Methadone Clinics: Higher Power's Answer

I will not confirm or deny if I have ever worked for methadone clinics, but I will say that through college and other environments I have developed many close friends who work at methadone clinics, and that my education and experience makes my opinion about them far more informed than most who have opinions on this subject.

Here's my opinion: Methadone Clinics are the most effective form of treatment for addiction known to mankind.  Do you doubt? Check out the scientific research on the subject.

Why do methadone clinics work? The following is my opinion, but I am sure there are many researchers who agree with me on some of my theory here:

1. As outpatient programs, they allow patients to change their lives outside of treatment, so that they can alter the social network they depend on to survive. This takes time. In all cases it takes chemical dependency counseling. In other cases group therapy or classes will help. In some cases mental health counseling is required. It takes a lot more than the 30 days that most inpatient programs provide (and of course patients can't change their social network locked up in an inpatient program or jail.)
2. Methadone has special properties that make it ideal for addiction recovery. It has a long half-life, meaning that it stays in the patient's system longer than other opiates. They only need to take this medicine once per day in most cases, and then even if they do miss a day most patients will not have severe withdrawal symptoms for 48 hours. This means that the LIFESTYLE of methadone is very different from opiate abuse, because methadone isn't a drug they use to get high, it is a medication they take that helps the patient with a specific medical condition they have (opiate dependency.)
3. Used as prescribed by a methadone clinic, methadone does not give an instant high, it acts very slowly to prevent withdrawal, but too slowly to satisfy the need to have instant gratification for a drug abuse habit.
4. The dirty secret people want to avoid talking about is though the withdrawal symptoms from other opiates and methadone is about the same, withdrawal from methadone lasts about ten times longer. So on one hand the patient has a carrot: when they do as the counselors say, they continue to get methadone which massively cuts down on their opiate abuse bill. On the other hand, if they don't make a serious effort to getting into recovery, the methadone clinic has a stick: the dreaded methadone detox.
5. Methadone clinics are an act of social engineering. When the methadone clinic reaches this far and deep into someone personal biology and social network, just changing things this deeply for one patient can have a huge impact on that patient's workplace, family, friends, and so on, for the better. Now multiply that effect by how many patients that clinic has as the years go by. The end result is the hopeless dregs of humanity are recycled into pillars of the community. It's this big picture effect that makes methadone clinics transform entire communities. Opiate abuse is a public health hazard, and a methadone clinic is a public health solution.

But isn't this just replacing one drug for another? No, because as I have stated above, methadone is quite unlike other opiates.

Isn't methadone just another pain medication, and thus isn't a methadone clinic just another pain clinic? Methadone clinics have always discouraged the prescription of methadone by people not working at methadone clinics. For the reasons mentioned above (2-4,) it is an incredibly bad medication for managing pain. Pain clinics may be compared to methadone clinics once they take the following precautions that methadone clinics also take:

1. Mandatory monthly random drug testing of patients.
2. Taking biometrics to be certain the incoming patient is experiencing physical withdrawal before they can become a patient at the methadone clinic.
3. Mandatory chemical dependency counseling and education for the patient.

Don't methadone clinic patients frequently relapse? All chemical dependency patients frequently relapse. Relapse is a learning process where patients figure out what does NOT work for their recovery. Some think it is an important part of developing the skills they need to get into full recovery. 

You have heard of nicotine gum, patches, vapers, etc. that people use as nicotine replacement therapy to stop smoking. That is how methadone clinics use methadone (in addition to mandatory counseling,) except for instead of quitting smoking they are quitting opiate abuse:

1. Just because someone on nicotine gum slips and smokes a cigarette doesn't mean they should give up on the gum. However they will need to learn from their slip up and make changes accordingly if they are to quit smoking. Same thing goes for getting into recovery long term, slip ups are likely to happen, but they are exactly how the patient - with counseling - can figure out how to quit.
2. As people try to quit smoking with nicotine replacement, they smoke a lot less cigarettes, and that is very good for them. When patients use their medicine prescribed by a methadone clinic, they use a lot less street drugs, which means less fatal overdoses, less criminal activity, less shared needles, and so on.
3. If a person permanently goes on to nicotine gum, and can't ever kick the gum habit, the health consequences of this nicotine gum addiction compared to continued smoking are laughably inconsequential. Likewise, if a person becomes a life long patient to a methadone clinic, the health consequences of this are laughable in the face of the health consequences of continued opiate abuse.

