It must be emphasized that methadone maintenance treatment is a
medical treatment for narcotic addiction. Recent research has
found that abstinent former heroin users have irregularities
within their immune and endocrine systems. However, these
irregularities are normalized with methadone maintenance. This further
underscores that methadone maintenance is a medical treatment
for a medical condition that has sociological and psychological
aspects, as do many medical conditions, ie heart disease. No
other treatment for opiate addiction as is successful as
methadone maintenance, resulting in a 92% reduction in heroin use when treatment is
appropriately done. No other treatment
for heroin addiction can boast such a success rate, and in fact
very few other medical treatments have as high a success rate as
methadone maintenance.
Programs who have high rates of illicit opioid use are, put
simply, “not providing proper treatment.” Discharging patients
for heroin use is unethical and usually programs which use such
tactics are not providing adequate dosage or are using the
medication as a tool to manipulate the patient’s behavior. Such
procedures would be considered unethical in every other realm of
medicine, but because drug use has been perceived as a
behavioral problem, discharging patients for drug use has been
tolerated in methadone treatment.
Imagine how this feels to the patient in treatment. What if you
were diagnosed with cancer and went for the usual radiation
treatments. You followed everything the doctor told you to do,
but in the end the cancer was still growing. Now apply this to
methadone treatment: you would be discharged because you did
not respond to treatment. If you had cancer would you not want
the doctor to try something else, like chemotherapy and if that
failed perhaps some new experimental treatment? You would want
the doctor to try everything to save your life. The same is
true for the methadone patient, if 70 mg doesn’t work, then
perhaps 80 or 90 or 200 mg will work. For the cancer patient
perhaps two radiation treatments will work. But imagine the
doctor blaming the cancer patient for not responding to
treatment and then discharging them. “If only you had tried
harder!” This happens to methadone patients every day, they are
blamed for the failures of their programs.
Not only does discharging methadone patients from treatment do a
terrible disservice to the patient, but also to the community.
Think of the repercussions when a patient is discharged. It is
inevitable that they will relapse within a short time and
considering the threat of HIV, strain resistant TB, hepatitis
and endocarditis the effects that the discharge will have on the
family of the patient is tremendous. The patient will no longer
be able to support their family because they will be thrown into
a state of “drug craving.” The crime that one patient will have
to commit to maintain their drug use has been estimated to cost society from
$150,000 to over $300,000 a year. And if this former patient is
arrested, which is very likely, then they will be a ward of the
state costing between $30,000 to $60,000 a year. And should
this former patient become infected with HIV the cost can be as
high as $300,000 a year, and as people with AIDS are living
longer the costs are rising dramatically.
Now I ask you, which is better for the person, the community and
the state? A methadone patient receiving adequate treatment who
supports their family, pays their taxes, pays for their
treatment and is a productive member of the community, or a heroin addict who will cost the
community money that
could well be spent on better purposes?
A Comment on Discharging Patients for Using Cocaine
Many programs have adopted the policy of discharging methadone
patients for using cocaine. Presently there is no treatment for
cocaine use, except hospitalization and counseling and hoping
that this time something works. However, NAMA believes that it
is unethical to discharge patients and thus refuse to them
treatment for their heroin addiction because they have developed
an ancillary problem. In normal medical practice a patient with
diabetes who did not follow medical advise now developed heart
disease because of this would not be refused their insulin.
Neither should a medication that works for heroin addiction be
refused because of another drug problem.
There are programs that discharge for marijuana use. This
simply does not make sense nor does it serve the community or
the patient and their family. Marijuana is used by a
large number of Americans and is associated with neither the high crime rates nor the
significant medical consequences resultant from abuse of other illicit drugs or alcohol. Furthermore,
many AIDS patients use marijuana on medical advice as a means of countering the “wasting syndrome”.
Discharging methadone patients for using
marijuana results in an untreated heroin addict that will cost
the community in crime and money.