I am currently on a methadone program. This is the fourth time I have been on a methadone program. So, obviously, methadone treatment is not successful in at least some cases. The average period of success for methadone treatment is 17 months. Many people return to heroin use and abuse. Most information about services on this page is relevant only in Australia.
This page discusses:

• Advantages of methadone treatment


• Disadvantages of methadone treatment


• When should a treatment be considered successful?


• Methadone services


• What to do if you want to go on a methadone program


• Information Links


• Explaining methadone to kids

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Advantages and Disadvantages

Like any treatment, medication or just about anything in life, methadone has its pro's and cons. You will notice in the list below that some advantages are also disadvantages so, to some extent, whether a certain effect is good or bad can vary from person to person.

These are some of the advantages I have found with methadone treatment.

1. It is legal so the addict is not in danger of being arrested, is not at the mercy of ruthless (or desperate) dealers and can, theoretically, live a normal life. I say theoretically because although methadone is more acceptable to society at large than heroin, methadone users are still subject to substantial discrimination for the medication they take.



2. It is much cheaper. The addict does not have to base his/her whole life, every waking moment around the drug. On heroin you must find the money to score, score (which isn't always straight forward and can take hours leaving the addict quite sick before he/she gets something), and barely have time to enjoy whatever high you might get before the cycle starts again. In this destructive cycle eating and personal care are often forgotten.



3. The addict only needs to be dosed once a day, as opposed to two, three, four or more times a day on heroin. My preference on heroin was at least four times a day, if my habit wasn't too bad I could get by on two, but at the times when it was available I would shoot up every couple of hours, ten times a day would not be unusual.



4. It effectively reduces cravings if the dose is high enough. I lived in a brothel and mixed with my drug acquaintances while abstaining from heroin use for a month. I did eventually score, but a month in those circumstances is quite exceptional (especially for me, not noted for my willpower).



5. You have the opportunity to distance yourself from the whole scene and state of mind that sustains your addiction. This is much easier to do if you're not sick and craving. The addict no longer relies on drug contacts to get through the day. The potential is there to sever ties with other drug takers and with dealers. Since many addicts have most of their friends in drug taking circles this opportunity is often passed by.



6. Methadone treatment is considered one of the more 'successful' treatments. Although many patients stay on methadone for many years, their quality of life improves immeasurably and those that do attempt detoxification have a better chance at becoming abstinent than those undertaking other types of treatment.



7. Methadone treatment can be very flexible. According to your needs you can maintain yourself on it for years or you can taper down slowly or very quickly. (Aside: I was once told by a friend that because the physical side of heroin withdrawal takes only a few days, you can take methadone for those few days for relief then stop suddenly. You effectively have relieved the symptoms of heroin withdrawal, but have not been taking methadone long enough to have a methadone dependence. I did try this once: went on a methadone program and quit after a few days, but I was such a mess at the time I can't really say whether it helped or not.)



8. For those on maintenance, there is no 'high' from methadone. A methadone maintenance patient on the correct dosage can drive a car, operate machinery, won't nod off and is quite able to be a fully functional worker.



9. Methadone reduces the narcotic effects of heroin and other opiates. In other words, if you take heroin while you are on methadone you won't get as stoned; if your methadone dose is high enough, you won't feel the hit at all. This can be a very effective discouragement to taking other opiates - why waste your money if you can't feel it?



10. Methadone is taken orally, not intravenously. There is, therefore, no danger from blood-borne diseases such as HIV and hepatitis. No puncture marks, no collapsing veins.

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There are also disadvantages to methadone treatment:

1. There is no 'high' from methadone. The addict often misses this. The 'high' is the reason people start taking heroin in the first place and is always sought even when addiction and tolerance make it scarce. I occasionally have cravings to get stoned even on methadone and am tempted to score to achieve this on top of the methadone.



