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| Methadone and the Anti-medication Bias in Addiction Treatment |
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There is a deeply entrenched anti-medication bias within the field of addiction treatment. This bias is historically rooted in the iatrogenic insults that have resulted from attempts to treat drug addiction with drugs. The most notorious of these professional practices includes: coaching alcoholics to substitute wine and beer for distilled spirits, treating alcoholism and morphine addiction with cocaine and cannabis, switching alcoholics from alcohol to morphine, failing repeatedly to find an alcoholism vaccine, employing aversive agents that linked alcohol or morphine to the experience of suffocation, and treating alcoholism with drugs that later emerged as problems in their own right, e.g., barbiturates, amphetamines, tranquilizers, and LSD. A history of harm done in the name of good culturally and professionally imbedded a deep distrust of drugs in the treatment of alcohol and other drug addiction (White, 1998). This article will explore how this anti-medication bias has influenced the perception of methadone maintenance treatment (MMT) by policy makers, addiction treatment professionals, MMT consumers, and the public.
Methadone maintenance treatment
The United States has a long history of attempting to stabilize the functioning
of opiate-dependent individuals with daily doses of prescribed narcotics. Nineteenth century physicians routinely provided such maintenance, and 44 communities operated morphine maintenance clinics between 1919 and 1924. Attempts at morphine and heroin maintenance were plagued by the pharmacological properties of the drugs - properties that left patients cycling each day through periods of acute intoxication and acute withdrawal. Mid-twentieth century studies of non-maintenance treatments for opiate addiction consistently reported relapse rates in the upper 90th percentiles (White, 1998).
In the mid-1960s, Drs. Vincent Dole, Marie Nyswander, and Mary Jeanne Kreek pioneered the use of methadone, a long-acting synthetic narcotic, in the treatment of heroin addiction. In contrast to morphine and heroin, blockade dosages (80-120 mg/day) of methadone lasted 24-36 hours, allowing opiate-dependent patients a window of stable functioning that prevented the twin impairments of narcotic intoxication and withdrawal sickness. What was most striking about opiate-dependent patients on methadone was their "physiological normality" (Dole, 1988). The positive evaluations of these early MMT trials led to the emergence of methadone as a major opiate treatment modality during the 1970s and 1980s. Today, approximately 179,000 of the more than 900,000 opiate addicts in the United States are enrolled in MMT (Kreek & Vocci, 2002).
MMT rests on three propositions: 1) opiate addiction is a brain disorder; 2) optimal daily doses of methadone normalize the metabolic processes of persons whose endogenous opioid receptor systems have been compromised by prolonged opiate use; and 3) methadone-induced metabolic stability provides a safe, homeostatic platform upon which more global efforts at physical and psychosocial rehabilitation can be constructed.
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