Methadone clinics unfairly stigmatized
We applaud the Baltimore Sun editorial board for its timely and important editorial (“Don’t let shootings fuel critics of methadone clinics,” July 16) exhorting readers not to disregard the data supporting the safety and efficacy of methadone treatment in the wake of the tragic shooting at the Man Alive clinic last week.
Of the three FDA-approved medications for the treatment of opioid use disorder, methadone has the most data supporting its effectiveness. Numerous studies have shown that treatment with methadone is associated with decreased illicit drug use, improved retention in drug treatment, increases in employment, reduced criminal activity, reduced transmission of HIV and Hepatitis C and reduced death rates, both from overdose and other causes. Mortality rates are two to three times higher for those not on medication. As the editorial board stated so well, “methadone works.”
In our clinical work with individuals with opioid use disorder, we individualize treatment and offer methadone, buprenorphine, or naltrexone to patients according to their clinical situation and personal preferences. Methadone is a safe, effective and indispensable treatment for many people in recovery in Baltimore and across the country.
An oft-repeated trope is that people taking methadone are “just trading one addiction for another.” This stigmatizing misconception conflates physical dependence with addiction. Methadone reduces cravings and blocks the “high” that can come from other opioids, such as heroin or fentanyl. Regular use of the medication causes predictable physiologic changes in the body , meaning withdrawal symptoms occur if the medication is stopped or drastically reduced abruptly. This is physical dependence. Physical dependence is not the same as addiction which, by definition, involves compulsive use of a substance despite negative, harmful consequences for the person with the disease.
The editorial board’s piece correctly points out that opioid treatment programs (“methadone clinics”) have been demonstrated to be just as safe as other businesses, with respect to surrounding criminal activity, and emphasizes the need for continued access to this mainstay of treatment in the fight against opioid use disorder and overdose deaths.
In the wake of the Man Alive tragedy, it is especially important to reaffirm the critical role that medications for addiction treatment, including methadone, play in saving and improving the lives of Marylanders.
Dr. Natalie Spicyn, Dr. Anika A. H. and Dr. Megan Buresh, Baltimore
The writers speak on behalf of the Maryland-DC Society of Addiction Medicine, a chapter of the American Society of Addiction Medicine.