2. There are side effects. Some of the more common side effects are drowsiness, constipation, sweating, loss of sex drive, disturbed sleep, dental problems, weight gain; less common but still seen in a significant number of patients are vomiting and serious bowel problems. For me the most noticeable is sweating and constipation. Also on occasions I get drowsy. Methadone is also notorious for lowering libido. (Heroin is also reported to do this although, personally, I find the opposite.) It is not uncommon for the side effects to actually take a significant toll on the person's health, and to be severe enough to cause the person to discontinue treatment.



3. If an addict does take heroin while on methadone, the effect of the heroin is lessened or even completely wiped out. This has supposedly led to overdoses, the addict just keeps taking more and more heroin in the hope of getting stoned. Anti-methadone advocates cite this as a reason to ban methadone treatments - that a certain percentage of people who have died from heroin overdose also have methadone on board.



4. The oral administration of methadone can be a disadvantage for some. Many people are addicted to the process of injection itself. I'm sure there are specialist psychological arguments about the reasons for this: self mutilation, association with the drugs, the pleasure of pain, etc. Whatever the reason, it can be an issue. Some people try injecting the methadone anyway even with cordial or other contaminants in.



5. More a disadvantage with the regulations than the actual drug is that a methadone patient is effectively under 'medical arrest'. Your doctor becomes your probation/parole/police officer. If you want to go somewhere for more than a day or two, you have to tell them where, when, often why, etc. It also closes doors to most overseas destinations. Obviously if methadone treatment was brought into line with other medical treatments (eg. insulin, anti-depressants) and de-stigmatised, this would no longer be an issue.



6. In the event that the methadone patient wants to detox and become completely opiate free, methadone takes much longer to detox from than heroin. Either withdrawal has much the same symptoms but where the physical symptoms of heroin withdrawal are largely over in 4 days, methadone takes more like 3-6 weeks. The severity of the withdrawal symptoms can, however, be greatly reduced by gradually reducing the daily dose of methadone before attempting detox.

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When is a methadone treatment successful?

There are differing opinions on how to judge the 'success' of any treatment. For the 'drug-free-world' lobby, no treatment is successful unless the client becomes completely drug-free. Staying on methadone is not a successful treatment because the client is still addicted to opiates.

This is too black and white, someone is clean or they aren't. If they are clean that is good, if they aren't that is bad. Not everyone can live up to these expectations, it is just setting people up to fail. By these criteria an anti-depressant treatment is not successful, no matter how happy or functional the patient is, until they stop taking anti-depressants; heart medication is not successful, no matter how many years it adds to a patients life, until the patient is free of the medication. It isn't a requirement in other treatments, why should it be a requirement in methadone treatment?

A more reasonable target is to see if the client's life improves: health, living conditions, social reintegration, employment, education, family relationships. I mean, who cares if the person is swallowing a small amount of liquid once a day, so long as he/she is healthier and happier than before. When the person is ready to become drug-free, then let it happen, but it is counter-productive to push and push until they are pushed over the edge. One step at a time is plenty when you are tackling such huge, steep steps.

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Methadone Services

The way the service is offered can have a great bearing on whether the treatment is successful. Unfortunately, some methadone programs are run in a way that punishes the clients rather than encouraging them. (for a particularly bad example click here) Others are just plain inconvenient. As more research is done and more experience is gained, treatment providers are improving their services.

Methadone clinics offer a specialised environment which has advantages and disadvantages. The client has access to specialised doctors and staff, but also to other clients. Seeing other addicts can be unsettling, especially if you notice that one of them is high.

Distance can often be a problem with clients having to make a long trip across a city or between towns every day. Pharmacies can be an answer to this. With methadone being dispensed from the local pharmacy and the client visiting the doctor regularly for the prescription, a clinic is not needed. This is the arrangement that I have at the moment.