How can I say that methadone clinics are the most effective treatment against chemical dependency in general when they are focused only on opiate addiction? Remember the part were the methadone clinic does random drug testing on patients: they test for all the big name street drugs, AND alcohol, AND some stuff you probably haven't heard of before. The chemical dependency counseling MANDATED by methadone clinics addresses all chemical dependency addiction, not only opiates. This is because drug use is a compound problem where most drug abusers do not only use one drug. To understand this you need to know how they classify drugs to see how their use is connected:

1. Hallucinogenics: these make you see the world differently. The most common legal one is tobacco, and the most popular one is marijuana. It also includes magic mushrooms, LSD, PCP, XTC and so on. These are the drugs people take to "go on a trip," like a smoker going out for a smoke break to escape reality for a few moments. Compared to uppers and downers, hallucinogenics are not very addictive.
2. Uppers: these give you more energy. The most common legal one is Coffee (caffeine), and the most popular one is crystal meth. It also includes Ritalin, bath salts and cocaine. When people use coffee at work to get a burst of energy, they are using an upper. Uppers are very addictive.
3. Downers: they help you relax and chill out. The most common legal one is alcohol, and the most popular one is pharmaceutical pain pills. It also includes opium, heroine, and anti-anxiety medications. Downers are even more addictive than uppers, and can have fatal withdrawal symptoms, unlike hallucinogenics and uppers.

Typically what you will find is that when someone is abusing drugs, they are using them in the same way that regular people might use tobacco, alcohol and coffee. When a normal worker might go out for a smoke break, your drug abuser may instead get completely baked with a joint. When a normal person might reach for a cup of coffee, a drug abuser might shoot up some crystal meth. 

Now this last part of the story is critical: when a normal person might shake off the negative consequences of being strung out on coffee and cigarettes all day at work - which is to say that so they can go home and sleep soundly they first stop at the bar for a drink - a drug user may instead shoot up some black tar heroine. The following statement has become cliche for soccer moms across the USA "How can I get the kids ready for school, go to work, come home, clean, help them with their homework, take them to scouts or sports, feed them dinner and get them to bed, how can I do all that unless I use crystal meth? And if I use crystal meth, how can I get to sleep if I don't use heroine?"

You found a needle in the park, and you are concerned your community might have a crystal meth or heroine problem? Sorry friends, your community has a crystal meth AND a heroine problem, they are two sides of the same coin. The only side of the upper/downer cycle who's withdrawals can actually kill you is the downers. If you can treat the downer problem, you knock out a leg of a 2 legged problem. Furthermore, methadone clinics will exploit this strongest of the two legs to knock out the other leg through counseling the patients are forced to take seriously with both a stick and a carrot.

12 steps has worked for a lot of people, shouldn't we be turning to our higher power instead? If there is a God, certainly methadone clinics must be miracles. Many methadone clinic counselors encourage their patients to attend 12 step meetings, 12 steps can still be a very valuable part of recovery as long as they don't let the devil fuel their pride with the lie that says "replacement therapy is just trading one drug for another."

Is methadone associated with fatal overdoses? Again I am endorsing methadone clinics here, methadone is not in and of itself an addiction curing wonder drug. To understand how overdoses work, you don't have to read through very many news articles before you realize that they happen through taking multiple types of downers together. Methadone, anti-anxiety medication, and alcohol are not very likely to fatally overdose the user individually by themselves, but combine any two of them together and you have a very real overdose risk. If combining all three becomes a habit, fatal overdose actually becomes likely. This part of why methadone clinics do so much testing on their patients biology. To be clear, methadone clinics dramatically reduce the risk of fatal overdose for opiate abusers.

