants creates the risk for fatality, not the methadone alone; continuing to provide methadone to those using other depressants would be unethical).
      Such a complex issue… all the more reason to treat each person’s needs individually and carefully.

    • Randall Webber | August 27, 2013 at 2:13 pm

      These are all valid points. Thanks for sharing them.

  18. Michael E. Dusoe, PhD, LCSW | August 27, 2013 at 2:56 pm

    My Two Cents Worth After 28 Years

    Myth #1: Methadone is a substitute for heroin or prescription opioids. Methadone is a treatment for opioid addiction, not a substitute for heroin. Methadone is long-acting, requiring one daily dose. Heroin is short-acting, and generally takes at least three to four daily doses to prevent withdrawal symptoms from emerging.

    Then, I would have to assume that the introduction of heroin was offered as a “treatment” for morphine addiction. At best methadone is a Medication Assisted Treatment, which is an enhancement to treatment. There is very, very, very little clinical treatment offered in methadone programs, as a physician to pretend otherwise is naive observation at best. If it had no analgesic properties why would it be a standard of care with cancer patients. Further, the Department of Transportation has a well researched and well written impairment profile which makes it likely that typical methadone clients may often be trapped in poverty and mundane jobs requiring little judgement and no risk. That is really what we think of this population. Giving medication is Medication Assisted Treatment…thats not what most other professionals would consider “treatment” which should involve the whole person. This is arrogant.

    Myth #2: Patients who are on a stable dose of methadone, who are not using any other non-prescribed or illicit medications, are addicted to the methadone. Patients taking methadone are physically dependent on it, but not addicted to it. Methadone does not cause harm, and provides benefits. People with many common chronic illnesses are physically dependent on their medication to keep them well, such as insulin for diabetes, inhalers for asthma and blood pressure pills for hypertension.

    Under DSM V, I believe they will be classified at some degree substance dependent…not a very forgiving characterization. At best it is an iatrogenic injury related to what? substance use disorders.

    Myth #3: Patients who are stable on their methadone dose, who are not using other non-prescribed or illicit drugs, are not able to perform well in many jobs. People who are stable on methadone should be able to do any job they are otherwise qualified to do. A person stabilized on the correct dose is not sedated, in withdrawal or euphoric. The most common description of how a person feels on methadone is “normal.”

    You certainly can’t be an airline pilot, or a nuclear engineer or a truck driver for that matter. Maybe the guy who does my heart surgery or root canal would be OK for this. How prejudicial is this perception and it betrays what I have said before “It may be OK to warehouse some people for the good of the community in the name of medicine?

    Myth #4: Methadone rots teeth and bones. After 50 years of use, methadone remains a safe medication. There are side effects from taking methadone and other opioids, such as constipation and increased sweating. These are usually easily manageable. If patients engage in good dental hygiene, they should not have any dental problems.

    It enhances your pain threshold which may contribute to neglect because injuries to teeth and bones may be masked.

    Myth #5: Methadone is not advisable in pregnant women. The evidence over the years has shown that a pregnant woman addicted to opioids has the best possible outcome for herself and her fetus if she takes either methadone or buprenorphine. A pregnancy’s outcomes are better for mother and newborn if the mother remains on methadone than if she tapers off and attempts to be abstinent during pregnancy. Methadone does not cause any abnormalities in the fetus and does not appear to cause cognitive or any other abnormalities in these children as they grow up. Babies born to mothers on methadone will experience neonatal abstinence syndrome, which occurs in most newborns whose mothers were taking opioids during pregnancy. This syndrome is treated and managed somewhat easily and outcomes for the newborn are good—it is not a reason for a pregnant woman to avoid methadone treatment. Mothers on methadone should breastfeed unless there is some other contraindication, such as being HIV-positive.

    Plenty of research to support approaches here…this is the opinion of the person who “pioneered” methadone treatment. So we will trade one stress on the baby for another and call it good medicine.

