Is Methadone a Good Alternative?

Medication Assisted Treatment programs use a few alternatives to dangerous opioids. Medications, including buprenorphine (Suboxone^®, Subutex^®), methadone, and extended release naltrexone (Vivitrol^®), are effective for the treatment of opioid use disorders.

Buprenorphine and methadone are “essential medicines” according to the World Health Organization.
A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid use disorder. However, because naltrexone requires full detoxification, initiating treatment among active users was more difficult with this medication. Once detoxification was complete, both medications had a similar effectiveness.
Medications should be combined with behavioral counseling for a “whole patient” approach, known as Medication Assisted Treatment (MAT).

Methadone and buprenorphine DO NOT substitute one addiction for another. When someone is treated for an opioid addiction, the dosage of medication used does not get them high–it helps reduce opioid cravings and withdrawal. These medications restore balance to the brain circuits affected by addiction, allowing the patient’s brain to heal while working toward recovery. The concept of using Methadone as an alternative has been around for many years MAT Decreases opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission. After buprenorphine became available in Baltimore, heroin overdose deaths decreased by 37% during the study period, which ended in 2009. MAT Increases social functioning and retention in treatment. Patients treated with medication were more likely to remain in therapy compared to patients receiving treatment that did not include medication. Treatment of opioid-dependent pregnant women with methadone or buprenorphine Improves Outcomes for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay. It’s primary barrier to entry is the high cost to patients who don’t have insurance.

NEW TREATMENTS

Various researchers and government entities are working on new treatment methods. These new treatments include: Vaccines currently under development target opioids in the bloodstream and prevent them from reaching the brain and exerting euphoric effects. Researchers are exploring the potential of Transcranial Direct Current Stimulation, a novel, non-invasive brain stimulation technique, for treating opioid use disorder. Improving Treatment Delivery – Researchers are exploring how the health care system can reach more people in need of treatment and helping providers understand which treatments will be most effective for which patients. Reaching Justice-Involved Youth – NIDA-funded research is aimed at identifying the most effective strategies for improving the delivery of evidence-based prevention and treatment services for youth through our Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) initiative.

ALTERNATIVES TO METHADONE

Costly methadone treatment for heroin addicts could be replaced by a substitute painkiller that is half the price, safer and less toxic.

In a study spanning three and a half years, researchers found that the prescription painkiller dihydrocodeine is equally as effective as methadone to help drug users kick the habit. The research by the Universities of Edinburgh, Napier and Adelaide could have major implications for treatment programmes for drug users, which have proved controversial not least because of the high costs involved. In contrast to methadone –which comes in liquid not tablet form — dihydrocodeine is much easier to store and comes under less stringent regulations because it is not as toxic and less likely to cause a fatal overdose. It is estimated that whereas methadone treatment can cost almost $2,000 annually per patient, the cost of dihydrocodeine is about $900.

MEDICATION ASSISTED TREATMENT AND AFTERCARE

While medication assisted treatment is certainly worthy of serious consideration, what should be mandatory is aftercare. Aftercare is the care after Rehab or Detox. Virtually no one remains clean sober for life after a few weeks or months in Rehab. The relapse rate is well over 85%. Aftercare provides months of therapy, support, training and consultation to help patients transition to a sober lifestyle. We believe the best course of treatment is: