I have always been an outspoken proponent of medicine assisted treatment which includes methadone, Suboxone and naltrexone. I genuinely believe that all three of these medications can be a valuable tool to help heroin and opioid users conquer their drug addiction. However, every treatment option comes with a laundry list of potential problems along with their inherent benefits. I’ve been thinking long and hard about this recently and have some concerns that I want to share with everyone.
Why Methadone is Called “Liquid Handcuffs”
Now I will admit upfront that I have always hated hearing this. The whole concept of methadone trapping you and keeping you from moving on with your life, hence the term/phrase “liquid handcuffs” bothered me from the very beginning. This is simply because I have seen the power of methadone being used as a valuable tool that has literally taken the heroin needle out of peoples arms and has helped many live drug-free lives. I understand that some do not consider this “drug-free” but I am not going to address this at this particular time. Frankly, I have written a plethora of other articles about this particular issue so I will refer you to “the brutal truth about medicine assisted treatment”. But what if methadone, while truly helping you live a life without drugs, kept you from actually moving on with your life, getting a job and becoming a productive member of society?
A Typical Scenario
Now let’s walk through a typical, standard scenario that may demonstrate why long term methadone use could be a problem.
The typical drug user starts using at an early age and learns what it means to be an addict in their late teens to early 20s. Many of these individuals are still living at home, don’t understand what it means to be out there on their own, working full-time, paying bills and living normal, productive and adult lives. Let’s say John Doe (not a real person) fits into this typical scenario.
John becomes a heroin addict at 18 years of age, immediately after he graduates high school. He had intended to go to college but because of his condition, he only wants to chase after his drug and get high. He hides this effectively from his parents for as long as he can but like any intuitive parent, they relatively quickly learned of his ongoing drug use and addiction problem. Now his parents are barely making ends meet and don’t have the proper insurance policy to send their son to a drug rehab facility that can help them get back on track. Besides, John isn’t quite ready for treatment and his parents, not knowing what else to do tell him that he needs to get help or get out. He chooses to get out because his burning desire and ongoing compulsion for heroin is too strong to give up at the moment. He thinks he can go live with his girlfriend anyway, and his parents gave him exactly the motivation he needed to go.
But like most young men or women, John didn’t realize how hard life was going to be without his parents assistance and both John and his girlfriend Jane (also fictitious) both end up living on the street chasing after their drug of choice. After losing practically everything, they both decide they want help. Neither of them have any financial support or help from their parents and decide that methadone is the best choice for their addiction treatment.
They walk into a clinic and they are told that they can get on Medicaid/state insurance and after they are approved, they can begin regularly coming to the methadone clinic and getting medicated. Of course, this is coupled with a requirement of individual counseling and regular groups.
Now let’s assume that there’s at least one positive thing that happens in their life. And their parents, because they have decided to stop using heroin and get treatment, they are allowed to move back home and have a place to live. The only requirement their parents have is that they continue treatment and stay off drugs. Of course, there are other situations where the parents see methadone as ongoing drug use and still won’t let them home but I will give the parents in this scenario some benefit of the doubt.
Now let’s look at the situation more closely. John and Jane are now off drugs, and they are back living at home. They are on medicaid and undergoing methadone maintenance therapy (MMT). Let’s assume that both of them are doing rather well and not abusing the program.
So they are successful in beating their heroin addiction but they now have to ask themselves this question. How long do they want to be on methadone? The average methadone patient continues at their clinic for 3 to 5 years. If John or Jane stay the average length of time, they will not be able to get jobs for 3 to 5 years. Getting a job would mean a loss of state benefits and they would not be able to continue at their current clinic. Now if they do decide to get a job and move over to a private clinic, they may be able to start making a little bit of money – but approximately $500 a month will be necessary to continue using methadone at a private methadone clinic. An 18-year-old young adult will likely only find a job making minimum-wage and after taxes bring in less than $1000 a month. That’s assuming they are working full-time at minimum wage which may not be 100% possible since a lot of these methadone clinics require multiple groups a week in the middle of the day. Some clinics however will do their best to work around people’s schedules.
Now what happens if John or Jane decide to stay at their methadone clinic longer than 3 to 5 years? What happens if their parents finally say enough is enough and demand they get off methadone sooner because they no longer want to support their adult child who they feel isn’t moving forward in their life? Are John and Jane stuck in an ongoing situation of using methadone maintenance therapy and not getting a job? Or even if they do get a minimum wage job, will they ever be able to financially support themselves?
How Common Is This Scenario?
Most methadone maintenance therapy clinics that take state or Medicaid insurance are full of individuals who are in very similar situations to the one above. Some are in worse situations but very few are in better situations.
A large number of older individuals who are in this position are either still living with friends, relying on family or living on the streets because they are in a position where they don’t want to give up their methadone but can’t actually do much to move forward in life and support themselves – thanks to Medicaid and a prior life of ongoing drug use.
