What is Methadone Maintenance Treatment?
- A) The most effective treatment for heroin and other opioid dependence?
- B) A means of reducing the transmission of the AIDS virus?
- C) The most progressive and misunderstood form of substance abuse treatment?
- D) All of the above?
The answer is: D) All of the above
Methadone maintenance treatment came into being in an unexpected way.
By 1963, on the cusp of the social revolution of the sixties, doctors and
public health workers had concluded what objective observers and users
alike had known for decades: that there was no treatment known which could
cure more than a small fraction of long term opiate (heroin, morphine,
etc) addicts. In fact, there wasn’t even any treatment which could honestly
claim to be more successful than no treatment at all! Every imaginable
option had been tried, from lobotomies and insulin shock to psychoanalysis
and the threat of lifetime incarceration. But in every case the result
was the same: between 70 and 90 percent of these chronic addicts would
return to opiates within a short time. In light of such statistics a number
of prestigious panels examined the problem and by 1963 had come to the
same conclusion: it was time to re-examine nearly fifty years of prohibition
and consider allowing doctors to prescribe addicts the opiates they needed.
At Rockefeller University in New York City, Dr. Vincent Dole, an expert
in metabolic disorders, and Dr. Marie Nyswander,
a psychiatrist who’d worked at the U.S. Public Health Hospital/Prison for
addicts in Lexington, Kentucky, began experiments with several chronic
heroin addicts. In attempting to determine if addicts could be maintained
on stable doses of pharmaceutical opiates, the volunteers were given access
to the spectrum of opiates available to medical practitioners. The researchers
tried everything from morphine to dilaudid, but found that it was extremely
difficult to stabilize the subjects. The addicts were either oversedated
or in mild withdrawal most of the time, and spent their days either “on
the nod”, waiting for their next shot, or comparing the relative merits
of the drugs used. Reluctantly, Drs Dole and Nyswander concluded that the
experiment had been a failure, and decided to “detox” the addicts and release
them from the hospital. To accomplish the withdrawal, they turned to a
synthetic narcotic called methadone. Methadone had first been synthesized
by the Germans during World War Two, and after the war it was used to withdraw
addicts at Lexington. It had the advantage of being cheap, significantly
orally active, and longer lasting than opiates like morphine. For the researchers
at Rockefeller, it seemed merely a convenient and humane means of ending
the experiment with maintenance. As the addict volunteers had been built
up to large doses of narcotics by street standards, they were given relatively
large doses of methadone to stabilize their “habits” before beginning the
reduction.
And then something completely unexpected happened. A few days after
the subjects had been switched to methadone, and before the “detox” had
begun, they began to exhibit very different behavior. Whereas for weeks
they had spent their days either feeling the effects of the narcotics or
complaining of their need for more narcotics, suddenly the focus of their
days turned away from drugs. One subject asked the researchers for supplies
so that he might resume his long neglected hobby of painting. Another inquired
after the possibility of continuing his interrupted education. In short,
the addicts- who when admitted to the hospital had looked and behaved very
much alike -now began to differentiate. They began to manifest the
potential that each had obscured during years of chasing street narcotics.
