Should Judges Get With the Methadone Program?

Should Judges Get With the Methadone Program?

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Medication-assisted treatment is a touchy subject in America’s drug courts, half of which ban it outright in favor of abstinence-based treatment only. But opioid withdrawal medication has proven to reduce drug mortality rates more than 70 percent. Are drug courts, in their admirable effort to help offenders get treatment rather than prison time, hurting more than helping by, in effect, aligning themselves with Narcotics Anonymous?

A Mandate for Methadone?

In a recent New York Times op-ed, science journalist Maia Szalavitz argues that all drug courts should allow methadone treatment for offenders with a chronic opiate dependence. Regulated maintenance drugs, she says, increase employment rates among users, inhibit the spread of disease and reduce crime. She insists it’s a no-brainer that the methadone option should be 100% available, even though many Americans (and drug court judges) assume that it simply replaces one drug with another. And she’s backing certain states’ pending legislation that would force drug courts to offer methadone treatment as an alternative to sending offenders to NA. And after the publishing of Szalabitz’s op-ed, Governor Chris Christie did actually sign the legislation into law in New Jersey.

“Maintenance replaces unhealthy behavior with simple dependence, the need to take a drug to avoid withdrawal. And that is not a problem with a legal, safe supply,” Szalavitz argues.

Initially, my reaction to the article was, “Nope. Disagree. Keep it moving, sister.” Then as I read and processed some of her points, I started thinking, “I still don’t necessarily agree but…I get it.” And by that I mean I get why science-oriented folks may think medication-assisted treatment or maintenance is the best solution for heroin addicts constantly facing prosecution for drug-related crimes. I also get why Szalavitz and others are appalled by the large number of hopelessly hooked citizens.

‘Essential Medicine’

Szalavitz cites the case of Robert Lepolszki, a 28-year-old heroin addict who was forced by a New York judge to stop taking methadone. The court only allowed complete abstinence programs. Not long after he came off methadone, Lepolszki died of an overdose.

“Lepolszki’s death was not an isolated incident—it was a likely outcome of denying access to a treatment that the WHO [World Health Organization] has called ‘essential medicine,'” Szalavits laments.

Opiate overdoses have done nothing but steadily increase since the turn of the century. But while Szalavitz makes her case for methadone, some towns in Colorado are outright refusing to license methadone clinics. Those and other communities see methadone as just another drug plague, with people illegally dealing in it, hoarding it or overdoing their dosage. Might as well let them keep doing heroin, some might say.

Szalavitz points out that giving an alcoholic a steady dose of gin to ease withdrawal symptoms will clearly have a negative impact on their behavior while maintenance drugs designed for the opiate users do not have such an adverse effect. This very well may be true but how long should someone be allowed to stay on a maintenance drug?

Weaning off the Wean-Off Drug?

It’s also important to recognize the distinction between those who are physically dependent and those who suffer from full-blown addiction. If the person is truly an addict, their dependence is usually rooted in something more fundamental than the pleasure-seeking cycle–such as mental illness, emotional trauma, environment or genetics. Anyone receiving Suboxone or methadone for an opiate addiction should be required to get some sort of emotional treatment, too, such as NA meetings if that’s all that is affordable, or individual therapy. Maintenance may do the trick, so to speak, for a while but what eventually weans someone off the wean-off drug?

In my humble (and I do mean humble; I think everyone has to find what works for them and their loved ones when it comes to addiction and recovery) opinion, abstinence should be the long-term goal no matter what. But in the meantime, we need to do anything we can to save others from the fate of Robert Lepolszki.

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  1. I’ve never used methadone, but anyone I’ve talked to that has says it is much harder to kick than heroin. First, it has an average half life of 20 hours—one of the reasons that methadone clinics that don’t open until 6 am have a group of clients hanging out at the clinic at 4 am waiting for it to open. They’ve been in withdrawal and can’t sleep.

    Second, it seems fairly standard to titrate up the dose of methadone until the client reports not wanting to get high any more; then raising the dose whenever there is a report of cravings or urges to use. So people use high doses of a substance classified as a Schedule 2 controlled substance—the same as OxyContin and morphine—on a daily basis. Many opioid addicts I’ve known never had the connections to have enough heroin or percs or whatever to not face withdrawal for months or years at a time. Imagine the hooks the drugs gets into you with that habit! I’ve read journal articles recommending dosing with methadone for five years at a minimum before considering a gradual taper off it.

    Third, I think the post acute withdrawal/withdrawal syndrome that hits when methadone users try to taper off is a big stumbling block. This seems to be partly because of not being prepared for the experience after the months of no physical or post acute withdrawal because of the methadone.My thought is that there is a more problematic withdrawal syndrome with methadone that is related to its greater half life (somehow), which also contributes to the difficulty of someone trying to kick methadone.

    Fourth,because of tolerance, the doses can get so high that tapering off can be almost an impossibility. When methadone is used for pain relief in opiate-naive patients, they start off with an 8 mg dose. most methadone clinics begin around 30 or 40 mg for an initial dose. Watch the documentary “Methadonia” on Netflix to follow some methadone clinic patients in NYC, where dose can reach over 200 mg daily.

    Methadone maintenance is not a “treatment” for opioid addicts. Rather, it functions as a form of social control, with lower rates of crime, lower using-related medical costs, etc. It does not belong in drug courts, in my opinion.

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About Author

Mary Patterson Broome is the Editor-in-Chief of RehabReviews.com and After Party Magazine and has also written for Women's Health Magazine Online, AOL and WE TV. She has been performing stand-up comedy at clubs, colleges, casinos and festivals across the country and internationally for over a decade. Originally from southern Alabama, she now calls Los Angeles home.