Methadone still tugs at emotions

Maybe it was because I was days away from preparing to attend the largest national gathering of executives from opioid treatment programs (OTPs), but a mid-March press release about methadone from Novus Medical Detox really caught my eye. The comments from the New Port Richey, Fla., facility certainly stood in sharp contrast to the tone of the discussions I would expect to hear a couple of weeks later, at the American Association for the Treatment of Opioid Dependence (AATOD) meeting.

“Beyond methadone's association with addiction, health risks and potentially fatal overdoses, patients prescribed the drug may also experience discrimination in the workplace,” the March 12 press release reads. “Even with a legitimate prescription, methadone often carries a substance abuse stigma or perceived occupational-safety risk.”

Novus's own website delivers an even sharper message. The heading for the website's description of the Joint Commission-accredited facility's methadone detox services reads, “Methadone Ruins Lives—Get Yours Back.”

I decided to contact Novus executive director Kent Runyon, asking him if he was concerned that this messaging could further stigmatize addiction—as well as the many individuals who have benefited from high-quality methadone treatment services. Runyon replied that he can understand the diverse perspectives that prevail on these topics, but he added that Novus continues to see a considerable number of patients who began a daily course of methadone for opioid addiction but ended up feeling somewhat misled by program professionals.

“They felt inadequately informed and educated about the challenges of methadone, and how difficult it would be to get off methadone,” says Runyon. “I see the ones whose tolerance and use level have increased, and no one seems to have had an interest in or ability to taper them down.”

Business has been brisk at Novus, which recently expanded to a capacity of 31 beds (I visited the Florida facility three years ago when it was a considerably smaller operation). A high percentage of its detox patients are seeking methadone detox (some have been in an OTP, while others may have been taking methadone to treat pain), says Runyon. A typical length of stay for methadone detox is around 12 days, he says.

Runyon points out, “I don't throw every methadone clinic in the same box,” but adds that too often he sees current or former OTP patients and wonders, “How did this person get this high a dose?” He says he now sees a similar pattern emerging with dosing of buprenorphine, which he says also presents a challenging detox.

“I recognize that addiction and dependency are highly complicated,” says Runyon, and he personally sees methadone as having a potentially beneficial harm reduction role for patients who cannot succeed at the outset in abstinence-based treatment. But he adds, “Let's look at methadone maintenance as Plan B. To talk about why you're using the drugs in the first place should be Plan A. I think that too frequently methadone becomes Plan A.”

Methadone has been one of the most highly stigmatized treatments in the addiction toolbox, and comments about methadone-related deaths need to be placed in the proper context because comparatively few of these occur among OTP patients. But where and how do you believe methadone best fits in the treatment equation? Share with us your treatment provider's perspective about methadone.