Discharge From Treatment for Drug Use

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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