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Methadone, a synthetic narcotic with a suppression effect lasting 24 to 36 hours, is the most effective medication to help heroin patients overcome their addiction. Methadone maintenance treatment (MMT) rapidly expanded following its demonstration as an effective medical intervention in the mid-1960s. In the United States, there are 500,000-1 million heroin users, with about 180,000 (about 18 to 36 percent) enrolled in MMT. Nevertheless, an array of controversial issues surrounds this treatment at the clinical, community, and governmental levels.

Principal benefits of methadone are its reduction of cravings for heroin, blockage of such narcotic effects as euphoria, and reduction of withdrawal symptoms. Unfortunately, most who withdraw from methadone return to using heroin. Proper dosage is crucial for retaining patients in treatment. While a dosage of 80 milligrams (mg) per day leads to higher retention rates, many clinics administer an average daily dose of 59 mg, the lower end of the therapeutic range.

Since 1964, in monitoring MMT for medical safety, researchers have noted minor and usually short-term side effects in the initial stages of treatment initiation, such as increased perspiration and constipation. In most cases, length of treatment correlates with improved health of patients. MMT participation also reduces risk for HIV and can be a supplementary source of pain management for cancer patients. In tests of intellectual functioning and perceptual motor skills, methadone patients' results fall into the normal range.

At the community level, the effects of MMT vary. For example, MMT admissions correspond with reductions in drug-related property crime, arrests, hepatitis, and deaths. Yet, community opposition has contributed to blocking the expansion of MMT. A principal concern is the diversion of methadone from patients to a street market, which often seriously affects a neighborhood's quality of life. The reasons for the street market in methadone range from patients' economic motivations to the need of heroin-addicted people to maintain themselves outside of a program when none is available and/or heroin is scarce or unaffordable.

The federal and state governments set regulations for MMT and the criteria for admission. Studies demonstrate that the layers of regulatory bureaucracy, which also sometimes include municipal agencies, impede the expansion, accessibility, and improvement of MMT. The traditional treatment model consists of community-based clinics to which a patient must report daily. Observed by a nurse, patients drink their prescribed dose. Patients who demonstrate compliance, including submission of a minimum of eight urine samples a year free of heroin, eventually get assigned to a reduced schedule in which they report once a week and receive six takehome doses. There have been widespread and deepening criticisms about the disproportion of resources directed toward program regulation at the expense of enhanced treatment services, such as integration of relevant social, medical, and psychological services. This has resulted in a movement toward diversification of program models. Increasingly, patients now get a range of treatment options, including MMT primary care facilities and office-based practices of a physician.

Bibliography:

1) Joseph, Herman, Sharon Stancliff, and John Langrod. 2000. "Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues." Mount Sinai Journal of Medicine 67:347-64.

2) "NIH Consensus Conference: Effective Medical Treatment of Opitate Addiction." 1998. Journal of the American Medical Association 280:1936-43.

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