Let's Stop The Insanity

by Anthony Scro

Anthony Scro is a NAMA volunteer, founder of the NAMA affiliate Association for the Betterment of Addiction Treatment and Education (ABATE) and has been a methadone advocate for over 20 years.

It goes on and on. It seems like it may never end. We've all heard the same questions. Suffered the same humiliation. "When are you going to get off that stuff?" "Why do you need that much?" "Don't you want to detox or, at least, come down a little?" "Do you plan to be a methadonian for the rest of your life?" "How in God's name can you let that baby be born addicted to that poison?"

It seems incredible to me that the medication methadone, the primary means of effectively treating opiate addiction recognized by physicians, governments and countries all over the world, is as misunderstood now as it was when it was first introduced as a treatment regimen in the 1960s. In the "old" days, I naively believed that intolerant attitudes and controversies surrounding dose levels, length of treatment, take home policies and pregnancy would gradually dissipate due to a combination of education, documentation of positive results and the mere passage of time. Unfortunately, this enlightenment has not taken place. Rather, it has intensified to a point defying both reason and scientific reality. After many discussions over the years with advocates and critics of methadone, I am simply at a loss to explain a phenomenon whereby a drug with proven efficacy is so emotionally and unfairly criticized. I can only conclude that those suffering from this fear of methadone and/or hatred of methadone patients simply because they choose a certain form of treatment, have developed a diagnosable mental disorder which I call methaphobia. This condition, if not treated can be dangerous to your health and the health of methadone patients.

In past years, many of the judgmental statements and stigmatizing philosophies about methadone served to make patients feel "bad" about what they should be feeling "good" about. That was damaging enough. But today the stakes are much higher. In light of the therapeutic use of methadone in the fight against HIV/AIDS; it has been found that methadone works as a true HIV prophylaxis if a former injecting user follows the medically prescribed treatment plan and practices safer sex behavior. "Methaphobic" attitudes can be deadly, can actually cost lives if an opiate user is denied access to methadone simply because someone does not like the treatment method. Here are some recommendations for the treatment of "methaphobia", specifically addressed to those working in programs.

Take ownership of your attitudes. Accept them as yours and no one else's. Even if you do not wish to change them, take care not to transfer them onto your patients who rely on your objective guidance.
Be open to the information about methadone. Read some of the reports, studies and findings. For example, a December, 1994 report released by the Institute of Medicine, an arm of the National Academy of Science, made these recommendations among others.
Physicians should be allowed to prescribe whatever dose of methadone is necessary for individual patients.
Methadone patients should be allowed to continue treatment if they are hospitalized.
Physicians should decide if addicts are appropriate methadone candidates, how long to administer the drug, and when patients can take methadone at home instead of in a clinic.
Pregnant addicts should be quickly treated with a full course of methadone, as there is no evidence that methadone is toxic to the fetus, while heroin is. Editor's Note: Withdrawal from heroin is contraindicated for pregnant addicts especially during certain periods of fetal development.
Listen to your patients. Ask her/him what they need to be productive. After all, whose recovery is it anyway? Treat her/him more like a consumer, and strive to attain a high level of consumer satisfaction.
Learn to appreciate success measured by positive outcomes. Don't get hung up or locked into a dose level, a mere number. The only number that counts is the one that eliminates opiates. By satisfying the physical needs of the patient, the climate is then established for the application of all the valuable supportive services.
Don't force pregnant women out of treatment. It is tragic to think that an expectant female, otherwise motivated for change, would be forced to resort to street heroin by virtue of an inappropriately ordered withdrawal from methadone, thereby exposing herself and the unborn child to harmful behavior. Entire families are dying. It is critical that there is continuity of care during the pregnancy period.
Finally, let's end the madness by signing our own "Contract" to work together with a wonderful tool (methadone treatment) to save lives.