|
Methadone Treatment Approaches
Availability of Treatment
About 20% of the
estimated 810,000 heroin addicts in the United States receive MMT (American
Methadone Treatment Association, 1999). At present, the operating practices
of clinics and hospitals are bound by Federal regulations that restrict
the use and availability of methadone. These regulations are explicitly
stated in detailed protocols established by the U.S. Food and Drug
Administration (FDA). Additionally, most States have laws that control
and closely monitor the distribution of this medication.
In July 1999 the
U.S. Department of Health and Human Services released a Notice of Proposed
Rulemaking (NPRM) for the use of methadone. For the first time in more
than 30 years, the NPRM proposes that this medication take its rightful
place as a clinical tool in the treatment of the heroin addict. Instead
of its use being mandated by regulations, programs will establish quality
assurance guidelines and have to be accredited. The proposed new system
will allow greater flexibility by the treating physician and ensure
appropriate clinical management of the patient's needs. This proposed
change in policy would eliminate most of the current regulations and
allow greater clinical discretion for treatment by the physician. Accreditation
establishes a clinical standard of care for the treatment of medical
conditions. In the foreseeable future, clinic and hospital programs
would be accredited by a national and/or State accrediting body. Responsibility
for preventing the diversion of methadone to illicit use will remain
with the Drug Enforcement Administration.
Is It Safe?
Research
and clinical studies suggest that long-term MMT is
medically safe (COMPA, 1997). When methadone is taken
under medical supervision, long-term maintenance
causes no adverse effects to the heart, lungs, liver,
kidneys, bones, blood, brain, or other vital body
organs. Methadone produces no serious side effects,
although some patients experience minor symptoms
such as constipation, water retention, drowsiness,
skin rash, excessive sweating, and changes in libido.
Once methadone dosage is adjusted and stabilized
or tolerance increases, these symptoms usually subside.
Methadone
is a legal medication produced by licensed and approved
pharmaceutical companies using quality control standards.
Under a physician's supervision, it is administered
orally on a daily basis with strict program conditions
and guidelines. Methadone does not impair cognitive
functions. It has no adverse effects on mental capability,
intelligence, or employability. It is not sedating
or intoxicating, nor does it interfere with ordinary
activities such as driving a car or operating machinery.
Patients are able to feel pain and experience emotional
reactions. Most importantly, methadone relieves the
craving associated with opiate addiction. For methadone
patients, typical street doses of heroin are ineffective
at producing euphoria, making the use of heroin less
desirable.
Benefits
Evidence shows that continuous MMT is associated with several other benefits.
MMT
allows patients to be free of heroin addiction. The
National Institute on Drug Abuse found that, among
outpatients receiving MMT, weekly heroin use decreased
by 69%. This decrease in use allows for the individual's
health and productivity to improve (Office of National
Drug Control Policy, 1998a). Patients were no longer
required to live a life of crime to support their
habit, and criminal activity decreased by 52% among
these patients. Full-time employment increased by
24%. In a 1994 study of drug treatment in California,
researchers found that rates of illegal drug use,
criminal activity, and hospitalization were lower
for MMT patients than for addicts in any other type
of drug treatment program.
The
Drug Abuse Treatment Outcome Study (DATOS) conducted
an outpatient methadone treatment (OMT) evaluation
examining the long-term effects of MMT (Hubbard et
al., 1997). The pretreatment problems consisted of
weekly heroin use, no full-time employment, and illegal
activity. Results of the 1-year follow-up showed
a decrease in the number of weekly heroin users and
a reduction in illegal activity after OMT. There
was no significant change in unemployment rates.
A Review
MMT
is one of the most monitored and regulated medical
treatments in the United States. Despite the longstanding
efficacy of MMT, only 20% of heroin addicts in the
United States are currently in treatment. The National
Institutes of Health Consensus Development Conference
on Effective Medical Treatment of Heroin Addiction
concluded that heroin addiction is a medical disorder
that can be effectively treated in MMT programs.
The Consensus panel recommended expanding access
to MMT by increasing funding and minimizing Federal
and State regulations. Further research must be conducted
on factors leading to heroin use and the differences
among various users and their ability to end opiate
addiction before the demand for heroin addiction
treatment can be effectively met by increased MMT
availability.
Source: www.whitehousedrugpolicy.gov
|
|
