Fifty years ago, America was gripped by a heroin crisis. Addiction had risen rapidly after the second world war, and centred on New York City, where approximately half of the country’s heroin addicts lived.
Desperate for a solution, Rockefeller University pitched the use of an alternative opioid, methadone, as a way of helping heroin users off their drug.
The immediate upshot of methadone treatment was that heroin users no longer needed to commit crime to pay for their habit, as the methadone was administered under a treatment programme.
Methadone is also administered via oral liquid, removing the dangers of injection. By blocking the euphoric effect gained from heroin, but still replacing the physiological need for opiates, methadone was used to stabilise users until they could withdraw from opioid addiction completely.
Science News published an article in 1967 claiming that this treatment was “the answer to heroin addiction”, with all 200 heroin addicts on methadone treatment clean and not using heroin.
However, methadone isn’t a simple medicine that ‘cures’ the ills of heroin addiction.
As previously mentioned, methadone itself is an opioid, a compound related to heroin and morphine. Although the euphoric effect of heroin is reduced in methadone, it is still addictive and has a sedative effect when taken. Short-term side effects include nausea, vomiting, itchy skin, and restlessness.
Its use as a harm minimisation tool means that users swap their heroin for methadone, but then must still withdraw from their addiction. The use of methadone does not remove an addict’s physical addiction to opioids, or deal with the psychological reasons for their drug use.
Under a combined therapy supervised by addiction specialists and doctors, methadone can be administered safely and the dosage can be gradually tapered down.
However, some methadone users remain in limbo, taking a maintenance dose of methadone and yet unable to completely wean themselves off it.
Long-term use of methadone can lead to respiratory issues, as well as tolerance to its effects, with addicts escalating their dosages to have the same relief. Methadone abuse outside of medical supervision is an issue, and in 2013, an NHS Scotland review found almost as many deaths from methadone (216) as heroin use (221).
Socially, methadone treatment programmes have been criticised for managing the symptoms of heroin addicts without truly curing their addiction. In 2015, Scottish drug misuse expert Dr Neil McKeganey claimed the methadone program was “out of control” in Scotland, and a “black hole” into which heroin users were disappearing.
The alternatives to methadone treatment, such as intensive residential care in a rehabilitation facility, or the drug suboxone, are much more expensive.
Suboxone is an ‘improved’ opioid replacement over methadone, as it combines the opioid buprenorphine with naloxone, which prevents the effects of opioid overdose. However, much like methadone, it is considered a replacement programme and not a cure.
It is clear that the answers to drug addiction are complex and difficult, and Science News’ eager call for methadone as the answer to heroin addiction was, sadly, short-sighted.
Image: Josh Estey