Methadone Maintenance Treatment

In modern medicine, opioid dependence or opioid addiction is regarded as a chronic disease that goes through cycles of remission (temporary diminution) and relapse (acute exacerbation). There are different treatment approaches for this disease that fall into two major groups:  drug-free lifestyle oriented therapy and agonist maintenance therapy, i.e. substitution therapy.  For the society, especially for the family members and next of kin of the drug-dependent individuals the most desirable treatment method is the one that is oriented on cessation of drug use from the very outset. However, the years-long international experience shows that it hasn’t been proved to be a highly effective treatment.

In this regard, a different treatment approach has been developed- the so-called agonist maintenance therapy, or substitution therapy, which implies application of substitute narcotic substances for a relatively long period of time. It is recommended that such therapy be combined with psychosocial support activities. Today, agonist maintenance therapy is regarded by international experts as the most effective means to treat opioid-dependent persons, to ensure their decriminalization, social integration, as well as to reduce harmful effects associate with the use of ‘street drugs’.

First introduced in the USA back in the 1960s, the substitution therapy is nowadays widely applied across the globe. The expansion of these programs was triggered by HIV/AIDS epidemic, as the aforesaid treatment is basically the only means to prevent the spread of HIV/AIDS and Hepatitis C among injection drug users.

Buprenorphine and methadone hydrochloride, or buprenorphine/naloxone combination, are mostly applied in the agonist maintenance therapy nowadays because of their specific therapeutic properties.

Methadone is a long-acting (lasting 24-36 hours per dose) synthetic narcotic substance. It is an opioid agonist, which implies that it has the same effect as morphine or similar narcotic substances. If applied in doses relevant to the maintenance therapy, it considerably reduces the need for drug without producing narcotic effect (so-called ‘high’) and eliminates withdrawal symptoms (so-called ‘jonesing’). Patient who undergo methadone therapy under medical supervision usually feel themselves well, they are adequate and able-bodied. Such treatment allows an opioid-dependent person to improve his/her physical and mental health, to give up on criminal life, to learn and work effectively, to become a full-fledged member of his family or community. The agonist maintenance program helps some patients to completely give up drugs, including substitutes, and start a drug-free life.

Methadone hydrochloride syrup, oral solution or tablets are applied in the maintenance therapy. It is recommended that they should be taken in a specialized institution or unit, under direct supervision of healthcare personnel, in order to maximally prevent outflow of methadone from a medical institution to the ‘black’ market. To avoid use of illegal drugs (so-called ‘street drugs’) the patients are regularly subjected to urine chemical and toxicological testing for detection of narcotic / psychotropic substances.  In case of patient’s failure to comply with the appropriate treatment regime, including use of drugs not prescribed by a doctor, he/she may be required to quit the program.

In case the drugs are taken without a doctor’s relevant prescription, the involvement in agonist maintenance therapy program in no way exempts a patient from legal liability.

Agonist maintenance therapy for opioid dependence has been recommended by the World Health Organization (WHO). This very organization has put methadone hydrochloride on the List of Essential Medicines.