Opioid Replacement Treatment
What are the benefits of Methadone Maintenance Treatment
The benefits of methadone as a component of a
comprehensive treatment program for opioid addiction
have been validated by dozens of clinical studies and
confirmed by numerous authorities in the addiction
treatment field. These include:
- A stable maintenance dose of methadone does not
make the patient feel either “high” or drowsy
(somnolent), so the person can socialize, work or go
to school, and generally carry on a normal life.
- Methadone can be taken orally once daily or in
split doses, helping to limit exposure to
injection-borne diseases like hepatitis and HIV.
- At adequate doses, methadone’s gradual,
long-lasting effects eliminate opioid withdrawal and
drug hunger or craving, unlike the rapid ups and
downs of short-acting opioids which lead to strong
desires for more drugs.
- Daily drug-seeking to “feed a habit” becomes
unnecessary, and the euphoria-blocking effect of
cross-tolerance makes other opioids undesirable.
- Once a stable dose is reached, there is little
change in tolerance to the therapeutic effects of
methadone, so it does not take increasingly more of
the medication to achieve the same results.
- When properly prescribed by an experienced
practitioner, methadone has a favorable safety
profile with minimal side effects.
How is success in MMT measured?
The broad goal of methadone maintenance treatment (MMT)
is to help opioid-dependent persons cease their use of
heroin and/or other abused opioids and lead more stable,
productive lives in recovery. However, good MMT programs
strive to help patients achieve many more specific
- Patients are encouraged to abstain from all addictive
substances – including alcohol, cocaine and other
stimulants, marijuana, and others
- The misuse of prescribed medications is discouraged
- Patients are expected to decrease and avoid criminal
behavior of any sort, and MMT program staff help resolve
current difficulties with the criminal justice system
- MMT medical staff help patients attend to health
matters, especially those possibly related to past drug use,
such as HIV/AIDS, hepatitis, and tuberculosis
- MMT staff identify and treat mental health problems that
might have contributed to or resulted from substance abuse
- Patient educational development and employability are
stressed and assistance is provided
- Program staff work with patients and their families to
resolve relationship difficulties, child care concerns, and
Attending to all of those
issues is a tall order and usually takes months or years
to accomplish. Addiction recovery in MMT is an ongoing
process, often moving forward in small steps at a time.
Methadone, itself, is only a medication that helps get
the hard work toward recovery started; the rest depends
on the motivation of the patient in cooperating with
program staff and making the many life changes necessary
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.”
Is heroin the only drug for which methadone maintenance
is a treatment?
Methadone, given on a daily basis as part of a
comprehensive recovery program, may be useful for
treating addiction to any opioid drug. This class of
drugs includes those made from the opium poppy, like
heroin, morphine, or opium itself – these are often
called “opiates.” Other opioids are made synthetically,
like oxycodone (Percocet ®), hydromorphone (Dilaudid ®),
hydrocodone (Vicodin ®), codeine, and others.
All of the opioids work on similar areas in the brain,
called mu-opioid receptors. Methadone, which is a
synthetic and very long-lasting opioid, works in those same brain areas, occupying the receptors so completely
that it blocks the effects of other opioids. In this
way, methadone prevents opioid withdrawal symptoms and
reduces drug craving. To do this, methadone only has to
be taken once a day, every day – called methadone
maintenance treatment or MMT – and, at the proper dose,
it does not make the person feel “high” or drugged. So,
the person can lead a more normal and healthier life.
MMT is not intended for
treating addiction to non-opioid drugs, such as cocaine,
alcohol, marijuana, or others. In fact, taking those
other substances of abuse while in methadone treatment
can hinder the person’s progress in recovery. However,
research has demonstrated that the majority of patients
receiving adequate methadone doses decrease or eliminate
their use of other psychoactive substances. Counseling
and psychosocial therapy, including participation in
12-Step groups, provide important treatments for dealing
with the problems of other drug and alcohol abuse.
Long-term retention in MMT also is vital for allowing
enough time for such approaches to exert their
How long does a patient need to stay in MMT?
Time in treatment is a critical factor for ongoing
addiction recovery. Typically, methadone-maintained
patients must attend a treatment program each day to
receive their oral dose of methadone; however, stable
and compliant patients are usually allowed to eventually
take home a number of doses, thus reducing their clinic
visits. Appropriate psychosocial therapy and other
support services are integral components of ongoing MMT.
Credible and authoritative
sources have concluded that patients treated for fewer
than 3 months in MMT generally show little or no
improvement. Studies have routinely demonstrated
reductions in illicit opioid use of up to 80% or more
after several months, with the greatest reductions for
patients who remain in treatment more than a year.
