More on methadone

Points is publishing a series on methadone and offers a case for methadone without resorting to describing it as “the most effective treatment for opiate addiction.”

It’s a pretty fair piece. I had only one quibble with the facts of the story. This is unusual and very welcome. However, the author and I disagree starkly about the context and meaning of those facts. (As I pointed out last week, we seem to lower the bar for these addicts.)

It opens with this statement:

…there is one treatment that offers real hope.

Okay hope is good. Hope for what?

Reduced Crime

One of methadone’s biggest strengths is reducing this criminal behavior. The vast majority of research shows a marked decrease in crime following methadone treatment. One particularly large study, involving over 600 patients, showed a 70.8 percent decline in “crime days” – a 24 hour period in which an individual commits one or more crimes – during the first 4 months of methadone maintenance treatment.

Reduced HIV Transmission

The post erroneously reports that, “More than 36% of new A.I.D.S. cases are attributed to intravenous drug abuse.” The report they cite actually says:

Since the epidemic began, injection drug use has directly and indirectly accounted for more than one-third (36%) of AIDS cases in the United States. This disturbing trend appears to be continuing. Of the 42,156 new cases of AIDS reported in 2000, 11,635 (28%) were IDU-associated.

These numbers includes people whose only exposure was IDU and people who reported possible IDU transmission AND male-to-male sexual transmission. A more recent report puts these new case transmission numbers significantly lower. Among men, IDU transmission was reported in 7% of cases. (IDU and male-to-male exposure was reported in another 4% of new male cases.) Among women, IDU transmission was reported in 14% of new cases. The total for all 3 groups would be 5594 new IDU-associated cases.

At any rate, the argument is as follows:

Even though methadone does not stop some addicts from continuing IV drug abuse, it reduces that needle share rate to 1/5. In addition to reducing H.I.V. infections, methadone reduces prostitution by addicts, another major cause of new infections.

Reduced Drug Use

When measuring whether a treatment is effective or not, the primary concern is whether addicts stop or use fewer drugs than before they started treatment. Methadone succeeds in this regard. Drug use declines dramatically in those who undergo treatment, and it continues to decline as addicts spend more time in treatment. Relatively new research shows that addicts who receive higher doses (measured as 80-100 milligrams) use even fewer opiates than the traditional treatment population, who are usually maintained on a sub-optimal dose.

A Couple of Qualifiers

First:

However, the majority of patients drop out within a year.

Second:

Nearly 40 percent of patients drop out of methadone programs during their first year of treatment due to incarceration.

What about Abstinence?

Abstinence is dismissed as absolutist and simplistic.

Defining success is of critical importance when assessing any treatment’s effectiveness. The simplistic view looks at whether a treatment stops an addict from using their drug of choice. This absolutist approach is problematic for a number of reasons.

Two stories of methadone (addictionandrecoverynews.wordpress.com)
Methadone’s cognitive effects (addictionandrecoverynews.wordpress.com)
Prolonged Methadone Treatment Can Affect The Nerve Cells, Behaviour (medicalnewstoday.com)