    Myth #6: Methadone makes you sterile. This is untrue. Methadone may lower serum testosterone in men, but this problem is easily diagnosed and treated.
    These myths, and the stigma of methadone treatment that accompanies them, are pervasive and persistent issues for methadone patients. They are often embarrassed to tell their other physicians, dentists and family members about their treatment. They may feel they are doing something wrong, when in fact they are doing something very positive for themselves and their loved ones. These mis-perceptions can only be corrected with more education for patients, families, health care providers and the general public.

    Never heard this, not a major factor. Although the induced dulling and lethargy observed in these populations makes it unlikely that they function like other sexually active couples along with the lower testosterone. Although speaking as a person treated with methadone twice, you should know that this was never a part of an informed consent I saw and would certainly create a hesitancy in healthy males who them might look for an alternative.

    Last point which I have asked before…would MDs favor it with or for their family, close friends.

    MD

    • Sean McKinnon | October 19, 2013 at 2:11 pm

      Wow I thought a physician would be more educated.

      When used in multiple daily doses methadone provides analgesia but when administered as a single daily steady dose the analgesic effects are not prevalent.

      Also persons who are on medication for diabetes and seizures and some heart related diseases cannot be the operator “at the controls” of a nuclear reactor what’s your point?

      You should know that when stabilized on a single daily dose of methadone after 3-5 days a person reaches a”steady state” where the amount of methadone being absorbed into the body is equal to the amount being depleted. This “steady state pharmacology” when used as a maintenance drug is why there is no euphoria, sedation, withdrawal, or analgesia. This is really basic stuff a person in your position should know. As a matter of fact some researchers have postulated that some people maintained on methadone might by hyper sensitive to pain.

      You should go over to pub med and other resources and actually read the literature and evidence based studies of MMT.

      • Jerry | March 19, 2014 at 10:39 am

        Very well said… I was about to say roughly the same thing. It’s truly sad how many physicians STILL prefer to stay attached to their outdated myths than to look at relatively new facts which prove those myths false.

  19. drugrehaborg | August 27, 2013 at 4:25 pm

    If someone has been clean and is leading a positive happy life using what a medical doctor has perscribed them who is anyone to judge?

  20. Tyro Prate | September 4, 2013 at 11:51 am

    Thank you for this article. It is very well-written and, importantly, accessible.

    The one small quibble I would have is that you should say that babies born to mothers engaged in methadone maintenance MAY experience neonatal abstinence syndrome.

  21. brandon | September 17, 2013 at 12:17 pm

    Can trt be done while on a mmt?

  22. Elizabeth C | October 6, 2013 at 7:14 pm

    Methadone saved my life!
    This is a good article!
    Thank You!
    <3
    ~Elizabeth

  23. john | October 12, 2013 at 1:10 pm

    It is so sad that we live in a world where people cant see the forest for the trees or trees for the forest. look at the person methadone works for a great many people to get them back a life and a great many people abuse it. It amazes me that we all ignore that the opiads that can be addicted to are basicly legal drugs being abused. So if we follow the logic of some of these nay sayers on treatment lets eliminate opiates from legal drugs along with methadone and that will end both problems. wake up people nothing works for everybody and anything can be abused from a car to methadone. I am losing my wife to crack and opiads and will keep trying to find the treatment that works for her. She is an individual and while the methadone worked for some people that she did pills with it didn’t work for everybody. All of you who think who think every person is exatly the same remember Stalin and Lenin thought that and after killing millions of the pwople they governed they still could make it happen

  24. Seamus | October 22, 2013 at 5:03 pm

    A very interesting paper. Would you know of any research don on health care professionals working whilst stable on methadone?

