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Policy Statement
Number 3
May 1994
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, i.e. 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.
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