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Methadone: Medicine or another addictive drug?

Zach Vance • Aug 1, 2016 at 12:00 AM

A fine line separates methadone’s treatment attributes and its deadly nature.

“The difference between appropriate prescribed doses and dangerous doses of methadone is small,” the Centers for Disease Control has published on its website.

Methadone was first synthesized 77 years ago, but the “substitute” medication is still perceived in contrasting ways by the public.

Whether deemed a savior or a monstrosity, it’s undeniable that methadone use has increased over the past 15 years.

And a gain in popularity means an increase in overdoses and diversion.

According to the CDC, six times as many people died of methadone overdoses in 2009 as did a decade before. Approximately 15,500 people died in 2009 from overdoses, and the CDC says methadone played a central role in the overdose “epidemic.”

“More than 30 percent of prescription painkiller deaths involve methadone, even though only 2 percent of painkiller prescriptions are for this drug,” the CDC’s website reads.

Methadone is referred to as a “full agonist,” which means it activates the opioid receptors in the brain resulting in the full opioid effect. Heroin, oxycodone, hydrocodone, morphine and opium are also classified as full agonists.

Stepping Stone of Boone’s Medical Director, Dr. Jana Burson, believes methadone can have tremendous benefits if administered correctly.

But she admits being skeptical at first.

“When I first started working, I wondered (about methadone). I never learned much about it (in medical school). I thought it was some kind of fringe area of medicine,” Burson said.

“But I came to find out there are over 50 years worth of studies that show the value of methadone treatment for opioid addicts. Anything from reducing HIV risk to reducing suicides.”

As the director of a clinic, Burson said she’s witnessed how methadone, combined with therapy, can repair an addict’s life.

“It’s neat because people do actually get better. You get to witness them get their life back,” Burson said.

The National Institute on Drug Abuse has concluded that methadone maintenance treatment is an effective treatment for heroin and prescription narcotics when measured by reductions of drug use, needle sharing, HIV infections, social health, suicide and lethal overdose.

Studies have also shown criminal behavior decrease after treatment of methadone, which is classified by law enforcement as a schedule II drug.

Research published in the International Journal of the Addictions in 1978 examined 100 heroin addicts for one year before admission to a methadone treatment program and one year after admission into a methadone program. The result was a decrease from 189 criminal charges before admission to 129 after admission.

Research in 2005 summarizing 52 studies and a total of 12,075 opioid-dependent participants found methadone treatment was more effective compared to other treatment regimens, like L-a-acetylmethadol (LAAM), heroin plus methadone and buprenorphine.

Another 2009 Canadian study published in the New England Journal of Medicine actually found quite the opposite.

Researchers found patients who took injectable diacetylmorphine, the active ingredient in heroin, were more likely to stay in treatment— as well as reduce their use of illicit drugs and other illegal activities—than patients who were assigned to oral methadone treatment.

The most common opioid addiction treatment currently in the Tri-Cities is prescribed buprenorphine, another semi-synthetic substitute.

Also known as Suboxone and Subutex, buprenorphine is less likely to cause overdoses and produces a lower level of physical dependance, according to Tennessee’s Department of Mental Health and Substance Abuse Services.

Buprenorphine is termed a “partial agonist,” which means it activates the opioid receptors in the brain, but to a lesser degree than methadone.

“Suboxone is just not strong enough for all patients,” Burson said. “There is never going to be one medicine to treat everybody.”

Similar to methadone, buprenorphine usage has also skyrocketed.

The Substance Abuse & Mental Health Service Administration lists 60 buprenorphine providers in the Johnson City area alone on its website. Data from TennCare showed Suboxone prescriptions increased by 200 percent between 2008 and 2013.

LAAM, another option to treat opioid addiction, LAAM, is no longer being prescribed by medical professionals.

LAAM, known as Orlaam, was a synthetic opioid and a “second-line” therapy for patients who failed to show acceptable response to other treatments, according to the Food and Drug Administration.

Due to reports of severe cardiac-related adverse events caused by the medication, it was discontinued in 2003.

Email Zach Vance at zvance@johnsoncitypress.com. Follow Zach Vance on Twitter at @ZachVanceJCP. Like him on Facebook.com/ZachVanceJCP

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