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The American Society of Addiction Medicine (ASAM) has developed criteria to be used in the consideration of treatment for any type of substance use disorder that results in the development of physical dependence. These criteria include:
Opioid dependence as a result of the abuse of opiate drugs is a continuing problem in the United States. The development of an opioid use disorder is often complicated by the development of severe physical dependence on the drug of abuse. The development of physical dependence consists of displaying both the syndromes of tolerance (needing more of a drug to produce effects once achieved at lower amounts) and withdrawal (the appearance of negative physical and emotional symptoms once the drug is discontinued). Because individuals who chronically abuse opioids and develop opioid use disorders develop significant physical dependence on these drugs, they experience severe difficulty attempting to discontinue their use.
Given the above considerations by ASAM, medication-assisted treatment (MAT) has been developed to address specific withdrawal symptoms for drugs like opioids.
MAT consists of the use of medications or a combination of medicines and behavioral interventions to address specific aspects of substance use disorders.
The American Psychiatric Association (APA) has outlined effective strategies for managing dependence on opioid drugs (tolerance and withdrawal):
Opioid replacement therapy consists of using a specific medication that attaches to the receptors in the brain that the opioid drug of abuse targets during the early phases of recovery. This strategy eliminates or reduces the withdrawal syndrome significantly, and physicians then attempt to slowly taper the opioid replacement medication to allow the individual’s system to slowly adjust to decreasing doses of the drug. Over a specified period of time, the drug is tapered and then finally discontinued, and the individual can continue their substance use disorder recovery. Methadone is a drug that has long been used as an opioid replacement drug.
Methadone is a synthetic or manmade opioid drug that can be used in the treatment of opioid dependence, especially for drugs like heroin. The use of methadone for the treatment of opioid dependence goes as far back as the 1950s. Its use became popular in the 1960s to address what was described as the “heroin epidemic.” In the early 1970s, an estimated 25,000 patients were enrolled in methadone maintenance treatment programs. The drug’s prescription became restricted to registered doctors and pharmacies as a result of the Narcotic Treatment Act of 1974 due to escalating cases of methadone abuse. Methadone is also used in the treatment of chronic pain in some individuals.
There are several reasons to explain why someone would elect to become involved in methadone replacement therapy or methadone maintenance therapy. The major reason to use methadone is to avoid withdrawal symptoms associated with discontinuing some opioid drugs, such as heroin, morphine, or other prescription painkillers.
Reasons to use methadone are outlined below.
However, being in a methadone maintenance program is not a panacea. There are some drawbacks as well, outlined below.
It is hoped that getting the drug legally will reduce the risk of harm (e.g., the risk of hepatitis or HIV due to needle sharing) and decrease the potential of addicted individuals engaging in criminal activities, but this is not always the case. Methadone maintenance is generally considered less harmful and less sedating than other opioid use, and safe for even pregnant women. Therefore even if individuals abuse methadone, it is believed to be advantageous over the abuse of powerful illicit drugs like heroin or prescription drugs like OxyContin.
However, as mentioned above, methadone does carry risk for physical dependence and abuse. Many critics point out that one addiction is simply being replaced with another in methadone maintenance programs. Thus, these programs, according to these critics, are not successful in helping people recover from addiction, and they are inconsistent with the goals and specifications outlined by ASAM and APA for the use of MAT.
There are a few alternatives to methadone that one might consider. These include:
Anyone attempting to negotiate the withdrawal process from opioid drugs should consult with a physician. Even though the withdrawal process associated with an opioid use disorder is not generally considered to be potentially dangerous, individuals may actually be at risk for harm due to dehydration, lapses in judgment due to experiencing severe withdrawal symptoms such as vomiting and nausea, and potential accidents or self-harm associated with anxiety and/or depression.
All of the medications mentioned in this article should only be administered under the supervision of a physician. Attempting to use these medications without being under the care of a physician is extremely dangerous. Physicians can immediately address any issues associated with use of the medications, such as the development of allergic reaction. They can adjust the dosage to fit the particular case and use other MATs to control any complications that occur during the withdrawal process that are not addressed by these drugs.
Finally, an individual wishing to recover from a substance use disorder should become enrolled in a formal substance use disorder treatment program that includes MAT (if necessary), substance use disorder therapy, participation in support groups, social support from family and friends, and other interventions that are appropriate for the individual case. Simply trying to negotiate the withdrawal process without addressing the reasons that drove the substance abuse, or developing new skills to cope with stress and avoid relapse, is doomed to fail.
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