The World Health Organization (WHO) has estimated that close to three million people in Europe and the US are addicted to some type of opiate, and in the US alone, over two million people are addicted to prescription opiates, and opiates make up 83 percent of admissions for intravenous drug addictions. This has given rise to many treatment methods to address opiate abuse. Two of those treatment methods are Methadone Maintenance Treatment or MMT and Rapid Opioid Detoxification ROD. While ROD is dangerous, and costly with few lasting results, Methadone Maintenance Treatment offers opiate addicts a safer, less expensive alternative with high success rates. While the argument persists that MMT programs are allowing the addict to trade one substance for another, the means of this justifies the end, and offers the addict a way out. Rapid Opioid Detoxification (ROD) is based on the theory that persons addicted to opiate based substances, only continue to use because the withdrawals are often too harsh and painful to safely make through. Nausea, vomiting, tremors, fever, cold and hot sweats, convulsions, and seizures are what awaits an opiate addict upon coming off of the drug.
The ROD program promises to obliterate. Upon intake the addict is asked to provide information on medical history, as well as drug abuse background. They are then asked to give a urine specimen, so that a positive need for treatment can be obtained. Once that need is established, an appointment is set. Usually within 72 hours after intake. On the day of the detox session the patient is expected to have abstained from illicit drug use for 24 hours. This reduces the risk of drug interactions. If the patient fails to do so, they will be asked to reschedule. Vital statistics are observed, the patients are assigned a room, hooked up to various monitors, and given anesthesia to render them unconscious. Once the patient is asleep a drug is introduced to their system to counteract, reverse, and clean the system of opiates. This plunges the patient into immediate full-onset withdrawals. For the next 3 to 5 hours the patient is wracked with agonizing convulsions, diarrhea, vomiting and sweats. Sometimes vitals drop and resuscitation is needed.
This makes it imperative that staff trained in life saving techniques remain vigilant through the entire process. Upon waking the patient will have no recollection of the process. Promoters of ROD promise that up to six months of withdrawal symptoms will be compressed into that 2 to 5 hour session. Although, according to the patients, this does not diminish the withdrawals or lessen the time frame for withdrawals to diminish and the cycle to complete. (This renders the whole ROD process useless in the eyes of many previous participants.) After the session, a different drug is then placed in the abdomen to block any euphoric effects of heroin and other opiate based substances. After a brief counseling by the prescribing doctor, the patient is released with a list of counseling agencies in their particular area. No follow up is required. According to the World health Organization this implantation causes the addict to try to overcome the blocker and thus overdose. The addict also, having all tolerance removed during the detoxification process, often picks up where they left off.
This I dangerous and often leads to death. On the other hand, new intakes to the Methadone Maintenance Treatment (MMT) are also assessed in much the same way that new patients for the ROD treatment are. Providing medical and drug backgrounds they also must provide a urine specimen to establish need of the treatment. (Although in the case of Fentanyl abuse, a blood test must be performed.) Once the positive for opiate abuse is confirmed, the similarities to Rapid Opioid Detoxification end. The patient then needs to have a physical performed to address any previously ignored medical problems, and make sure they are in fact, healthy enough to undergo treatment. The liver, kidneys and heart must be tested for abnormalities. Hepatitis C and HIV/AIDS tests are given. An initial assessment by a counselor is provided to a=determine emotional causes of substance abuse. (If emotional or mental problems are present, they are usually assigned to the appropriate staff, not to an outside agency.) Once the admittance process is completed, it usually takes up to two weeks to begin dosing.
Dosage usually depends on the severity of the patient’s substance abuse, but other factors such as tolerance and metabolism plays a big part in dosage as well. Most patients will begin at 10-20 mgs daily with increments of 5-10mgs every 5-7 days. This continues until therapeutic dose in reached. (Therapeutic dose is the lowest dose possible to achieve cessation of cravings and pain of withdrawal. Usually over 50mgs to maximize benefits.) Patients are encouraged to continue the therapeutic dose for a minimum of two years. Once a patient has decided to begin a taper, it is highly recommended that they not go down more than 2-4 milligrams weekly. Coming off at such a reduced rate will allow the patient to experience weaker withdrawals that take longer, and are spread out over several months instead of very intense withdrawals, experienced all at once, that put the patient at increased risk for relapse.
