Does MMT just substitute one addictive drug
(such as, heroin) with another (methadone)?
Methadone Maintenance Treatment (MMT) is a form of drug replacement therapy, using
a medication (methadone) to overcome the compulsive need for other
opioid drugs (such as heroin or other abused opioids). While the person
is, indeed, physiologically dependent on methadone, the pharmacologic actions of
methadone are quite different from addictive opioid agents – methadone is not a
mere substitute.
An analogy is how prescribed insulin is used as replacement or “substitution” therapy
in an individual with diabetes. The person remains “dependent” on insulin; however,
a chronic disease condition is kept under control and effectively managed by the
administration of a licensed, prescribed medication.
With adequate methadone, addictive behaviors cease. Persons on methadone may not
be “drug-free”; however, they are being helped to overcome the debilitating influence
of illicit opioids and lead more healthy, normal lives in recovery. It also is important
to note that the behavioral hallmarks of true addiction – such as unsuccessful efforts
to cut down on drug abuse, the endless search for
more drug, avoidance of obligations in pursuit of drug, and use despite personal
harm – are eliminated during MMT.
The many specific benefits of MMT overshadow any concerns about continued reliance
on the use of medication for treating the chronic, relapsing disease of opioid addiction.
Some people have discounted methadone as being nothing but a “crutch” for persons
who are too weak to become drug free. However, as Vincent Dole, MD – a developer
of MMT – once commented, “There’s absolutely nothing wrong with using crutches if
it helps the person get back on his feet and move forward in addiction recovery.
We need more crutches like that” [Personal communication to S. Leavitt, 1996].
Sources:
Goldsmith DS, Hunt DE, Lipton DS, Strug DL. Methadone folklore: believes about side
effects and their impact on treatment. Human Organization. 1984;43(4):330-339.