  25. Ingrid | October 29, 2013 at 5:11 pm

    Today is the second day for me on Methedone. I was using heroin at $150.00 a day. My first night was so hard. So much pain. Since my second dose at 40mg this morning, I can’t believe how I feel. Normal. I relapsed 1 year ago from a ten year stint of using pain pills, and quit cold. I was then just shy of ten years clean. I don’t know what I was thinking when I picked up again. I thought I knew how to “manage” an addiction LOL! All it took was a very painful torn rotator cuff injury, six months of agony, and boom! There I was seeking out pills. I have now decided that if I’m going to stay with using methodone, I know now that it will be probably my life’s maintenance! I will always be an addict, and my brain will always be broken no matter if I’m 20 years strong recovered! My thinkers broke! Anyway, so far, so great with methodone. Every person has a different issue for why they are addicts. No one is “special” in this disease! Good luck everyone.

  26. Ms. K | November 17, 2013 at 4:11 pm

    I disagree with this article. Have you ever seen a baby withdraw from methadone? I cannot believe that methadone does not have long-term negative effects on a child’s development. Studies need to be done.

    And I have worked with many long-term methadone users under the age of 50 who had to have both of their hips replaced. Are you going to tell me that their hips did not degenerate from methadone? That it was only from heroin?

    It’s common sense that controlled dosing of methadone is safer than a person using illegal heroin, but that does not make it okay. The goal should be to use methadone as a short-term bridge, not a lifestyle. Sure, withdrawal from methadone is hard, but that’s life. Studies need to be done on the long-term effects of methadone use.

    • Christine | January 21, 2014 at 4:28 pm

      My dad needs a hip replacement but has never been on methadone, as well as a close friend of his who has had a replacement, so what’s your point? In the UK, the surgery with the longest waiting list is for hip replacements. You think most of those people are on methadone?? Those people you speak of most likely would have needed replacements if they had never taken it anyway. That’s no proof that methadone rots bones. As far as babies, I agree it’s always best to be clear of any drugs when pregnant, but an already opiate addicted pregnant person just can’t quit cold turkey, they will most likely miscarry. Given the choice of heroin off the street and methadone, the methadone will be far safer for the fetus.

  27. Natalie Gary | December 9, 2013 at 1:10 pm

    Hello to everyone!,
    First, I want to say that I’m sorry for all who have lost loved ones due to addiction. In my opinion, each individual is different when it comes to illegal and legal drugs . As far as body chemistry and enviromental factors for behavior. I’ve been in many accidents and I also suffer from spondylitus and arthritis at age 36. I’ve been on pain meds for many years and built up a high tolerance to opiates. I started seeing a new pain doctor who prescribed methadone 80 mgs a day for pain . Sorry to say, this.didnt help much and that was 6 months ago. Now, the doctor has cut the methadone in half and prescribed me morphine IR 15 mgs twice a day for break through pain along with the methadone . Now, I just feel worse. I don’t even know what’s what anymore when it comes to these meds. I feel like a lot of these doctors just use me as a guinea pig because the doctor promised me that I will feel so much better with his new plan. I try to research about what I’m on and half of everything I read is opposite of the other half? I’m just confused and so tired of being in pain. I wish someone out there could at least give me some information on what I’m taking now . It scares me. Best of luck to everyone who has to take these meds too. Be safe.

  28. Kim | December 26, 2013 at 8:27 am

    My son, grandson, granddaughter and her husband are in this program…my son has other people give urine…to pass test. They take this methodoine home and shoot it up. He and my grandson…shoot it up. Their teeth are rotting…they also use other drugs along with the FREE meth…Our Goverment supplies! How long will they be on this program I ask…indeffenate I am told. It’s a FREE high…and as a parent I am out raged at this program. The behavior is worse then before…you have our children now convinced…that this is ok for a life time and way of life. People we need help that will free our children! Not give more drugs… God help us!

    • Bob | April 5, 2014 at 6:01 pm

      I think you mean methamphetamine, a completely different drug.

  29. Jim | December 31, 2013 at 12:19 pm

    My stepdaughter was a heroin addict for 2 to 3 years. She has been on methadone for more than 12 years. Is this really a good long term approach for treating the addiction? Should not true addiction treatment eventually lead to a person developing the coping skills and support system to end the treatment within a reasonable numbner of yeras?

