On July 10, 2015 the Centers for Disease Control (CDC) released Morbidity and Mortality Weekly Report (MMWR) on the Heroin epidemic that is sweeping the United States. By the standard of the Internet, this is old news by now but I’m just getting around to writing about it. And the report identifies critical information the public—and public officials—need to be aware of so the more publicity the better.
The big finding from the report is that heroin use has increased overall by 63% between 2002 and 2013 and amongst virtually all demographics regardless of gender, ethnicity, or socioeconomic status.
Even more striking is heroin deaths have quadrupled between 2002-2013.
Nearly all heroin users have also used at least 1 other drug.
As confirmed by many other reports, abuse of prescription opioid painkillers increases your risk of heroin use 40X! And 45% of heroin users are also addicted to opioid pain medication.
The report offers several viable responses that should be taken to curb the heroin epidemic:
Prevent: prevent and reduce abuse of prescription opioid painkillers
Reduce: increase the availability of medication-assisted treatment (MAT), which combines proven, effective medications such as methadone and buprenorphine with counseling and behavioral therapies
Reverse: expand the use of the naloxone to prevent heroin overdose
Above all, increased education and awareness of the heroin epidemic and medications available to treat addiction (methadone, buprenorphine) and prevent overdoses (naloxone)
The report also argues that states must play a key role in addressing this epidemic through such measures as implementation/expansion of prescription drug monitoring programs, significantly increased availability and access to MAT and naloxone, improved educational programs, and other measures.
I hate to be condescending but how the scientific community perceives a phenomena and how the public at large perceive the exact same thing can be starkly different.
For example, there is still a debate over the scientific legitimacy of global warming and climate change. Of course, this flies in the face of reality. In the scientific community, there is no more doubt over climate change than there is over heliocentricity (the theory that states the Earth revolves around the Sun). Study after study comes to the came conclusion, the scientific evidence is overwhelmingly in favor. But I’m not writing to debate climate change.
The same type of dichotomy exists for replacement/maintenance therapies for addiction. Methadone and the related compound buprenorphine (Suboxone, one of its formulations) are still considered controversial or ineffective or “replacing one drug for another.”
In brief, methadone is a compound that acts on the same target as heroin (the mu opioid receptor) but unlike heroin, it acts for a very long time (24hrs). Dr. Vincent Dole, a doctor at the Rockefeller University in New York, and his colleague, Dr. Marie Nyswander, had the brilliant idea of using this very long-acting opioid compound as a way of treating heroin addiction. Indeed, methadone has the advantage of not producing the intense, pleasurable high that heroin produces but is still effective at curbing cravings for heroin and eliminating withdrawal symptoms. Dole and Nyswander published their first study in 1967 and methadone has been an approved—and effective—treatment for heroin addiction worldwide ever since.
However, controversy over the use of methadone exists. Even the opening of a methadone clinic can incite protests. The persistence of negative attitudes towards methadone and the stigma against treating addiction as a medical disease has prevented addicts from receiving proven medical treatments that are effective at curbing cravings and actually keeping them off of heroin and in treatment programs.
So just for a moment, let’s suspend our preconceived notions about what methadone is or how it works and let’s just ask our selves two simple questions:
Does methadone work?
Does methadone keep addicts off of heroin and in treatment?
The answer is a resounding YES!
Many controlled, clinical studies have examined the effectiveness of methadone. But a comprehensive comparison of methadone versus control, non-medication based treatments has not been considered amongst the various studies.
Researchers at the Cochrane Library performed this type of comprehensive analysis. Data was considered from 14 unique, previous clinical studies conducted over the past 40 years. Researchers compared methadone treatment versus control, non-medication based treatment approaches (placebo medication, withdrawal or detoxification, drug-free rehabilitation clinics, no treatment, or waitlist).
11 studies and 1,969 subjects were included in their final analysis.
The results were clear. Methadone was found to keep people off of heroin and in treatment more effectively than control treatments. Urine analysis confirmed methadone-treated addicts were more likely to be heroin-free and regularly seeking treatment.
Of course, as I stated above, this is nothing new. But it’s important to note that abstinence therapies or treatments that encourage addicts to go “cold turkey” don’t really work; inevitably, relapse will occur. A medical treatment exists to help addicts fight their cravings so their brains are not fixated on obtaining heroin and these people are able to regain normal daily functions. And in time, methadone doses can be tapered down as intensity and frequency of cravings decrease.
The debate now should not be on whether methadone works, but on how to use it effectively and how to expand its use so that as many people as possible can benefit from it.
Most importantly, methadone helps an addict to return to normal life. End of story.