Heroin addicts and methadone treatment
...one of the most successful treatments for heroin addiction...
Even when we provide addiction treatment, we often erect barriers around it. The state of methadone treatment for heroin addiction is an example of how government policy collides with a goal of positive public health outcomes when it comes to dealing with drug addiction.
Untreated heroin addiction and its link to crime and illness cost society some $20 billion a year, according to the National Institutes of Health. The estimated cost of treating hepatitis B and C, AIDS, and other illnesses linked to dirty needles and heroin addiction accounts for $1.2 billion of that total. Heroin is also one of the hardest drugs to quit "cold turkey" and for good.
Methadone maintenance is a replacement therapy in which heroin addicts take regular doses of the long-acting methadone, a synthetic opiate, to quell withdrawal and cravings that would otherwise drive them back to heroin use. It is one of the most successful treatments for heroin addiction. "For IV drug users, injecting opiates and at significant risk of AIDS . . . who can't or won't give up that opiate effect, [methadone] is a tremendous public health benefit," says A. Thomas McLellan, a researcher at the University of Pennsylvania. A 1994 study of drug treatment in California found that methadone maintenance clients achieved greater reductions in illegal drug use, criminal activity, and hospitalization than addicts in any other kind of drug treatment.
Methadone treatment is also highly cost-effective. According to the New York Academy of Medicine, the lifetime Medicaid cost for each injecting drug user with AIDS is about $109,000. In contrast, one year of methadone treatment costs about $5,000 per patient.
But there are many obstacles in the way of heroin addicts who seek methadone treatment. The dispensing of methadone is rigidly regulated. Only a handful of physicians in the U.S. are registered to provide methadone treatment in their practices today, since, to dispense the drug and be approved for treatment, physicians have to make a special application to the FDA and the DEA. The Department of Health & Human Services and the FDA also decide dosage regimens and how, and under what circumstances, methadone maintenance may be used to treat opiate addiction. Most methadone is dispensed from clinics that must obtain an extra license and comply with a mountain of both federal and state regulations.
The result is that, for many heroin addicts, getting methadone treatment is a tremendous burden. There are approximately 737 active methadone clinic programs in the U.S., according to the FDA. Although programs vary with regard to methadone dosing and take-home policies, most dispense medication as well as provide counseling and other medical services. But many states don't allow methadone clinics, forcing some patients to drive hundreds of miles each day to get their required daily dosage. Idaho, Mississippi, Montana, New Hampshire, North Dakota, South Dakota, West Virginia, and Vermont don't allow methadone clinics. Clinics in states that do allow methadone often have strict morning hours that make it difficult for patients to stick to the regimen. One heroin addict featured in a 1997 New York Times article said he traveled four hours round-trip every day to swallow his methadone and produce a urine sample -- a process that takes five minutes. He described his quest to stay off heroin as a sometimes "white-knuckle experience" because he has to travel during snowy and icy New England winters to arrive at the clinic by 9 a.m. and return home to begin work.
Heroin addicts in Athens, Ohio, also have to travel long distances if they want methadone. The closest methadone clinic to Athens is Columbus, Ohio, 74 miles away. Betty Woellner, a drug and alcohol counselor with Health Recovery Services, Inc., in Athens, agrees that laws need to be changed to make access to methadone easier but she says changing the public's attitude toward heroin addiction is an important first step. Woellner says the public remains undecided over whether addiction is a disease or a moral failure and the fear of opiate addicts creates an unwillingness to spend treatment dollars on them. Many members of the public fear the consequences of opening new methadone clinics in their communities. "There is a lot of old historic judgment about heroin addiction," says Woellner. "But it is a myth that anyone will go on methadone for fun. These are people who truly are desperate and can't get through the day without heroin."