  30. Jim | January 6, 2014 at 1:51 pm

    I am allergic to opiates and have been taking 40mil of methadone for 13 years for nerve pain.I am thank full they make this drug so I can lead a normal life without constant chronic nerve pain.

  31. ididit | January 8, 2014 at 2:17 am

    I did it. 3.5 years on heroin, age 20 I went to methadone… got up to 150mg.. tapered 2-3mg/wk… hit 39mg. I got pregnant. my son was born, withdrawal free.. came home with me 2 days after birth. No CPS issues. i was a model patient. 7 months after i had my baby, i took my last dose at 3mg. :)

    7.5 months since last methadone dose… 4 years since heroin use… healthy percect child…
    got my ged, scoring 99% on 3/5 tests..

    life is f’ing good. it can work. :)
    sry for lazy grammer, its bedtime.

    • Lupe | January 15, 2014 at 11:42 pm

      I am so happy to read this. I held back going on methadone because of the many horror stories out there about people trying to come off methadone maintenance only to learn that most of these stories come from people who just jump off maintenance or did it really quickly. More people like you need to get their stories out there. I am on my 3rd month on methadone and am more happy I been years. I am going back to school next week and am excited to live my life how i was suppose. For now my focus is to get back on track and then slowly taper off. I would love to hear more about how you did it(:

  32. Debra Mullen | January 8, 2014 at 8:41 am

    I’m so grateful that I have 27 years clean. I’m still involved in my NA recovery. I go to meetings and stay in the middle of the boat. I come from 13 years of being on Methadone, and shooting drugs since the age of 21. I got clean March 18, 1986. My experience with Methadone was just one more drug I was addicted to. The withdrawal was hard as I was also using dope. I went into treatment which I would suggest for anyone trying to get off Methadone, drugs, whatever. The treatment center gave me clonidine to lower my blood pressure and they were able to see my withdrawal by taking my blood pressure a few times a day. (Laying down and standing up). I was on the medication for close to 18 days or so. I didn’t have pain, and it saved me 6 months of hell by being in treatment. I understand the pain management with Methadone, however if you are an addict, you had better be honest about your disease of addiction. The responsibility is on the addict not the Dr. I am thrilled to not have to drop urines and go through the changes that the clinic presents to one. I hope I have been an instrument of hope that someone can be drug free and I too was just like them. Drs keep writing scripts and send these addicts to methadone clinics. I feel the Drs do need a special course on understanding addiction.
    . I had kidney stones last year, and the first thing I told my Dr was “I’m a recovering addict”..When I had some surgery done, the hospital still sent me home with some Narcotics. R E A L L Y??? Thank God my recovery is grounded and I have a support group that I stay HONEST with. I love my life today. Thank you for reading my thoughts about addiction.

    • Christine | January 21, 2014 at 1:15 pm

      Debra, I think it’s great that you were able to find a treatment plan that works for you. It is no wonder that MMT was not a successful treatment program for you if you were shooting dope at the same time. In a perfect world, we would all be able to attend a 12 step program and maintain sobriety without the use of medication, but not all of us are wired that way. I struggled with addiction for about 33 years, and I have been to hundreds, if not thousands of NA/AA meetings, along with a few inpatient treatment facilities. I could never maintain sobriety long. It’s amazing I’m not dead now. I put myself in so many dangerous situations physically, sexually, and mentally during my struggles with addiction. I lost a lot, including my children. Amazingly, all of that didn’t even stop me. MMT did not solve my problems immediately, but it did stop me from using heroin pretty quickly. Slowly, I got my life together. I have been in the program about 10 years, and it’s the best thing I’ve ever done for myself and those who love me. Many of us cannot go the route you did in treatment, and as a recovering addict, you should be understanding of that. I agree that recovery is the responsibility of the addict and not the doctor, and that’s what being in methadone treatment is all about. It’s about taking responsibility for your life. The doctor/treatment center is there to provide the tools to make that happen, but ultimately, the responsibility is always on the one suffering with the addiction.

