Introduction
This paper deals with the subject of Methadone Maintenance Treatment. It aims at enlightening the reader about the reasons, impacts and other issues associated with the same. It is significantly important to shed some light on the related issues in order to facilitate better understanding of the issue at hand. Thus, the paper first explains a few related concepts before going deep into the matter of Methadone Maintenance Treatment. (Jacobs, 2002)
Background
An opioid refers to a chemical material, which affects the body in way similar to morphine. It is primarily used for providing respite from extreme pain. These substances function by combining with opioid receptors located predominantly in the central nervous system and the gastrointestinal tract. The use of opioids fosters both the valuable as well as adverse consequences. Opioids are classified under different categories among which the most common are natural, semi-synthetic, synthetic and finally endogenous opioid peptides. (Jacobs, 2002)
Natural opiates are the alkaloids present in the resin of the opium poppy, which include morphine, codeine and thebaine. Papaverine and noscapine, which demonstrate a dissimilar action mechanism, are not considered natural opiates. Semi-synthetic opiates are prepared by using the natural opioids. Examples of semi-synthetic opiates are hydromorphone, hydrocodone, oxycodone, oxymorphone, desomorphine, diacetylmorphine (Heroin), nicomorphine, dipropanoylmorphine, benzylmorphine and ethylmorphine. Examples of fully synthetic opioids are fentanyl, pethidine, methadone, tramadol and propoxyphene. Lastly, endogenous opioid peptides are the ones, which are produced naturally in the body. For example, endorphins, enkephalins, dynorphins, and endomorphins are endogenous opioids.
In order to comprehensively understand Methadone Maintenance Treatment, one needs to understand the concept underlying the terms opioid dependence, which in turn requires knowledge about substance dependence. Thus, the paper makes an effort to provide a brief explanation of these terminologies. (Strike, 2007)
American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) points out that the central aspect relating to substance dependence can be considered as “a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues use of the substance despite significant substance related problems…a pattern of repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior”. (Turner, 2005) In this context, it should be observes that due to the inherent ambiguity of the term “abuse” in addition to the different perspectives of different people it is difficult to separately define “use” and “abuse”. Further, one should also note that the word “addiction” is increasingly being replaced by the expression “drug or substance dependence” across the medical arena. Opioid dependence according to the DSM-IV is a form of substance dependence disorder. As in the case of substance dependence, the manual identifies the key aspects linked with opioid dependence as physical tolerance of, and dependence on, opioids, in addition to the uncontrollable use of opioids regardless of the adverse effect on health.
Tolerance may be described as the requirement of noticeably greater quantities of the substance than required before to attain a state of intoxication or achieve desired consequences or else distinctly reduced results with sustained use of equal amounts of the substance. (Wittchen, 2005)
Withdrawal can be characterized by either the appearance of the typical withdrawal syndrome for the substance or else when the dependent uses the same or a similar substance to mitigate or circumvent withdrawal symptoms.
The following phenomenon describes the dependence on opioids:
- Opioid is frequently consumed in greater quantities or over a extended period of time than was proposed;
- There is a continual want or fruitless efforts to cut back on or control the use of opioid;
- A lot of time is spent for engaging in actions which are essential in order to get hold of opioid (e.g., going to multiple treatment centers or making long distance trips);
- Essential societal, professional or leisure-time activities are renounced or abridged as a consequence of consumption of opioids;
- The continued use of opioids, even after being aware about the adverse affects like experiencing a continual or frequently occurring physical or emotional difficulty, which was probably induced or aggravated, by the use of opioids. (Wurst, 2008)
Anxiety and chaos become integral part of the live of the people heavily dependent on opioids. They often undergo severe physical and psychological difficulties because of their dependence. They are time and again faced with the possibility of untimely fatality from unintentional drug overdose, aggression etc. Using the same needles, injections, straws or other unhygienic drug-taking apparatus, increases a risk of getting infected by human immunodeficiency virus (HIV), hepatitis C virus (HCV) or other infective agents. The adverse effects of opioid dependence may perhaps be aggravated by social negatives like poverty and destituteness. Psychological disorders for example gloominess, antisocial personality disorder and irrational fears develop due to prolonged exposure of opioids.
