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Kicking Heroin: Is Methadone the Answer?

Summary & Participants

Methadone has been used since the late '60s to help heroine addicts overcome their addiction. But is this drug really a cure? Or does it just create a new addiction?

Medically Reviewed On: July 09, 2008

Webcast Transcript

VAREN BLACK: I'm Varen Black, and welcome to our webcast. You've probably heard of methadone clinics, where heroin addicts can get treatment. But what is methadone, and is it really a cure? Joining me to talk about the treatment of heroin abuse is Dr. John Franklin, Director of the Addiction Psychiatry Division at Northwestern Memorial Hospital.

Dr. Franklin, how does methadone work?

JOHN FRANKLIN, MD: Methadone is a synthetic opioid medication that's actually been around since the late '60s, and the idea is actually using methadone, which is a long-acting opioid medication, to substitute for shorter-acting opioid drugs like heroin. The advantage of having a longer-acting medication is that actually the opioid receptors, the receptors that are associated with the pleasure of heroin, are actually occupied by the methadone so that if someone tries to shoot up on top of it or use heroin, they basically get no effect.

This allows them to have a mild stimulative effect of an opioid and not have to go out and support a habit by using heroin. It's something that they use once a day, and it's something that's prescribed in federally licensed clinics so that one of the main advantages that they found about this medicine is people could return to a productive lifestyle. They could be employed, they have more stable home environments, and that's been the main advantage of methadone.

VAREN BLACK: It sounds like it could be a hindrance more than a help. Is it an example of trading one dependency for another?

JOHN FRANKLIN, MD: Well, it is trading one dependency for another, but it's one dependency that's better than another. People that use IV drugs or use street drugs have the potential for being exposed to medical complications of IV drug use like infections and AIDS and hepatitis C, so you eliminate that by using methadone.

VAREN BLACK: Let's talk about the length of time that people take methadone. Do they need to take it for the rest of their lives?

JOHN FRANKLIN, MD: Well, methadone can actually be used for two or three different purposes. One is for detoxification. Most people that use methadone to get off of heroin and don't use any other treatment option will relapse to heroin. One option is to actually stay on methadone, and that's actually been the most successful drug treatment modality or option that we've developed to date. 60 to 90 percent of people in good methadone clinics will decrease their heroin use. Many of these people decrease it entirely and get back to a productive life.

VAREN BLACK: What are some of the other options for treating opioid dependence, if you could briefly explain those?

JOHN FRANKLIN, MD: Probably the newest and the latest thing is a medicine called buprenorphine, which is a little different from methadone. One of the disadvantages of methadone is that once people are on it it takes a long time for them to get off. If they were on it for six months, 12 months, two months, they were doing well and they wanted to get off of methadone, they couldn't stop immediately. It may take several months for them to get off. Buprenorphine is a medicine that can be used for similar purposes, for detoxification, and for maintenance, so people on buprenorphine will decrease illegal drug use. But you can detoxify or take people off buprenorphine in a matter of days, and it's going to be a real advantage.

The other way that buprenorphine is being introduced is that doctors in their offices can actually prescribe it. One of the disadvantages of methadone to date has been access. People can only get it in methadone clinics. This is going to open up a whole population of people that haven't gone to methadone that will go to a private doctor to get treatment. There are approximately 14 states that don't have methadone clinics at all.

VAREN BLACK: So those people have to go to their doctors, or they just don't?

JOHN FRANKLIN, MD: Those people don't have methadone available to them unless they go over the border to another state.

VAREN BLACK: Thank you, Dr. Franklin, for being with us and sharing with us this important information and helping us understand the treatment options for opioid dependence. Thank you for being with us. I'm Varen Black.