  33. Christine | January 21, 2014 at 11:47 am

    It’s really kind of infuriating seeing some of these negative comments regarding the methadone program posted by those who have either had no experience with opiate addiction, or just plain did not use the treatment and the methadone in the correct way. I have been on methadone for almost 10 years, and it saved my life. I was addicted to heroin, and my addiction took me to places I thought I’d never go. I went through a lot of pain during those many years of using, not to mention the agony that I put those who love/loved me through. My dose was at 98mg for a few years, but eventually I tapered down to 20mg which has been my stable dose for a couple of years. I decided to go to a lower dose because eventually I would like to wean off the program totally. I had no problem tapering. In fact, I didn’t even notice the decreases. It was done very slowly. It is amazing how far I have come. I am now in my third year at a university that is in the top 100 national ranking for colleges, and I have a 3.8 GPA. I am taking graduate level classes, along with my undergraduate classes working towards a masters in Psychology. My goal is to get my certification and become a counselor in methadone treatment. I want to help others to find the happiness and joy that I have in treatment and in my life in general. I have the methadone program to thank for it. I have tried 12 step programs, and I been to four in-patient programs. Nothing worked for me until I found MMT. What works for one person may not work for others. There is no cookie cutter treatment model. It’s unfortunate that so many misinformed people would knock such a program that has saved countless lives. Thank you Dr. Salsitz for such an informative article!

  34. Hugh | January 30, 2014 at 5:39 pm

    Isn’t it true that an opiate addict can live a long life as long as they have unfettered access to that substance, regardless of what it is? In other words, as long as you can afford clean, equally measured doses of heroin, you can function just fine, right? Or, as fine as anyone addicted to an opiate can be. And if this is true, isn’t the argument for methadone simply an argument for legalization of heroin, benzos . . . you name it? Doesn’t this mean that the case for easy, long-term methadone “treatment” becomes the same pathetic argument that so many people use about alcohol: “we tried Prohibition and it didn’t work”?

    I understand that opiates physically change the brain, that abusers cannot feel pleasure the way “normal” people can. But is this the best we have to offer, a lifetime of artificially induced well-being? Is it right to accept such a hollow compromise?

  35. Kim | February 5, 2014 at 12:53 pm

    This article is pc pablum designed to make drug dealing doctors and self deluding junkies feel better.

    Doctors are SALES PEOPLE FIRST! The white coat signifies a personality that craves an absurd amount of respect.

  36. Tami | February 9, 2014 at 9:05 pm

    Thank you for your article. I have to assume that the people who have such negative attitudes toward methadone treatment programs have never been addicted to anything, nor are you a parent of a child with a long time addiction to alcohol who later developed an addiction to opiates. He is my only child. His father was a violent alcoholic who committed suicide when my son was 13. I never thought my son would drink. He hated his father when he was drunk and revealed to me after his father’s death that he no longer had to worry about his dad killing me when he was at school. I had no idea my child was consumed with this kind of worry. Escaping his father was out of the question. He told me he would kill me and my son if I ever left him and I fully believed it. I wanted out and wanted my child out but there was NO escaping the man.

    My son’s father was admitted into 3 residential rehab centers on 4 different occasions over a 15 year period. Upon his release, the first thing he did was pick up a six pack or a bottle of liquor on his way home.

    I can’t say for sure if it was a genetic factor, self-medicating, or peer pressure that led to my son taking his first drink but I do know that after having that first drink, he never stopped. I prayed it was a phase but it was quite apparent that he was an alcoholic by the time he was 23 years old. I begged, cried, offered to pay for any rehab program of his choice, etc. in an effort to get him to stop drinking. He’d just tell me that I worried too much. I couldn’t focus on work nor could I sleep at night for YEARS because I feared getting the phone call that every parents dreads.