Another contrast in the ROD program and the MMT program is that ROD is a very dangerous practice, resulting in seizures, heart attack, respiratory depression, and death in patients that are unhealthy to begin with, and taking into consideration, the fact that attention has not been paid to the addicts health in quite some time, makes the practice much more unsafe. There is also no way to determine how each individual will react to the opioid reversal drug, or how their bodies will hold up to the horrendous amount of stress caused by the withdrawal process. It is almost impossible to determine if an addict has maintained abstinence for the prescribed amount of time before the session. Several deaths in 1996 , resulting from inadequate measures being taken to ensure enough time had passed since the patient had last used, and the therapy session. This, as well as, other factors caused the FDA to pull their previous backing from the ROD programs, as well as, the ultra- rapid detoxification programs, deeming them unsafe and “…although showing promise, needs further study…”
Also, six deaths at a prominent clinic in Toronto forced the health department and other organizations to do evaluations into the safety of the practice, and forced subsequent closure of aforementioned clinic. The health department’s findings had a domino effect on the closings of clinics around the country and in Canada. Although, it is not illegal to operate a ROD clinic in the United States, it is becoming increasingly harder to find an ROD treatment facility that operates a legitimate Rapid Detox Program.Another risk to the ROD program is the implantation of Naltrexone. This is the drug that is placed in the abdomen to stop the effects of opiates. The drug attaches itself to the opioid receptors in the brain. This makes it extremely hard to feel any effects from the drugs. The addict relies on these effects when getting “high”. When those receptors are blocked, it forces the addict to go to greater and greater lengths to gain any feeling of euphoria. This results in toxicity and sometimes even death, as the addict has no idea of the effect the drug has on his/her body since they are not feeling the usual effects. Even though MMT programs are a safer option, they are not without substantial risks.
Methadone, like any other opiate, is an addictive substance. Therefore, there is a potential for abuse and patients must be closely monitored. Another risk factor comes from patients active on the MMT program abusing/using other legal and illegal drugs, particularly benzodiazepines, certain psychotropic drugs , as well as natural supplements and OTC drugs. Therefore it is very important to inform all healthcare staff and facilities from which you receive care, of all vitamins, medications, and to ask what possible side effects and interactions you could expect from these. (Certain allergy medications should be avoided) It is also important to carry a card (usually provided by the MMT clinic) stating your status as a methadone patient. This help in avoiding the accidental administering of opiate antagonist that can result in severe, immediate withdrawals. In addition to the health risks of the programs, efficiency needs to be addressed. Methadone treatment began showing promise in treating opiate addicts in the mid-1950s, with the first clinics opening in the early 1970s.
Since the opening of those clinics, studies in the U.S. an Australia have shown promise in an area otherwise void of progress, with opiate addicts on methadone therapy taking successful strides toward recovery, many of whom had repeatedly tried and failed to achieve sobriety. Patients in the MMT programs, began almost immediately, to show progress toward becoming productive members of society. With the instances of criminal activity, high risk behaviors, (needle sharing, and sex for drugs) and overdose on the decrease, and taking care of employment, familial, medical and personal responsibilities on the increase, MMT found backing in all phases of the government as well as private parties. Countless studies since the beginning of MMT programs have shown the effectiveness of methadone maintenance programs, with the majority of patients on the program for two or more years, not relapsing, and of those who did relapse, more than half returned to be successful on the clinic. In comparison Rapid detox programs have a relapse rate of well over half returning to drugs with in seventy two hours.
While some attribute this to the continuing effects and pain of withdrawal symptoms, others attribute the high relapse rate to the fact that there is no form of continuing care offered to the patient. However, it may, in fact, be a combination of the two that is responsible. Along with the withdrawal symptoms, and the fact there is no one else to turn to, to help with the temptation of easing those symptoms with drugs, the addict, with no skills to keep them clean, feel as though there is no alternative, and give in , if only to ease the pain. Thus the cycle is started once again. Another aspect of the ROD clinics is the astronomical costs. Ranging anywhere from $6,500 to $20,000 for a one day treatment session., makes this form of treatment out of reach for thousands of people suffering from an opiate addiction. Seeing that there are millions of addicted persons who come from a low socio-economic background and are living in squalor, makes it seem as though ROD programs are only for the wealthy. This is a bit hard to swallow, because to effectively address the problem of addiction, we need to focus on addiction in all classes, not just the wealthy.
While Rod clinics only offer their services to people who can afford to shell to thousands of dollars for a one day session, MMT programs offer either free or low cost treatment. And with the backing of government funding to help addicts return to normal life, the treatment has become available to all classes of people. Even without the funding from the government, MMT programs are relatively inexpensive. Ranging from $65.00 – $77.00 weekly, with some clinics letting patients pay by the day. This makes it easier for poorer people to gain access to treatment. The weekly price includes: counseling sessions, individual and group, doctor visits, urine screens, and medication. (Methadone) this is a huge contrast to the price of ROD programs and what they include. There is no denying that the Methadone treatment program is superior in treatment, efficiency, as well as the cost. Looking at the healthcare risks, the cost, and relapse rates, it is hard to understand why ROD practices are still in existence.
The argument against MMT programs are made mainly by the backers of the rapid detox programs, and uninformed people who have no understanding of how methadone works as an opiate blocker, reduces cravings and withdrawal symptoms. While it is understandable that the argument against methadone maintenance programs is that addicts are in essence, trading one highly addictive, illegal substance, for another highly addictive, legal substance. Which may in fact, be the case, although to counter that argument, on one hand, you have an addictive substance that allows no room for anything else, takes over your life and often leads to death, on the other hand, you have an addictive substance, that helps the addict become stable and productive, take control of their lives, and become something they never dreamed. If someone condemns another for choosing life, then so be it. Sometimes, life is held in the hand least expected.