Patients often require MMT indefinitely, as would be
expected with any chronic medical condition. Once a
patient has been stabilized on MMT, withdrawal from
methadone carries substantial risks. Virtually all who
abandon MMT and do not pursue further recovery treatment
of some sort eventually relapse and potentially
How can I get off of methadone?
Since methadone creates a physical dependency on the
drug, stopping it abruptly (e.g., “cold turkey”) would
lead to intense withdrawal symptoms and drug craving.
The accepted way of discontinuing methadone is called
medically supervised withdrawal (MSW). Its main
objective is to relieve or prevent uncomfortable
withdrawal symptoms and craving while the patient
gradually achieves an opioid-free state.
During MSW – sometimes erroneously called “detox” – the
daily dose of methadone is decreased by small amounts
over time, taking many weeks or months. This should only
be done under the care of a doctor, and only after
discussing the reasons for wanting to discontinue
methadone and considering ongoing treatment
alternatives. Relatively few persons who withdraw from
methadone or other opioids, and who do not continue in
some form of addiction treatment program, stay drug-free
for any extended length of time.
A more rapid form of
withdrawal, taking only hours, requires that the person
first be put completely to sleep (under general
anesthesia) in order to tolerate the otherwise severe
withdrawal symptoms, and then certain medications are
used to purge the body of methadone or other opioids.
This method is expensive and still undergoing study in
terms of its safety and long-lasting benefits. Many, if
not most, persons undergoing this treatment have
eventually returned to illicit-opioid abuse (relapsed).
Why is methadone harder to “kick” than heroin?
Surveys have found that substantial numbers of MMT
patients are concerned about difficulties in withdrawing
from methadone, claiming it is harder to “kick” than
heroin. However, this is a persistent myth that was long
A blind comparison study years ago at a federal facility
for addiction treatment in Lexington, Kentucky, found
that withdrawal symptoms actually were less severe in
patients maintained on methadone than in those taking
equivalent doses of short-acting opioids like heroin.
Because it is long-acting, withdrawal from methadone
does last much longer than withdrawal from short-acting
opioids. Therefore, a person who has experienced “cold
turkey” withdrawal separately from heroin and methadone
might say that “kicking” methadone was worse – because
it lasted longer. This is one way the myth might have
started and it ignores the fact that methadone
withdrawal should never be done “cold turkey” to begin
However, gradual withdrawal from methadone, when
properly done under medical supervision, can be
virtually free of discomfort. On the other hand,
patients who try to withdraw from methadone by
themselves, on their own time and dose schedule, almost
always experience undue discomfort and fail.
Also, some patients forget
that the reason they came into MMT was because they
could not stay away from opioid drugs on their own. When
they decide to leave MMT and find they cannot just stop
taking methadone, they blame the methadone rather than
the heroin or other opioids that deranged their brain
chemistry in the first place. For many former illicit-opioid-addicted
persons, methadone is a lifelong medication necessary
for stabilizing brain function, much like a person with
diabetes needs insulin every day to live a normal life.
Are there any alternative treatments for Opiate
YES, Buprenorphine was approved by the FDA in 2002 as
the first medication for treating opioid dependence
available for use in office-based settings through
implementation of DATA 2000 and through opioid treatment
programs. Multiple studies have shown that Buprenorphine
is a safe and effective alternative to methadone for
managing opioid dependence, and is a particularly
effective option for patients with prior, not current,
How does an agency become a certified provider for
Community providers who are interested in becoming
certified for prevention services should contact the
Office of Prevention Services to obtain basic information on the
standards and credentials required for certification.
Is it a requirement to be a certified agency to
receive funding from the Division of Mental Health and Substance
Yes. Other funding sources within the state currently
do not require certification.
What kinds of Prevention programs are funded by the
Division of Mental Health and Substance Abuse Services?
The majority of prevention programs currently funded
are Universal prevention programs. Future programs will
need to assess the needs for Selective and Indicated
programs. Communities may also need Environmental
strategies and applicable policy and practice changes to
alleviate substance abuse issues.
Where are Prevention programs located?
A prevention directory of certified providers may be
obtained through the MHSA receptionist or the
How may I obtain Prevention materials (brochures,
videos, government publications, paraphernalia) on
Two clearinghouses within the state are available for
the public and community providers. The North Regional
Information Clearinghouse in Anniston 256-237-8131 and
the Drug Education Council 251-478-7855 in Mobile is
the South Regional Information Clearinghouse. These
services are offered at no cost to the consumer.
How does an individual become credentialed in
ADA is the primary contact for individuals to attain
Prevention credentials. The contact number is
256-796-4490. Additionally, individuals are required to
have twenty (20) hours of continuing education per year.
How may I obtain information on National resources
for Prevention activities?
The following websites will be of help:
Adolescent RFP FAQs