HEROIN ADDICTION - HOW METHADONE WORKS

Porter Starke Services' Chemical Dependency and Addictions Program has
a clear understanding of the dynamics involved in heroin addiction.
While we do not dispense methadone, we believe in its efficacy and
have witnessed many successful recoveries using this pharmacotherapy.
There is a general misunderstanding about this medication and I wish
to educate the public about it.

Thirty-two years ago, Dr's. Vincent Dole and Marie Nyswander conceived
the idea that a long-acting opiate might stabilize the neurochemistry
and behavior of heroin addicts. Now, every professional caregiver who
has treated heroin addicts properly with methadone knows how effective
this medication can be.

Whether a heroin addict's reward pathway (in their brain) was
defective to begin with, or whether it was altered by the long-term
insult of excessive dopamine release (brain chemicals called
neurotransmitters), it seems to function normally only if an opiate
continuously occupies the "mu" opioid receptors. This continuous
receptor occupancy is the stabilizing factor that permits addicts on
methadone to normalize their behavior and to discontinue heroin use.
It is, therefore, not correct to think of methadone as a substitute
for heroin; its totally different pharmacokinetic properties make it,
in effect, a completely different drug. It is true that both heroin
and methadone can occupy the "mu" opioid receptors. But the steady,
stable occupancy by methadone contrasts sharply with the repeated
excessive "highs" followed by excessive "lows" with heroin.

Methadone is not an experimental medication. It is more soundly based
in biologic science and has been proven in more clinical trials than
many drugs we use in modern science. It has helped hundred of
thousands of heroin addicts all over the world. It is safe and
efficacious. Taken by mouth, it is absorbed into the circulation, and
it occupies the "mu" opioid receptors in the brain for about 24 hours.
Its stabilizing action puts an end to the pattern of alternating
"high's" and "sickness" several times a day that is typical for heroin
addicts.

The effectiveness by mouth permits the addict to discontinue
intravenous drug use, thus reducing the risk of hepatitis, AIDS, and
other blood-borne infectious diseases. Quitting intravenous drug use
is also the first step away from a set of bizarre anti-social behaviors.

When used properly, methadone allows a heroin addict to stop using
heroin. It diminishes the craving for heroin, and by producing opioid
tolerance it blocks the heroin "high". Very important if a patient on
methadone occasionally use heroin, that event need not become a
relapse-it can remain a single episode without significant
consequences. In contrast, an abstinent ex-addict can almost never
prevent a single "taste" of heroin from leading to a total relapse.

Methadone itself is a therapeutic aid, not a panacea. No magical
interventions can stop a heroin addict from using, unless there is
some motivation to stop. Thus, methadone must be accompanied by
skillful counseling and rehabilitative aid, by psychotherapy as
required (co-morbidity with other mental illnesses is common), by job
training if needed, by family involvement and so on. Success requires
a well-run program with well-trained staff, who understands that
heroin addiction is a chronic relapsing disease and who will treat the
addict with respect, such as Porter Starke Services, Inc.

The primary criterion of success is cessation of heroin use and of
other drug abuse, as well as social rehabilitation. Giving up
methadone eventually is realistic for some patients, not for others;
it is certainly NOT a primary goal of treatment. As the underlying
defect in the reward pathway has not been cured, there may well be
addicts (and we don't know how many) who will require lifelong
maintenance, much as diabetics require insulin.

Carmen Arlt is the Director of Chemical Dependency & Addictions at
Porter-Starke Services, Inc.