Hi,
I think i may well be a "Methadone Mullah", having prescribed it for
thirty years as an inner city GP.
I find the high emotion involved in what seems to be an "anti-
methadone" as much as a "pro-abstinence" debate, very surprising.
I think back 30 years, to when my GP Trainer told me that people who
use drugs to excess can be divided into " those who do it to get
'high' and those who do it to get 'by' " .
Those in the first group who find to their surprise, that they are
waking up shivering until they take heroin each morning, will
generally organise their own detox , with the help of family and
friends, and most will of course succeed and get on with their lives,
and some will write newspaper articles about their escape from heroin.
For those in the second group, heroin is not their only problem, and
they will not generally find it so simple, because when the cushion
of heroin is taken away, the pain of their lives will return. They of
course need a lot more psycho social help, but also will need time to
pass while they build other ways to cope.
This is the group helped by methadone or buprenorphine prescribed to
replace the heroin, as unlike heroin, these are both long acting
medications, which last more than 24 hours, and so allow the person
to wake in the morning without shivering and shaking, to raise their
heads from the immediate physical daily need for heroin , while they
regain their physical, social and psychological strength and well being.
Eventually it is my experience that in many cases these people will
feel able to plan a life without opiates. i have many patients who
have taken ten or twenty years to reach this level of strength, but
eventually they are delighted to escape from opiates (including
methadone ) and get on with their lives. I certainly do my very best
encourage people registered at my surgery on every occasion I see
them, to continue with life plans of every kind , while i continue
to prescribe the maintenance methadone which gives them the time and
space and strength to do that. A daily heroin habit is of course a
full time job, as funding, buying and using it generally leaves no
room for anything else.
Some of the damaged and struggling second group described above will
need and will eventually benefit from the kind of help only offered
within a "therapeutic community", and in the end that will of course
be their route to a life without heroin However most of the hundreds
of thousands of people (in the UK alone) who find themselves
dependent on heroin do not want or need to leave their own
communities in order to get on with their lives, but they may well
benefit from an interim period taking methadone . i cannot see why
this is thought to be so bad.
And then there is also the research evidence .....
all the best
Judith Yates
GP Birmingham UK.
On 28 Jul 2009, at 10:08, Henrik Thiesen wrote:
> Hi Rowdy
>
> You´re so right - calling methadone treatment "endorphine
> replacement" is in my opinion an absolutely faulty idea. In my
> opinion methadone or buprenorphine (or any other long-term opioid)
> can be used to give people addicted to opioids a break but over
> time things fall apart if nothing else is introduced. I have here
> in Denmark seen miserable "patients" on 3-400 mg´s of "endorphine
> replacement" so the replacement idea isn´t valid in my opinion.
>
> The use of methadone has, when given freely and liberally as it is
> in my country, a tendency to make the system sloppy. Problems are
> taken care of with more methadone ("because his only problem is
> lack of endorphines") and benzoes and lack of systematic health and
> social care is covered in more methadone. The result often is
> devastating.
>
> I have for 5 years been treating people who are "out of the system"
> which may mean that they get lots of methadone but no help beside
> that - and we can see that methadone helps a lot in the acute phase
> but after a while it is just another drug for many. I showed in my
> initial report on street-homeless drug users that the people with
> the most severe social- and health-problems were using just as many
> drugs if they were on methadone or not (and the Danish system does
> not exclude people who use drugs beside methadone so the endorphine
> replacement idea seems not to be valid here)
>
> If methadone management were a true treatment - it would be
> replaced by opioid rotation as we see it in pain management and the
> surrounding psycho - social care would be upgraded. As it is now I
> it may end up with a system that tries to force metadone on non-
> opioid addicted people as I have seen it at several occations -
> simply because they don´t know what else to do.
>
> Methadone is a drug among others in a complex treatment of a
> complex situation - it is not the treatment, except for those few
> that responds to methadone as an antidepressant - but they only
> need very little (5-10mg methadone or 2mg buprenorphine - which
> might be given as a patch)
>
> A new report from our center for durg research underlines the
> faulty system - most users on long-term methadone feels lost in a
> system which has lost interest in them - as a frontline treatment
> provider we also see it as a lowered system-interest and lowered
> financial support for drug free treatment.
