The Myth of Methadone Maintenance Therapy (MMT) by Franklin Mohan

Dr. Frank Mohan, MD, FCFP(LM), CCFP, BA, BEd.

Former Adjunct Professor, (Retired) Department of Family Medicine, University of Western Ontario.

What is addiction?

According to CAMH, Canada, 

One simple way of describing addiction is the presence of the 4 Cs:

  • Craving
  • loss of Control of amount or frequency of use
  • Compulsion to use
  • use despite Consequences.

Think of craving a substance such as an opiate or alcohol as equivalent to the urgency of having to defecate when there are no facilities available. The urge for relief is so great, one can find oneself attempting behavior not considered socially acceptable, like heading to a bush in a city park, behind a dumpster downtown, or even between two cars in a parking lot. The desire for an opiate in addicts is not so much as for a “high” but a desire to avoid withdrawals. A dose of an opiate rids the body and mind of that desire. Consequently, an opiate addict will engage in socially unacceptable behavior to acquire the next “fix” such as stealing, stealing from parents and friends, robbing, selling drugs to pay for one’s own addiction and these behaviors consequently lead to legal problems.

Photo by Karolina Grabowska on Pexels.com

There is a myth that a drug addict is a homeless, vagabond consuming drugs downtown, injecting and discarding needles in back alleys. Sure, there are some that engage in this kind of behavior. However, in a typical addictions clinic, the majority of clients are so-called middle and upper class persons, sons and daughters of professionals, business people and gainfully employed in business and the trades.

All opioids are chemically related to opiates. Opiates are derived from opium. Addiction to opioids has effects common to that of opium: lack of self-care, sense of responsibility, socially unsuccessful, reduced interest in family, jobs and education. The victim is driven to acquire opioids at all costs with the consequent legal repercussions.

It is difficult to reason with an addict.

When one tries to stop opioids, the withdrawals that occur involves:

  1. Physical symptoms (lasts roughly 5 – 6 days)
  2. Psychological symptoms (lasts 2 years or more)

Opioids muddle the mind and reasoning is impaired. Co morbidities like depression, bipolar disease, ADHD, OCD are exacerbated.

Methadone is also an opioid (synthetic). Why then is it used in the treatment of an opioid addict? Isn’t one opioid being replaced by another? 

The Answer: (derived from evidence based studies)

Methadone is an opioid that doesn’t muddle the mind. There is no ‘buzz’ from Methadone. Once an addict is off all other opioids and is on Methadone, she is able to rejoin society, becomes interested in self-care, jobs, education, stoppage of illegal activities and resumes familial obligations. 

Judson et al. 2010, recruited 160 patients, 84 stable methadone patients and 76 unstable. When assessed on 22 factors indicating positive social functioning, stable patients achieved a statistically significant level of success. Interestingly, the 76 unstable, demonstrated a measurable level of success as well.

Multiple peer reviewed works have shown that if an addict is not on treatment after the initial physical illness of withdrawal then there is a 96% chance that he will drift back into using within 6 months.

Methadone is used for a minimum of 2 – 3 years during the ‘psychological withdrawal period’ during which it allows the patient to realize social success. Those who had been using for more than 2 years, may have to be on MMT for many more years before tapering off. Relapse is a possibility as addiction is a life-long disease.

The MMT program is supervised by the College of Physicians and Surgeons of Ontario (CPSO). The rules are rigidly adhered to and so being a MMT patient is very restrictive. In order to commit to MMT, a patient must be motivated in order to attend appointments weekly, observed by the pharmacy staff taking their daily dose, provide urine samples weekly under video surveillance, attend psychiatrist appointments, and have to have special arrangements for going out of town. 

Therefore, it is the addicts not in treatment that must be viewed with a jaundiced eye, and a feather in the cap given to those in MMT treatment.

Dr. F. Mohan MD, FCFP(LM).

20July 2021