Some clinics and doctors have draconian rules, in the client's best interests of course, but that doesn't stop us from feeling as if we are being treated like prisoners rather than ordinary human beings. If you can't ask the person sitting next to you the time for fear of being kicked out, it can make the place feel pretty tense. Urine tests should be used, if at all, as a guide to see how someone is doing, not as a threat. Surely someone with drugs in their urine is more in need of treatment; whose interest is it in to discontinue their program? Not the clinic, they lose a client (though there is no shortage of clients lined up waiting to get in); not the client or his/her family, they lose a stabilising influence in their lives; not society, one more person has a reason to steal and cheat.

There is more emphasis being placed on client service now and some clinics are responding accordingly. Coopers Cottage, in Sydney's south-west realises that just dispensing methadone is not enough, much better results come by working through the clients problems.

Just dispensing methadone is not enough, much better results come by working through the clients problems. Working through problems with clients, not telling them what's best for them and they'll do it whether they like it or not, is the way of the future. Taking each client as an individual, tailoring their treatment to best suit the client's needs. As addicts begin to be regarded as humans with rights and feelings, so the treatments become humane and the addicts become humanised.

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I want to go on a methadone program.
What do I do?

In Australia, the bottom line is you have to get in touch with a licensed methadone prescribing doctor. Methadone is a prescription drug, and like any prescription drug you have to visit a doctor to get a prescription. However, only certain doctors are authorised to prescribe methadone for the treatment of heroin addiction. You have to find one of those.

The best way to do this is to contact a Drug and Alcohol service. Here is a link to ADCA (Alcohol and other Drugs Council of Australia) who has a huge list of contact telephone numbers for many areas within Australia and in some cases, websites, for drug related help within Australia. The ADIS and Directline numbers put you in touch with direct telephone counselling, some of them 24 hour.

This is a start: it will give you someone to talk to who is trained (unlike me) to counsel you and who has access to information and contacts. But it is best to find a face-to-face service that will look after your needs personally. Ask the telephone counsellor to tell you where your nearest Drug and Alcohol Health Centres are.

Don't feel that you have to settle for the first service you find. Different clinics have different policies, levels of client service, staff etc. If you don't like the way you are being treated at one place, shop around. This is not easy or sometimes (like if you are in a rural area, like me) it is not even possible, but it is something you should consider if you feel that you may discontinue the treatment because you don't like the clinic.

Also, if you are using a needle exchange, this is a good place to get information. Many needle exchange facilities are part of treatment and counselling facilities.

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Online Information Links

• The world's WORST methadone clinic.

  An account by a client at this particular methadone clinic in the USA. This account details the mistreatment and coercion experienced by methadone patients as a matter of course at this clinic. It highlights how a bad clinic can be responsible for family breakups, treatment failure and even the death of its patients.

• CEIDA (Centre for Education and Information on Drugs and Alcohol) Methadone Fact Sheet



• Is Methadone a Form of Treatment or is it Legal Opiate Dependance?

  Article about methadone treatment by Nick Stafford, another self confessed heroin user. It has an original and unusual viewpoint about the culture of drug use and how the state deals with it. We drug users have a right to our culture, it should not be stamped out by the state. Methadone treatment is a de facto acceptance of our right to take opiates.

• METHADONE TREATMENT An ADCA Issues Paper

  A brief summary of current literature and discussion on an issue of importance to the Australian alcohol and other drugs field, prepared by the Alcohol and other drugs Council of Australia (ADCA) Library to assist discussion of the issue by ADCA members, health workers, commentators, journalists and those with an interest in the topic. You can also contribute to the discussion on the paper in their forum.

• National Alliance of Methadone Advocates

  NAMA has information on methadone, including a quiz to test how much you really know (as opposed to how much you think you know). They have history, policy discussion, and some articles in an education series with topics including: "Methadone Maintenance and Patient Self-Advocacy" and "Starting a Patient Run Program". Also links to other methadone sites.

Explaining Methadone Treatment to Kids

	Heroin addicts are people just like everyone else (strange, but true). We often have families that we love. We have trouble explaining some things to them. Here is a cartoon that attempts to explain methadone treatment, and why we need it, to kids - especially kids who have addicted parents.

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