Considering that 1) methadone has more prolonged withdrawal symptoms, and considering that 2) methadone clinics bring many drug abusers together in one place where they can more easily reinforce each other's bad habits (as with 12 step programs,) do methadone clinics actually make it harder for drug abusers to quit? Look at these assumptions:

1. Once a person is using ONLY methadone, they are no longer in a cycle of getting a short term rush at the expense of long term well being, as described above. Their social network has changed adapted to their new lifestyle of no longer abusing prescription and street drugs. At that point, getting off methadone at a methadone clinic is a simple matter of the patient working with the professionals there to slowly detox from the methadone at the patient's own pace, on the patient's own terms. This makes relapse much less likely than quitting cold turkey. It is certainly much "easier" and likely than quitting cold turkey. (And over the years I have in fact met many "pillars of the community" who were "methadone clinic graduates.")
2. Bringing a community of drug abusers together in one place to get into recovery also helps spread good habits related to quitting drug abuse. For example, patients at methadone clinics must attend mandatory counseling sessions. If a patient is waiting at a bus stop with another patient, the patients can reinforce the good habit of attending these counseling sessions by relating positive experiences to each other which they have had with their individual counselors.

More importantly, by bringing a cross section of the drug abusing community in one place, there relationships can be studied up close by the methadone clinic. The professionals there start to understand how the entire drug abusing community works together. This information is very useful for those methadone clinic professionals systematically taking apart that community by helping individual patients move beyond that community. (Good luck getting that opportunity to study the active drug abusing community with a wall standing between chemical dependency professionals and the active drug abusing community, like what you have in a 30 day inpatient program or jail.)

Are other types of drug abuse treatment such as 12 steps or inpatient programs trivial? All established forms of drug abuse treatment are helpful. Certainly there are some drug abusers who have not stepped over the line into opiate abuse, and those drug abusers are by definition beyond the reach of methadone clinics. Any drug abuse treatment program that can help a drug abuser kick their habit before they get into sustained opiate abuse is very beneficial. However these programs need to be very fast to recommend methadone clinics to drug abusers who are discovered to have a significant opiate abuse problem, else those programs become an enabling part of those drug abusers avoidance of methadone clinics!

Will drug abusers learn better if we let them suffer the consequences of their actions? Three important points here:

1. First, many people get into opiate abuse because their doctors over prescribed pain medication, through no fault of the patient. That is a tragedy, not a "learning experience," we do not want people to learn to avoid doctors.
2. Let's apply this logic to other medical conditions. Should we quit treating smoking related illness because most smokers were not forced at gunpoint to start smoking? Should we quit treating obesity related diseases because their is some chance that the conditions could have be prevented through better self control? This leads us to my 3rd point:
3. "Just let them die" is not a mature way to approach this topic. If that is your joke, note that not only is it a point of dark humor, it is point of inappropriate humor in the face of the Hippocratic Oath.

Don't most heroine users quit using before they fatally overdose? Methadone clinics effectiveness is scientifically established. Contrast that to this quaint notion of "some heroine users stop on their own." Downers can replace each other, and many alcoholics are heroine users and vice versa. I am sure many heroine users avoid fatal withdrawal by replacing opiate abuse with alcohol abuse, leading to death from internal organ failure or drunk driving accidents. BUT THE BEST WAY TO CURE THESE ALCOHOLICS WAS PROBABLY TO GET THEM IN A METHADONE CLINIC WHEN THEY WERE USING HEROINE!

Will methadone clinics cause more problems in our community than they solve? No, it dramatically reduces crime in the community, while also socially re-engineering the community to be less drug abusing, as I have described above. The source of rumors to the contrary is a blight on the 12 step community and an example of how misinformation from the 12 step community is harming addicts. With adequate investment in Public Safety and Community Relations staff, I have seen crime near neighbors of one methadone clinic actually reduced during the hours the methadone clinic was open!