Methadone treatment is widely criticized, but often, those criticisms are based on myths or lack of understanding. Granted, methadone, like any treatment has its drawbacks. It is not the right treatment for everyone.
However, it is an incredibly valuable treatment option and it saves lives. It is worth taking the time to understand. (Need a quick primer on methadone? Read part 1 here).
Before continuing, I must make a key clarification. I am not a medical professional. I do not have a license to practice medicine. The information here is general and NOT a substitute for consultation with a medical doctor. Only you and your doctor can determine if methadone is appropriate for you.
Myth 1: Methadone is just replacing one drug for another
On the surface this appears true, but we need to look at the whole picture. When actively using illicit substances, the “wanting” is reinforced. There tend to be large swings between withdrawal and using as much as you can when you can.
When a steady, safe, stable supply of an opioid is provided, tolerance becomes the focus rather than the wanting. To truly understand addiction, one must understand how factors such as timing, dose, drug, set and setting all contribute. Not only do all these factors contribute to the development of an addiction, but they are also key factors in overdose. When both our tolerance and our supply are stable, we are less likely to overdose.
On a stable, appropriate dose, the patient will not be impaired—nor will they have to divert time, money, and attention to the act of getting drugs. When someone is taking methadone as prescribed, they will be dependent on it, however they will not be addicted to it. This is not just semantics—this is a critically important distinction. It is not just a drug change; it is a life change.
Since it is legal and the dosing schedule is predictable, it provides for a level of stability difficult to acquire with daily illicit opioid use. Additionally, often the route of administration is causing harm, i.e. injecting, snorting, smoking. Since methadone is taken orally, there are fewer health risks associated with it.
Myth 2: Methadone gets you high
Like many prescription medications, context, and dose matter. If you have an opioid tolerance (a requirement in methadone programs), and are taking the correct dose for you, you will not get high. Someone dependent on most other opioids will need to use every 4-6 hours to stave off withdrawal.
A stable adequate dose should keep a person free of any withdrawal and cravings for 24 hours.
Myth 3: Methadone clinics are just legal drug dealers
Not all clinics are created equally. There are some amazing clinics and there are some terrible ones. Ideally, methadone clinics should have well trained, accessible medical and mental health staff. And you should be able to actually talk to them! Dosing should be flexible, i.e. not having a general rule about keeping doses low. Too low of a dose and a person will never stabilize and they will have to take additional opioids to be well. Dosing should be individualized and adequate considering your medical history, other medications you may be taking, etc.
The processes and the rules can feel frustrating at times, for both staff and patients. However, methadone clinics are highly regulated so often the rules are not optional. Many clinics do not receive any funding, meaning they need patient fees to keep the doors open.
At most clinics, there is a set cost regardless of how much you participate. However, take advantage of any classes, groups, or therapy they have available--it is a good way to get more out of what you are paying for and get additional support.
Myth 4: Methadone weakens your bones
This is a myth, but that achy feeling is usually tied to your dose. Muscle aches are a symptom of opioid withdrawal and can be a sign that your dose is not high enough. If your dose is inadequate your body will begin to go into withdrawal. Methadone does not get into your bones.
Myth 5: Methadone rots your teeth
Another myth…but with a caution. All opioids can cause dry mouth, as many types of medications do. Consistent dry mouth can lead to dental problems. However, it is an easy fix. Good dental hygiene and drinking plenty of water go a long way. There are also OTC dental products formulated for people who have issues with dry mouth.
Myth 6: You cannot be on methadone if you are pregnant
Methadone, as well as buprenorphine (Subutex) or buprenorphine-naloxone (Suboxone) is not only safe for pregnancy, but also generally the safest treatment for pregnant women. Some states, such as New York have laws regarding priority access to treatment if you are pregnant. If you are considering beginning methadone treatment, be sure to tell the clinic that you are pregnant; they may be able to get you in sooner and in some places you may be eligible for free or reduced fees.
According to the American College of Obstetricians and Gynecologists (ACOG), “opioid agonist pharmacotherapy is the recommended therapy and is preferable to medically supervised withdrawal because withdrawal is associated with high relapse rates, which lead to worse outcomes [for pregnant women with an opioid use disorder]”.
If you choose to detox during your pregnancy, it advised to consult with your physician and avoid detoxing alone.
Myth 7: People on methadone are not really in recovery
I call bullsh*t! No one group gets to define recovery for everyone. Methadone (and suboxone too) are evidenced based treatments. Maintenance therapies can lower mortality rates by up to 75%.
For many patients methadone turns out to the missing piece to getting their lives back on track. Many people in methadone treatment have the goal of abstaining from all other drugs, some do not. That does not invalidate the treatment, nor does it invalidate the person who continues to use.
In his book, In the Realm of Hungry Ghosts, Gabor Mate reminds us that harm reduction is as much an attitude as it is a set of policies and methods. “…we do not hold abstinence as the holy grail, and we do not make our valuation of addicts as worthwhile human beings dependent on their making choices that please us.”
Support if you need it
If you or someone you care about struggles with opioid dependence, Substance Use Therapy is available. You may want to examine your use, make changes, learn about treatment options, or maintain positive changes you have already made. Whatever you are facing, you do not have to face it alone.
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About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.
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