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Opiate consumption has been prevalent for centuries, and with its usage came opiate addiction. For so long there have been many differing opinions on how to free one's existence from its forceful grip. Throughout history, not much has been known as to combating this enemy; either give it up or give in to it. Then in 1963, an amazing thing happened. Two doctors discovered a way to treat the opiate addicted patient with a "not so new" drug called Methadone. Finally, after years of digging, a humane means of addiction therapy had been unearthed. So, why does this compassionate means of aid come with such opposition in today's society? Is abstinence really a better option than Medication Assisted Treatment? Is there truly a "black and white" answer to this "grey" question? Let's see...

Opium use dates back to 3400 BC where it was cultivated from poppy plants in lower Mesopotamia, which today would be in the area of modern day Iraq. (1) Since then, it has been farmed in the Middle East, China, and areas of Mexico among others. People would cultivate the plant and ingest it through several different methods: smoking, snorting, "skin popping" (sub dermal injection), or "mainlining" (intravenous injection). The users took pleasure in its pain killing, euphoric, and sleep inducing effects, and especially in the non-existence of any ill after effects such as a "hangover" upon waking. Today, opiates are the main ingredient in illicit drugs such as heroin, and prescribed meds such as Percocet.

Of course, with the "good" there also comes the "bad" and the "ugly". For instance, since most heroin is taken by injection, HIV, AIDS, and Hepatitis C is easily transmitted by cross contaminating shared needles. (2) Aside from disease risk, people also become physically dependant on the drug and find they need to take it regularly else they experience terrible withdrawal symptoms such as nausea and vomiting, fever and chills and shakes. Many become unable to hold jobs or provide for their families because they cannot function normally whilst on the drug. Finally, many conform to a life of crime in order to pay for their habit as they have no job to do so with anymore. It's not hard to see that the bad outweighs the good in this circumstance.

So what's the big deal? Why don't the users just say "no" and just deal with the withdrawal symptoms as it should only last for a few days? They can say no and then they can go back to work and support their families and everything will be "fine and dandy" again. In all actuality, there are groups out there who believe that abstinence is the proper way to manage opiate addiction. In this essay, we will explore the notion of abstinence versus "Medication Assisted Treatment" (MAT) with Methadone as the primary medication (others are available on the market such as Buprenorphine.) There are many pros and cons in dealing with both therapies, and we will take a look at both to determine their efficacies.

MEDICATION ASSISTED TREATMENT

What is "Medication Assisted Treatment?" This is the process by which heroin addicts use a synthetic opiate, most commonly Methadone, to curb withdrawal symptoms while slowly detoxing off opiates. This medication helps counter the withdrawal effects by replacing the real opiate with the controlled fabricated opiate, then slowly weaning the patient off in a clinical environment. This legally obtained medication is taken in a clinical setting in conjunction with a program consisting of counseling sessions which delve into the deep psychological aspects of opiate addiction. This process battles the addiction war not on one but TWO levels; physical and mental.

It wasn't until a failed study attempt at Rockefeller University in New York City, by doctors Vincent Dole and Marie Nyswander in 1963 where Methadone use came about. During their study, they attempted lobotomies, insulin shock, heroin replacement (with morphine), and psychoanalysis to treat opiate addiction. Their accomplishments were extremely limited, and worse yet, 70 - 90 percent of their "successes" would return to opiates within a short time. Failure abound, they decided to ditch their study.

However, according to the law the doctors had to "detox" their patients before discharging them from the experiment. They decided to put their patients on Methadone. However, instead of lowering the dose, they increased the dose and examined the patients one final time. Amazingly, the patient's behavior changed for the better! Dole and Nyswander's final conclusion came to be that opiate addiction creates physical dependency requiring medical attention. "Substances are not addicting; some of them create a physical dependency, which means that there are withdrawal symptoms when the substance is withdrawn." (3) And like any medical disorder, a medication is most often needed to control symptoms. Methadone was their supplement to their biological defect.

According to the CDC, "it is estimated that 5,000-10,000 Intravenous Drug Users die of drug over-doses every year. In 1997 National Institutes of Health report estimated the financial costs of untreated opiate addiction at $20 billion per year. These costs, combined with the social costs of destroyed families, destabilized communities, increased crime, increased disease transmission, and increased health care costs, mean that opiate addiction is a major problem for affected individuals and society." (4) With this knowledge, it would seem that finding a drug treatment program with proven results would be the best investment for the opiate addicted individual.

MISCONCEPTIONS

However, as always when something good comes about, there are bound to be a number of flaws. First of all, there are those who believe that taking the drug is not safe. Some believe that there are physical and cognitive impairments that come with taking Methadone on a daily basis. However, the White House Drug Policy states very clearly that "Methadone does not impair cognitive functions. It has no adverse effects on mental capability, intelligence, or employability. It is not sedating or intoxicating, nor does it interfere with ordinary activities such as driving a car or operating machinery. Patients are able to feel pain and experience emotional reactions. Most importantly, methadone relieves the craving associated with opiate addiction. For methadone patients, typical street doses of heroin are ineffective at producing euphoria, making the use of heroin less desirable." (5)

Also, there is the misconception that if you are on Methadone, that you need to tell your employer that you are on it. This is untrue. Methadone is not routinely tested for during employment drug tests. According to the US Department of Health and Human Services, "Once you're on a stable dose of methadone, it shouldn't affect the work you do or how well you do your job. For most jobs, there is no need to mention that you take methadone. Your employer has no right to know."(6)

Another fear for the Medication Assisted Client is that of being poisoned by Methadone. This is an actual concern according to statistics. According to the Food and Drug Administration, "the number of poisoning deaths linked to methadone is rising faster than the number of poisoning deaths from any other narcotic drug. However, unlike other narcotic pain relievers a single dose of methadone can remain in the body anywhere from eight to 59 hours. As a result, the drug builds up to toxic levels if it is taken too often, in too high an amount, or with other medications." (7) Methadone is meant to be given to a patient in a clinical setting under the watchful eye of a licensed clinician. It is their belief that the poisonings occur when the patient is not being fully honest with the clinic staff. What is not mentioned, however, is the most likely scenario of poisoning due to the client's "scoring" of "street" Methadone (sold on street without prescription) or is using other drugs in addition to it. They take the uncontrolled substance along with their prescribed medication and poisoning occurs.

