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Replacement Therapy pt4

Is anyone reading this or am i talking to myself? ill press on in hopes that one person hears me.Ok, this is the part where I throw lots of fact, figures, studies and such at you, but please stay with me , I want you to see I didn’t arrive at my opinion on a whim. I know what my personal experience was and is like but I was astounded by the numbers that support my opinion. Studies have shown that methadone is an effective treatment for heroin and prescription narcotic addiction when measured by:
* Reduction in the use of illicit drugs
* Reduction in criminal activity
* Reduction in needle sharing
* Reduction in HIV infection rates and transmission
* Cost effectiveness
* Reduction in sex work (prostitution)
* Improvements in social health and productivity
* Improvements in health condition
* Retention in addictions treatment
* Reduction in suicide
* Reduction in overdose

This is taken directly from the NIDA National Institute on Drug Abuse as is the following :
Research Highlights

Recent meta-analyses have supported the efficacy of methadone for the treatment of opioid dependence. These studies have demonstrated across countries and populations that methadone can be effective in improving treatment retention, criminal activity, and heroin use (Marsch, 1998).
An overview of 5 meta-analyses and systematic reviews, summarizing results from 52 studies and 12,075 opioid-dependent participants, found that when methadone maintenance treatment was compared with methadone detoxification treatment, no treatment, different dosages of methadone, buprenorphine maintenance treatment, heroin maintenance treatment, and L-a-acetylmethadol (LAAM) maintenance treatment, methadone maintenance treatment was more effective than detoxification, no treatment, buprenorphine, LAAM, and heroin plus methadone. High doses of methadone are more effective than medium and low doses (Amato, Davoli, Perucci, et al., 2005).
Patients receiving methadone maintenance treatment exhibit reductions in illicit opioid use that are directly related to methadone dose, the amount of psychosocial counseling, and the period of time that patients stay in treatment. Patients receiving methadone doses of 80 to 100 mg have improved treatment retention and decreased illicit drug use compared with patients receiving 50 mg of methadone (Simpson, 1993).
A systematic review conducted on 28 studies involving 7,900 patients has demonstrated significant reductions in HIV risk behaviors in patients receiving methadone maintenance (Metzger, Woody, McLellan, et al., 1993).
A randomized clinical trial in Bangkok, Thailand, included 240 heroin-dependent patients, all of whom had previously undergone at least 6 detoxification episodes. The patients were randomly assigned to methadone maintenance versus 45-day methadone detoxification. The study found that the methadone maintenance patients were more likely to complete 45 days of treatment, less likely to have used heroin during treatment, and less likely to have used heroin on the 45th day of treatment (Vanichseni, Wongsuwan, Choopanya, et al., 1991).
In the Treatment Outcome Prospective Study (TOPS), methadone maintenance patients who remained in treatment for at least 3 months experienced dramatic improvements during treatment with regard to daily illicit opioid use, cocaine use, and predatory crime. These improvements persisted for 3 to 5 years following treatment, but at reduced levels (Hubbard, Marsden, Rachal, et al., 1989).
In a study of 933 heroin-dependent patients in methadone maintenance treatment programs, during episodes of methadone maintenance, there were (1) decreases in narcotic use, arrests, criminality, and drug dealing; (2) increases employment and marriage; and (3) diminished improvements in areas such as narcotic use, arrest, criminality, drug dealing, and employment for patients who relapsed (Powers and Anglin, 1993).
In a 2.5-year followup study of 150 opioid-dependent patients, participation in methadone maintenance treatment resulted in a substantial improvement along several relatively independent dimensions, including medical, social, psychological, legal, and employment problems (Kosten, Rounsaville, and Kleber, 1987).
A study that compared ongoing methadone maintenance with 6 months of methadone maintenance followed by detoxification demonstrated that methadone maintenance resulted in greater treatment retention (median, 438.5 vs. 174.0 days) and lower heroin use rates than did detoxification. Methadone maintenance therapy resulted in a lower rate of drug-related (mean [SD] at 12 months, 2.17 [3.88] vs. 3.73 [6.86]) but not sex-related HIV risk behaviors and a lower score in legal status (mean [SD] at 12 months, 0.05 [0.13] vs. 0.13 [0.19]) (Sees, Delucchi, Masson, et al., 2000).

Ok I hope all the numbers and research don’t put you off. I also don’t want to give the idea that I think it’s right for everyone, but i am of the opinion that the stigma should be lifted for those who choose to do maintenance along with a 12 step program. That when dealing with addiction that we are dealing with many factors and the cookie cutter must be eliminated . No one approach is all right or wrong, but it seems to me that people have very strong feelings about this and if I’m able to show someone that open-mindedness is more important then method then my job is done.
Just recently one of the stars of the show Glee overdosed and died after an attempt at unassisted sobriety. The actor Cory Monteith had long struggled with opiate abuse and had recently did a stint in one of these rehabs that insist the only way to be clean is total abstinence . I site this case because you may have heard about this fellow because he’s on television but trust me many addicts die in their first year of sobriety because they relapse and try to do as much as they were doing before they cleaned up. The lower tolerance sets them up to overdose. If you’re asking yourself if I hold these rehabs responsible for these deaths I say emphatically , yes I do! The research is in, there’s no excuse to not give people more options then the one approach these places have used for years with a less then 10%success rate!
Many of these rehabs have this bootcamp style of conditioning the addict, using a method referred to as ” breaking you down to build you up”,where the addict is berated and intimidated to “break down” the ego. Some even go as far as re-enacting past trauma to make one confront the past. In my opinion these rehabs are flawed in a big way and a kid forced into one comes out more rebellious then ever. You can tell me that junkies need a firm hand and that many of them got in their current position because no one has told them no or dealt with them harshly . I’d say no two people are the same and while that approach may be a much needed therapy we need psychiatric background to see who needs what!
While NIDA has been in favor of maintenance or assisted detox for quite some time, many rehabs continue to push these one size fits all therapies. Some have incorporated Methadone and Suboxone into there programs and many have opted for a different approach , such as Community Reinforcement and Family Therapy (CRAFT), which focuses on building a social environment including family and friends that reinforces sobriety and discourages drug use by providing addicts with coping mechanisms as well as support networks to build and maintain recovery. There’s the key. I just think the therapy needs to be tailored to the addict and not the other way around.


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