Private Methadone Clinics
Most people who attend and get treatment from private methadone maintenance therapy clinics are in a different position. Either they have parents who are willing to pay for them or are slightly older individuals who have either been able to maintain jobs during their addiction or fell into ongoing drug use/drug addiction later in life and have been able to get back on their feet landing a new decent paying job while affording methadone on their own.
The sad reality however, is that the vast majority of people using methadone maintenance therapy are not attending a private clinics and aren’t in a position to pay for their own treatment. Many of them, have lost it all to addiction and by undergoing methadone maintenance therapy, they may be in a position where advancing their life is at the very least delayed if not permanently halted.
My Personal Methadone Story
I am one of the rare exceptions in that I started using drugs and became an addict later in life, was able to hold onto a job and begin treatment to get my life back. I was able to continue with methadone treatment while working hard at my job and starting / running this online recovery community / organization.
Additionally, I also made a personal decision that I was not going to stay on methadone for a very long time. While I do not begrudge others for their own choices, personally, I did not want to be on methadone forever. I also did not want to be on it for 3 to 5 years. So after about 4 months, maybe less, I started tapering down from 70 mg which was my maximum or blocking dosage. I decided that “slow and steady” was the best way to go so I only went down 1 mg a week. That means my Methadone taper would take over a year. But my plan was to wean down so slowly that I would not feel any Methadone withdrawal.
I am now at 8 mg, an exceptionally low dose well below the starting point which is usually between 20 to 30 mg depending on the clinic. On Friday, I will go down another milligram to 7 mgs. My plan has worked beautifully so far and I believe that it will be 100% effective. At this rate, I will be completely done with methadone in the beginning of April. Now there are a few unknowns in my mind regarding whether or not I will feel anything on doses lower than five or even when I stop. However, this will not deter me or my decision to stop using methadone.
Is Methadone Maintenance Therapy a Good Idea?
I firmly believe that like anything else, methadone may be a good option for some people and not for others. I have been making this very clear from the beginning. Now allow me to get more specific, which I’ve really never done before. And please understand that this is just my opinion, it is not a judgment and anybody who is on it that I don’t feel is an ideal candidate, I still personally support your decision and will do my best to support and encourage you in the midst of your addiction treatment and recovery.
Who Are Ideal Candidates For Methadone Maintenance Therapy?
I honestly feel that Methadone probably isn’t the best option for young adults who have not yet established a truly independent life and still rely on their parents or anybody else to sustain their current way of life. Just look at the scenario above and you can see why I feel this way.
Personally, I feel that methadone may be an ideal choice for independent adults, already established with a current job or a career path and can support themselves and their treatment for as long as they need.
Regardless of whether or not you are an ideal candidate for Methadone or not, I also feel that it is ideal to get on and get off as quickly as possible.
Are you Clean and Sober Using Methadone?
This is a very controversial topic and a lot of people do not agree with me and have criticized and accused me of not being a true recovery advocate for making this claim, but I do still, genuinely believe that somebody taking methadone as directed by a physician and not abusing it is clean and sober, the same way someone who suffers from depression using Zoloft is still clean and sober.
Whether or not methadone is an ideal choice of treatment and possibly prevents you from moving forward in life as quickly as you would like to, is a completely separate question. As I have already described above, I feel that the older, more established independent adult who can afford their own treatment can continue moving forward in life without consequence as long as they continue with their treatment. While I personally feel it’s ideal to come off as quickly as possible, if someone is living a normal, healthy and productive life and chooses to stay on methadone for 10 years or even forever, that’s their choice and there’s nothing wrong with it.
The problem as I described it above has to do with preventing young, unestablished individuals who still have to depend on someone else from moving forward with life because methadone and or state insurance is holding them back. Thus, my advice to anyone in this position would be to start tapering off slowly as quickly as possible so that you can begin moving forward and living your dreams without being or feeling trapped.
No Judgment and Exceptions to Every Rule
Now I want to be clear that the above opinion is stated without judgment and there are also exceptions to every rule. I believe it is far better to live on methadone or Suboxone (even if you have to rely on state insurance) than it is to go back to living in active drug addiction and putting a needle in your arm.
Understand also however, the addiction is a lifestyle and just because you’ve stopped taking heroin doesn’t mean that it’s ok to keep using Xanax or other drugs. Methadone doesn’t help curb cravings for other drugs and thus, men and women using multiple drugs will have to find other ways to stop using those. Counseling and groups at the methadone clinic should be a valuable asset and tool to assist you in making a decision to stop using other drugs and live a substance free life.
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Written by William Charles, Owner / Publisher of Kill the Heroin Epidemic Nationwide™, Heroin News and the National Alliance of Addiction Treatment Centers (NAATC)
We are a community for recovering heroin addicts providing support and recommending the best treatments and clinics to people interested in conquering their addiction.
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