Researchers calculate that approximately 40,000 to 90,000 natives in Canada on a regular basis are exposed to heroin. A major fraction of the opioid dependent population is formed by injection drug users. Unattended, opioid dependence relates to costs involving criminal behavior, medical attention, drug cure, reduced yields, and, ever more spread of HIV, HCV along with other blood-borne infective agents. In 1996, approximately 50 percent of the approximated 4,200 new HIV contagions, which took place in Canada, were found to be amidst injection drug users (IDUs) with the figures of the year 2000 stating 70% of existent HCV infections were linked with injection drug use. Overall, illegitimate drug consumptions lead to an expenditure of about $1.37 billion in Canada in 1992, and approximately 70% of this was accredited to opiate use. (Schut, 2002)
Methadone Maintenance Treatment
Methadone in the form of Symoron, Dolophine, Amidone, Methadose, Physeptone, Heptadon and many others, is a synthetic opioid. It finds uses in the form of an analgesic, antitussive as well as maintenance anti-addictive in the field of medicine. Although the chemical structure of methadone differs from that of morphine or heroin, it combines with the opioid receptors to create identical effects. In addition, it is useful in dealing with unremitting pain because of its long half-life and comparatively lesser prices.
Even though other structures for curing opioid dependence are still being researched in Canada and elsewhere, methadone maintenance treatment till date continues to be the most extensively used form of opioid dependence treatment. Methadone maintenance treatment, irrespective of the method of delivery (oral or injection), proves to be a successful means of reducing or perhaps completely stopping the use of addictive opioids. (Jacobs, 2002)
Methadone’s significance in treating of victims of opioid dependence is due to a number of factors. It exhibits cross-tolerance properties with other opioids like heroin and morphine. Its effects last for a considerably long period, and oral dosage of methadone facilitates the stabilizing of the opioid dependent patients by preventing the opioid withdrawal syndrome. Further, it can even obstruct the ecstatic feelings which addictive drugs like heroin, morphine produce when used in high doses (60-80MG+). Consequently, patients receiving correctly dosed methadone can decrease or perhaps entirely stop the consumption of such substances. Methadone is standardized only for treating of opioid dependent patients. It is not proposed as a means to decrease the consumption of non-narcotic drugs like cocaine, methamphetamine, or alcohol. (Berger, 1999)
Methadone functions by assuaging the indicators of opioid withdrawal syndromes. A constant and adequate blood level of methadone concentration curtails the persistent longing for opioids. Given that methadone’s effects last longer as compared to some other opioids, for instance heroin, just one oral dosage on a daily basis averts the inception of opioid withdrawal indicators – including apprehension, impatience, and runny nose, scratching, along with queasiness and vomiting – for at least 24 hours or longer. Methadone weakens the ecstatic impacts of other opioids by means of cross-tolerance, without itself essentially inducing euphoria, drugging or analgesia. This implies that self-administered illegitimate opioid usage does not result in euphoria, reducing the clients/patients probability of either making use of illegal opioids and even diminishes the chances of overdoses. (Jacobs, 2002)
People undergoing a methadone maintenance treatment program receive their prescribed doses orally once a day and it is generally put into an orange drink. In view of the fact that methadone has long-acting effect, the necessity to infuse other opioids is lessened and this decreases the dangers linked to injection drug use. In addition, tolerance to the impacts of methadone usage grows very comparatively gradually, which permits a lot of people who suffer from opioid dependence to be put on a consistent methadone dosage in an unharmed way for several years. When correctly prescribed and distributed, methadone is deemed a medically harmless medication. (Siassi, 2003)
However, there exists no general definition for a methadone maintenance treatment “program”. Nevertheless, the universal foundation in all forms of methadone maintenance treatment evidently the utilization of methadone. Program mechanisms and guidelines differ extensively around the globe and across Canada itself. A wide-ranging course of action in methadone maintenance treatment, by and large incorporates numerous elements, which can be approached in diverse ways and at tailored levels of concentration. The major components of methadone maintenance includes: methadone dosage; medical attention; cure for other substance dependences; psychotherapy and support; psychological health services; fostering wellbeing, syndrome prevention and edification; association with other social supports and services frameworks; and outreach and encouragement. (Jacobs, 2002)
Benefits