>
> HenrikT (reviewer of the Danish Medicines List, Opioids and
> benzodiazepines)
> http://www.hjemlosesundhed.dk/?English
> ----- Original Message -----
> From: Rowdy Yates
> To: [log in to unmask]
> Sent: Saturday, July 25, 2009 12:32 PM
> Subject: Re: [EFTC] Methadone and the Damage Done
>
> Souraya
>
> Hello - hope things are good in Lebanon. As for Neuberger's
> response. This is no big surprise. As far as I can see, any time
> that a study produces even a partially critical result on MMT some
> methadone mullah steps up to say (a) this is a flawed study or (b)
> the sample is atypical or (c) it's the practitioners' fault for not
> giving the "patients" enough methadone!
>
> Draw your own conclusions on these desperate defences at a time
> when it would appear that the addiction business may again be
> slipping from the grip of the medical oligarchy!!
>
>
> Rowdy Yates
> Senior Research Fellow
> Scottish Addiction Studies
> University of Stirling
>
> http://www.dass.stir.ac.uk/sections/showsection.php?id=4
>
> http://www.drugslibrary.stir.ac.uk
>
> On 25 Jul 2009, at 10:05, "souraya frem" <[log in to unmask]>
> wrote:
>
>> hello roudy
>>
>> I just take that chance to send you my warmest regards to you and
>> everyone on the list :)
>>
>> just read the article you send and also had a look on the readers
>> comment
>> any clarification on that matter
>> just in order to have a clear unswer regarding methadone
>> definition & effectiveness
>>
>> quoting for the reader's comment:
>>
>> "J.R. Neuberger | 21 Jul 09
>> These "results" fly in the face of decades of research in the US
>> and point up no lacking in the effectiveness of methadone
>> treatment, but instead illustrate the results attained when
>> patients are chronically UNDERDOSED. At the proper dosage,
>> methadone treatment results in longevity AND reduced illicit opiod
>> usage. This study points up a serious flaw in how the treatment is
>> being dispensed in the region specified and nothing more. Also,
>> methadone is endorphin REPLACEMENT therapy and is a substitute for
>> nothing. The use of this terminology itself points up possible
>> prejudices on the part of the researchers of this piece.
>> "Substitution" implies one drug being replaced with another.
>> Methadone is, instead, a medical treatment for a medical
>> condition--that condition being a damaged endorphin system in the
>> brain which this therapy normalizes. It is endorphin replacement
>> therapy and is both safe and effective at the proper daily dose.
>> Kind regards, J.R. Neuberger National Alliance for Medication
>> Assisted Recovery"
>>
>> all the best
>>
>> souraya
>> On Tue, Jul 21, 2009 at 11:22 AM, Rowdy Yates
>> <[log in to unmask]> wrote:
>> This isn’t really about TCs but it is an interesting study showing
>> that whilst long-term prescribing of methadone reduces mortality
>> risks, it also increases the likelihood of continued injecting:
>>
>>
>> http://www.pulsetoday.co.uk/story.asp?
>> sectioncode=23&storycode=4123296&c=1
>>
>>
>> Rowdy Yates
>> Senior Research Fellow
>> Scottish Addiction Studies
>> Sociology, Social Policy & Criminology Section
>> Department of Applied Social Science
>> University of Stirling
>>
>> E: [log in to unmask]
>>
>> W: http://www.dass.stir.ac.uk/sections/showsection.php?id=4 (home)
>> http://www.drugslibrary.stir.ac.uk (library)
>>
>> T: +44(0)1786 – 467737
>> M: 07894- 864897
>>
>>
>> Academic Excellence at the Heart of Scotland.
>> The University of Stirling is a charity registered in Scotland,
>> number SC 011159.
>>
>
> Academic Excellence at the Heart of Scotland.
> The University of Stirling is a charity registered in Scotland,
> number SC 011159.