    My son will soon turn 34, and now has a 2 year old daughter. The mother wasn’t a drinker but had a long-term opiate addiction. My son followed suit and was soon addicted to opiates in addition to alcohol! Then, I hear there’s a baby on the way…my first grandchild! I was ignorant enough to believe that ANY pregnant woman just stopped using drugs and of course, she realized that I was gullible enough to believe that she wasn’t using simply because she said she wasn’t. I found out when she was 6 months pregnant that she was using as heavily as ever and had been ever since learning she was pregnant. I was devastated and all of my hopes for my 1st grandchild were destroyed in an instant. She had managed to dodge her doctor knowing (somehow) until he caught onto her when she was 6 months along. He ordered her into a treatment program for expectant mothers and told her that the baby would be taken from her as soon as it was born if it was born addicted, and that she would got to prison if the baby was stillborn or died from withdrawal. That program used subutex (sp?). She had a perfect, non-addicted baby that weighed almost 7 pounds.

    As soon as the baby was born, the mother went right back to using and so did my son. He stopped using during the time that she was in the program but never stopped drinking. My son brought the baby to me when she was 2 months old and asked if I’d care for her until they got their lives straightened out. During that time, they both tried suboxone which is ridiculously expensive and the clinic in my area offers no counseling and sends them out the door with a script for a months supply. They couldn’t afford the suboxone even with our financial help. They stopped the treatment, went back to using, and my son attempted suicide 2 months later. He was sent to a residential rehab center which released him in less than 2 weeks. His fiance had a supply of opiates waiting on him when he got home from the rehab center.

    My husband and I had wised up by this time and learned to recognize when they were using…really don’t know how we missed it in the beginning. The worry and sleepless nights had were tearing me apart. I not only had my son’s well being to worry about but also my granddaughter’s welfare. And, forget Child Services being of any assistance. There are so many opiate addicted parents in the area where I live that they are having to ignore the problem because they don’t have enough foster parents to take the kids in. Of course, I would have taken my granddaughter but the social worker didn’t even give me time to explain that.

    I know this is LONG but I want the anti-methadone people to be able to put yourself in my shoes. I’ve never been an addict and viewed methadone very much as some of you do. Immediately after my granddaughter’s first birthday party celebration, my son asked me to step outside and talk with him in private. I assumed they were about to get evicted or one of them had lost yet ANOTHER job. He told me that he wanted me to know that he and his fiance had been in a treatment program for a little over a month and asked me to keep an open mind about it. I heard the word methadone and my heart sank. He then explained to me how strict the clinic was, that he was required to pass regular drug tests, and required to attend one on one counseling as well as group. He said he had to go to the clinic every day. I thought methadone was for drugs only so I asked him what about his drinking problem. He told me that it was helping with that, too. He told me that as his daughter had gotten older, was walking, following him around and calling him Da-Da, that he started thinking about how much he wanted her to look up to him and be proud of him. He said he never wanted her to view him as he had viewed his own father. I realized right then that he was serious about his treatment and WANTED to be clean and sober. He had NEVER included himself in the same category as his father…maybe because my son wasn’t a violent drinker or in denial…not sure.

    My son and his fiance have now been in treatment over a year. Both have been clean and sober the entire time. Not once have they used other drugs. My son was actually in a car accident and got banged up pretty badly 3 months into his treatment. A pulled out in front of him as he was traveling down a 4 lane and he had nowhere to go! So, no, the accident was in no way his fault. My husband and I were on the scene immediately and transported him to the ER. The first thing he told them was that he was a MMT patient. I asked if he HAD to tell them THAT as I was a little embarrassed. He told me YES, because he didn’t want them to give him something that could KILL him!