A final absurd misconception meant to vilify Methadone is that it was named after Adolf Hitler. So, how do they get "Adolf Hitler" out of "Methadone?" The common brand name of Methadone is Dolphine. Villains connect the name "Dolph" ine with A"dolf" Hitler, since they knew that the drug was synthesized by the Germans in the era of WWII. The belief is that Adolf Hitler was a bad person who wanted to control people using Methadone is how he did it. In reality, in Latin "dolor" means pain and suffering. The "-phine" in Dolophine comes from morphine, which comes to us from "Morphin," who was the god of dreams of mythology. (8)

The myths surrounding Methadone can only spoken by people who do not truly understand it. It is well known that people fear what they don't know. So in order to counter the negative feelings surrounding heroin addiction and Medication Assisted Treatment, the public must be educated that this is the best policy. However, there are still educated people out there who believe that abstinence is the best policy. We shall explore this notion next.

ABSTINENCE

As with anything else, nothing is 100% effective. Critics claim that the addict on Methadone may appear sober, but is truly not "clean" as they are only masking their addiction with another drug. This leads to the other notion that the addict is only trading one addiction for another. One of the most nationally recognized organizations that propose the suggestion of abstinence is Narcotics Anonymous. "The only requirement for membership is the desire to stop using," says the program's World Service Board of Trustees in 1996. They go on to say, "Does NA have the right to limit members' participation in meetings? We believe so." The folks at Narcotics Anonymous believe that to be allowed to speak at one of their meetings; one has to be free from taking any substances. They state that they will not turn anyone away; however, they are only to participate only by listening and by talking with members after the meeting or during the break. They say it is not meant to alienate or embarrass, but it does. They go on to say that someone who is under the influence of drugs who speaks out at a meeting will only be met with confusions and mixed messages. (9)

To groups such as Narcotics Anonymous, they view the methadone patient as an addict. After all, they are physically and mentally dependant on a substance. Who cares that the person on Medication Assisted Treatment does not partake in illegal activities to support their habit? Who cares that the person partaking in MAT holds a job and is a viable member of society? To groups like Narcotics Anonymous, they are still morally inferior.

In Russia, speaking of Methadone can land you in jail. The New York Times posted an article demonstrating said fact. Dr. Ivanets, a Russian opponent said that a group of doctors holding a pro-methadone conference were a "group of dissenters." They also go on to say the Methadone entraps patients in lifelong addiction, and they accuse Western countries of pushing the treatment on Russia for commercial gain. Antagonists call methadone a "dead end." The preferred method of opiate addiction assistance is to give sedatives and painkillers to cope with withdrawal symptoms. To which clients are then released after a month or two with the expectation that they will remain clean, which rarely occurs. (10)

WHAT DOES IT ALL MEAN?

So, with all of these people who are for and against Medication Assisted Treatments, who is to say who is right. I chose to turn to my mother Ms. Lacey Norris for guidance. She has seventeen years experience in the area of Substance Abuse. She obtained her Master's Degree in Agency Counseling from the University of Northern Colorado, has a CAC-III (Certified Addictions Counselor) license, and is also the author of the short novel Memoirs of a Methadone Mama. I felt that she would make the perfect candidate to question as she is both experienced and educated on the subject, not to mention that is a caring and compassionate person who truly knows what seems to work best for the client.

So I ask Lacey, what's the deal with Methadone? Is it decent or is it dangerous? Ms. Norris' reply was all too simple yet precise. She states: "Methadone isn't bad or good. Methadone just is." As she states in her book, Memoirs of a Methadone Mama:

"If you believe that a drug is a drug then you will not see

using methadone to stop the use of a narcotic as a success.

I think if the person's lifestyle has improved, they are clean

from illicit drugs, and are not partaking in said lifestyle,

and then they ARE a success." (11)

You said it, Ma!

LIST OF WORKS CITED/ENDNOTES

1. PBS Frontline. The Opium Kings: Opium throughout History. 1998. Web. 13 April 2010.

2. Booth, Martin. Opium. A History. New York Times. 1996. Web. 13 April 2010.

3. Velten, Emmit. Myths About Methadone. National Alliance of Methadone Advocates. 1992. Web. 13 April 2010.

4. Department of Health and Human Services. IDU HIV Prevention: Methadone Maintenance Treatment. Web. 13. April 2010.

5. Walters, John P. Office of Drug Control Policy. Methadone. 2000. 13 April 2010.

6. U.S. Food and Drug Administration. SAMHSA and FDA Join to Educate the Public on the Safe Use of Methadone. 2009. 13 April 2010.

7. Department of Health and Human Services. Introduction to Methadone. 2008. 13 April 2010.

8 Velten, Emmit. Myths About Methadone. National Alliance of Methadone Advocates. 1992. Web. 13 April 2010.

9 Narcotics Anonymous. Regarding Methadone and Other Drug Replacement Programs. 1996. 13 April 2010.

10 Schwirtz, Michael. Russia Scorns Methadone for Heroin Addiction. New York Times. 2008. 13 April 2010.

11 Norris, Lacy. Memoirs of a Methadone Mama. (Denver: Outskirts Press, 2009.), p.86