Essay Sample on Methadone Maintenance Treatment

Since its first introduction in 1965 by Nyslander and Dole, almost 1.5 million people all over the world have been treated with methadone, and the efficacy and safety of methadone has been well established (Wolff & Hay, 1994). The most substantial benefits of methadone are such as a decrease in criminal behaviors, as estimated by self-reports and arrest records, as well as an increase in employment status which range from 40 percent to 80 percent in patients engaged in methadone maintenance programs (Ball & Ross, 2012). Methadone maintenance has proved useful regarding reducing general medical morbidity, minimizing mortality and improving social functioning.

Various studies have supported the expediency of methadone maintenance programs in reducing the likelihood of HIV transmission among intravenous drug users. However, methadone maintenance has not been shown to be effective in achieving abstinence from opiates. Long-term follow-up studies of discharged patients from methadone maintenance program indicate that just about 10-20 percent of patients are abstinent at 3-5 years after discharge (Zaric, Barnett, & Brandeau, 2000).

There is not a single dose of methadone that is optimal for every patient. Even though 40-60 mg/day of methadone is often sufficient to block opioid withdrawal symptoms, high dosage were found to be associated with longer treatment retention, reduced consumption of illicit drugs and reduced incidences of HIV infection. Among patients who received at least 71mg/day of methadone, heroin was never detected. This in contrary with patients who receive a dosage of 46 mg/day of methadone or lower, who were highly likely to abuse illicit opiates compared to those receiving higher dosage.

Different observations made by Strang & Sheridan, (1998) from Maudsley Hospital, London suggested that flexible dosage regimens were associated with better rates of retention and an overall successful outcome. They gave recommendations that clinicians should not hesitate to make the choice of temporarily increasing the dosage of methadone to assist a patient in coping with stressful life occurrences.

The purpose of psychosocial interventions in improving responses to methadone maintenance treatment has been underscored by the results of different observations. McClellan et al., (1993) compared three levels of treatment services where every patient received at least 60mg of methadone. The three levels of treatment included standard methadone services, minimum methadone services, and enhanced methadone services. The enhanced services group showed the best results as noted by few positive urine tests for licit drug consumption and generalized improvement in psychosocial functioning.

Methadone, used as a less harmful but still addictive opioid, is occasionally substituted for heroin in drug treatment, with the rates of success ranging from 60 and 70 percent in some treatment centers. In fact, patients with opiate dependence and chronic psychosis fare better with methadone maintenance in contrast to treatment regimens involving detoxification and total assistance. However, methadone maintenance is still controversial since it involves drug-seeking behavior, blocking symptoms of opiate withdrawal, and stabilizing an individuals mood. The time of methadone treatment often range from 180 days to several years, or methadone maintenance can last indefinitely.

According to the reports by Farrell, Ward, Mattick, Hall, Stimson, Des Jarlais, & Strang (1994), people who misuse opioids benefit more from methadone maintenance when it is provided in combination with psychosocial interventions. This combination results in great improvement as measured by reduced family issues, decreased drug consumption, less psychiatric symptoms and increased rates of employment.

References

Ball, J. C., & Ross, A. (2012). The effectiveness of methadone maintenance treatment: patients, programs, services, and outcome. Springer Science & Business Media.

Farrell, M., Ward, J., Mattick, R., Hall, W., Stimson, G. V., Des Jarlais, D., ... & Strang, J. (1994). Methadone maintenance treatment in opiate dependence: a review. BMJ: British Medical Journal, 309(6960), 997.

Wolff, K., & Hay, A. W. M. (1994). Plasma methadone monitoring with methadone maintenance treatment. Drug and alcohol dependence, 36(1), 69-71.

Zaric, G. S., Barnett, P. G., & Brandeau, M. L. (2000). HIV transmission and the cost-effectiveness of methadone maintenance. American Journal of Public Health, 90(7), 1100.

McLellan, A. T., Grissom, G. R., Brill, P., Durell, J., Metzger, D. S., & O'Brien, C. P. (1993). Private substance abuse treatments: Are some programs more effective than others?. Journal of Substance Abuse Treatment, 10(3), 243-254.

Strang, J., & Sheridan, J. (1998). Effect of government recommendations on methadone prescribing in south east England: comparison of 1995 and 1997 surveys. Bmj, 317(7171), 1489-1490.