As with the case with a number of drugs used for the treatment of various diseases, the use methadone also has its pros and cons. However, owing to its advantageous characteristics there are a number of good reasons to use it as a means to treat people with opioid dependencies. Various reviews and researches reveal that methadone maintenance treatments is a valuable procedure to reduce the dependence on other opioids, dependence on other substances such as cocaine, criminal behavior, death rates among IDUs, dangers associated with use of injections, threats associated with the spread of HIV and other STDs, transmission of HIV, and perhaps even risk related to increased HCV and other infection agents transmission. (Jacobs, 2002)
Methadone maintenance treatments are also effective in develop a better physical and psychological health, social conduct, superior living conditions in addition to having positive effects on pregnancy consequences. Results from various studies indicate that methadone maintenance treatment is related to amplification of retention in treatment. As a result methadone maintenance treatment has the capability to be advantageous, not only for individuals undergoing treatment, but also for those who are implicated in providing the treatment, in addition to being beneficial for the broader community and society all together. (Cushman, 2003)
For opioid dependent patients, methadone maintenance treatment provides a way in for a constant supply of a permissible, pharmaceutical grade prescription. Consequently, individuals undergoing treatment gain relief from the anxiety of upholding a steady supply of unlawful opioids, which frequently entails criminal behaviors and highly hazardous sexual and injecting practices. Instead of feeling an unvarying cycle of highs and lows as the outcome of repetitive consumptions of heroin like opioids, their frame of mind and psychological states alleviate. On the whole, investigations point out that individuals undergoing MMT spend a lesser amount of time in engaging in narcotics consumption activities daily, cut back on their use of unlawfully attained opioids, decrease their use of other substances like cocaine, marijuana and alcohol. They tend not to engage in drug trading and get involved in scandalous activities. They demonstrate much lesser death rates as compared to the unattended victims of opioid dependence and significantly reduce injecting practices. In case of pregnant patients, receiving MMT reduces obstetrical and fetal complications. (Jacobs, 2002)
For the people who provide MMT, it is can be viewed as a prospect for them to offer a significant constituent of therapeutic and community health care, build up partnerships and collaborate with other services and offer the clients/patients a wide variety of services and supports. It is an opportunity for them to institute a constructive, supportive and beneficial relationship with opioid dependent patient and take notes of their experiences, which would be immensely valuable to the future researches in the field.
Methadone maintenance treatment could be beneficial for the society as a whole. The potential advantages in that context may include abridged drug-related scandalous activities, reduced prostitution and proper disposal of discarded used syringes in the society. (Dole, 2003)
Given the high expenditures associated with unattended opioid dependence, MMT contributes noteworthy cost benefits towards the society, which is valued above the outlays associated with treatment. Studies indicate that the yearly expenditures of MMT are comparatively lesser as compared to the yearly expenditures linked with untreated heroin dependence and custody or drug-free initiative. It is also a substantiated fact that criminal activities in relation with heroin use lead to social expenditures, which were four times graters than the MMT outlay. In Toronto, the mean social expenditure of an unattended illegal opioid dependence victim has in recent times been projected to be $44,600 per year whereas facts reveal that MMT could be provided for only about $6,000 per year. (Cushman, 2003)
Limitations
In spite of such a huge assortment of advantageous provided by MMT, there are a number of limitations associated with this approach. The use of methadone possibly could cause some undesirable consequences in the early phases of treatment. Such effects may appear as increased perspiration, constipation, libido anomaly, orgasm irregularity, sleeplessness, loss of appetite, queasiness, drowsiness, fretfulness, headaches and ache and chills. Further, various societal obstructions also contribute to limitations of MMT.
Hindrance caused due to non-complying attitudes towards treatment including apprehension and misinformation, ideological variance among practitioners, inadequate resources essential for proper treatment, not having enough practitioners, Stringency of regulations and insufficient supports for clients/patients are only a few to name among them. (Dole, 2003)
Conclusion
The fact that Methadone Maintenance Treatment has achieved a considerable level of success in treating opioids dependent patients is well documented. It helps victims to appreciably reduce or even completely stop the use of illegal opioids. The implementation of MMT offers a number of advantages not only for the patients undergoing treatment but also to the providers of the treatment and the society as a whole. However, there are a number of issues, which impede the proper implementation of the program. These issues must be addressed with immediate effect in order to uphold the interests of the society.
References
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