Methadone may be the most reviled medicine in the world. Not only is this opinion unfair, but it’s also dangerous for the lives of opioid addicts who may die from overdoses of heroin or fentanyl when they are no longer able to get prescriptions of oxycodone or other opioids and the only alternative is going cold turkey.
Invented in Germany as a substitute for hard-to-come-by morphine in the 1930s, in the 1950s methadone became the go-to remedy for heroin addicts in the US as a form of opioid replacement therapy, medication-assisted treatment (MAT), or medication-maintenance treatment (MMT). When heroin-addicted GIs started coming back from Vietnam in the 1970s, President Nixon started a federal methadone program.
Since then it often has been regarded as just another addictive substance, little better (if at all) than heroin. True, it has been subject to abuse, and it can take months or years for patients to complete their methadone maintenance (12 months is average), but it is inexpensive and, when taken as directed, relatively harmless.
A few years ago the CDC claimed that methadone was responsible for one in three opioid overdose deaths when only a single drug was used. That seems surprising, but if that was true and not a glitch of some sort, it isn’t any longer. According to data from the National Vital Statistics System, as reported by the Kaiser Family Foundation, in 2015 only one in 15 opioid overdose deaths were related to methadone.
Not everyone does use it as directed, and it is possible to overdose and die due to methadone abuse, but that is true of virtually all drugs and many other substances besides, and it is possible to taper off of methadone without relapsing into heroin use.
To prevent such misuse, methadone patients usually have to report to a clinic or doctor’s office every day for a daily dose of the drug.
Methadone is not right for every patient. In 2006, the FDA reported that the “respiratory depressant effect of methadone occurs later and persists longer than” its pain-killing or withdrawal-suppressing effects.
Another MMT is buprenorphine (often combined with naloxone as Suboxone) and is up to six times safer than methadone, but it requires that the patient has started withdrawal. Methadone can be administered immediately.
The other widely used opioid addiction drug naltrexone (or Vivitrol in its once-a-month injection formulation) requires total withdrawal because it doesn’t maintain; it prevents patients getting high on opioids in the first place (though they can still get high on other types of drugs, such as benzodiazepines and methamphetamine).
Substance use disorder treatment needs more options, not fewer.
