Methadone Myths – We Need Gilda Radner Back

The comic skit of the late, great Gilda Radner on Saturday Night Live was refreshed for me today by the brilliant essayist Holman Jenkins to make a point similar but unrelated to my topic here.  In her character of Emily Litella she would go into a social commentary rant based on wrong facts. She would shout and pound the table, but when Chevy Chase corrected her, the reply was always “Never Mind.”

Edwin A. Salsitz, MD, FASAM, and Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center in New York, together with the literature of 50 years of effective treatment, provide the proof that contrary to myths that still abound, methadone is not the same as heroin in its effects on the brain.  It is effective in ending heroin addict craving and so helps them to get back to school, work and productive living.  It is safe for pregnant heroin addicts.  We continue to get rants by folks who do not know these facts. There is a longer list but these make the essential points for my purposes here.

Not all heroin addicts need treatment and it is well established that many, perhaps the majority do live productive lives without treatment.  Most mature out of addiction by their late thirties. However, there are those who can well benefit from methadone and other chemical treatments.  As a result many clinics sprang up over the country, and, of course the sky-is-falling mentality in government was awakened  and the clinics came under heavy regulation.  The clinic regulation system developed into a “double-edged sword” as Dr. Salsitz puts it. The benefit of the clinic approach is to have other services available to the patient in case of need, but the regulators insist that methadone patients come in for their dose on a daily basis.  An advantage of methadone treatment over heroin use is that you can take one pill a day instead of many, but going to a clinic every day is a serious pain. It’s likely a deterrent to many because of work schedules, transportation time and costs, plus additional costs per dose.  Every administration of a pill or injection involves some staff person to supply it plus the provision of parking and waiting room space and other minor, but cumulative expenses.

In KILL THE DRUG TRADE the TCC SOLUTION of tolerance, counseling and control explains how the many clients of the system will be shown they can switch from heroin and other opium based products to methadone and other chemical treatments. The system staff doctor would make sure of the safety of the change.  A pregnant heroin addict client would be required to go on a chemical substitute.  Heroin use hurts the fetus.  It is a key element of the system that once the substance of choice is established by agreement between system operator and client, the drug is delivered to the client in amounts consistence with use over an interval such as one month.  The client is monitored by the counselor to assure compliance with the agreed upon usage rate.  If this system were adopted there would be no logic in forcing a methadone user to come to the office daily, and, in fact, it is likely that logic would prevail to permit re-fills without re-visits.

It would be Emily Litella-esque to argue that methadone patients could not be trusted under a counselor/monitor system.  It is time for the war on drugs to go.  I wish I had Gilda Radner here to help me make that case.

Preview the book: KILL THE DRUG TRADE  at the Reform Drug Policy Project: http://www.finchdiablog.com.

©  All rights reserved to Dave Finch May 7, 2014

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