    I’m am SO PROUD of my son for seeing the need to finally stop drinking and using drugs. As far as trading one drug for another? Not hardly! He takes his methadone dose every day, and has even dropped it by 5 mgs. started out on 80 mgs. and is now at 75 mgs. I drove him to the clinic during the time we were waiting on the insurance to replace his car, spent many days with him when he was not working and came to help me with yard work, and see him pretty much every day as he lives 4 houses away from me now. NOT ONCE HAS HE EVER APPEARED TO BE THE LEAST BIT IMPAIRED FROM HIS METHADONE DOSE!!! His self-esteem has returned, along with his sense of humor, he’s in great health, has a much better complexion, is a wonderful father, has held the same job for over a year now, as has his fiance, and I have my son BACK as I knew him BEFORE these addictions. He and his fiance pay for the treatment themselves and have had to make sacrifices to do it but it’s not nearly as costly and certainly not as dangerous as the drugs and the alcohol.

    So, I’ll advocate MMT for ANY addict who truly WANTS to get clean while being able to work to provide for their family, and be the parent their children deserve! But, those HORROR stories that you all hear about are mostly related to addicts who do not really WANT to be clean and sober. They mix the methadone with other meds that they know they aren’t supposed to, and they end up impaired, get into accidents which might result in other people getting hurt as well as themselves, or DEAD. And, if these people KNOW they are risking their lives by mixing other drugs with the methadone, do you really think they care enough about themselves to respond to residential detox? No, they’ll be right back to using as soon as they are released. I don’t worry about encountering an addict under the wheel who is a committed MMT patient! I worry about encountering one who ISN’T!

  37. So Confussed | February 16, 2014 at 2:35 am

    With all the other myths out there about the half life of methadone, Dr Salsitz, can you say what the half life of this drug truly is? if a person was taking 10mg a day for 3 years, how long would it be in their system? I just don’t know what to tell my son when he has asked, please help

  38. Nick E | March 4, 2014 at 2:18 am

    FINALLY! a doctor that understands…ive been on for 3 years as well as my partner. If it wasnt for methadone i would most likely be dead..i lost my life to opiate pills..and got it back with methadone..ive heard a lot of these myths…but always knew there was more to it.

  39. April | April 15, 2014 at 8:02 pm

    Thank you for sharing, there are certainly many myths about people who are on a methadone maintance program. I have been in this such program for 10 months, and it has SAVED MY LIFE. In my addiction I had lost everything… My home, my car, my job, and most of all my self being. It hurt to breath when I couldn’t get my “fix” for the day. It was the 1st and the last thing I thought about… So after 5 years of living that way I took myself to a methadone clinic. I myself was a critic before hand… This was another place to get high… WRONG! I had to go everyday and take random drug tests…. I seen my counselor on a regular basis. And now… I have been going for 11 months w/out one relapse, my dose never got higher than it should… I stayed at a comfortable 48 mg…. I am a “normal” person who has a full time job, I have got my insurance license in over 30 states and sale health and life insurance, I am purchasing my first home and land, I have a vehicle now, and pay my bills on time… Anyone who doesn’t know me before going wouldn’t believe that I was an addict. So good does come from methadone maintance, my family would say I would dead had I not gone. It is embarrassing to talk about, but their are many more closet methadone maintance stories like…Please don’t be too judging to this treatment :) — so thank you to the ones who realize people like me deserve to live life “normal” too!

    • rachael | April 16, 2014 at 1:27 pm

      Thanks April for your story! I worked in addiction research, in medication assisted treatment for 7 years and there are many many patients like you – those who do well and who get a chance at a life. I have often heard, and believe strongly, that more depends on the organization dispensing the medication than the medication itself when it comes to issues like diversion, benzo or other substance abuse, and detrimental clinic “culture.” I had the advantage of working for an organization whose primary focus was providing comprehensive and excellent patient care and was willing to use research and data to drive clinic policy and treatment decisions. Thank you again for sharing your story – it is important for us all to remember that behind the medication myths and stigma are everyday people, just trying to make their lives better.

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