Dear Editor:
The author of a recent column on methadone exemplifies the adage about someone who knows just enough to be dangerous."" Mr. Seib is to be commended for his research in which he discovered a number of facts about methadone; but from these facts, he has come to an interpretation that is far from factual, and is potentially dangerous to your readers.
As a clinician in Addiction Medicine for 25 years, and now as President of the American Society of Addiction Medicine, I'd like to clarify some points for your staff.
1. Methadone is indeed a synthetic opioid; it is a powerful analgesic and can be used safely and effectively in pain management. It is best known, however, as a medication authorized by the federal government in 1970 to treat opioid dependence and withdrawal.
2. SuboxoneA,Ar is the trade name for buprenorphine, a synthetic opioid with unique properties. It can work for analgesia, but was approved by the federal government in 2003 to treat opioid dependence and withdrawal, and it is extremely effective and safe in so doing.
3. Patients who receive maintenance treatment for their opioid addiction with either methadone or SuboxoneA,Ar have not substituted one addiction for another despite this common misconception. A patient stabilized on maintenance treatment does not experience cravings or pre-occupation, does not use opioids in escalating doses or in an out-of-control manner, and is no longer in a state of active addiction, even though he or she is ""physically dependent."" Methadone is the most studied treatment in all of addiction medicine, and its benefits are clear-cut: Patients under treatment experience lower rates of Hepatitis C and HIV/AIDS, are more likely to be productive as employees or students, have much lower rates of criminal activity and usually do not use any unauthorized opioids or other illegal drugs.
4. Methadone is far from a ""horrible drug,"" as your headline blazed, and is clearly beneficial to society, not detrimental. Its availability (which is patchy in the United States, due to misconceptions, stigma and politics) vastly reduces injection drug use rates and the health consequences from such dangerous behavior. It is puzzling that your editorial team allowed such an inflammatory and inaccurate headline for a story whose first paragraph describes how maintenance treatment will ""slowly allow addicts to withdraw from their dependency (sic) and help them re-enter society.""
5. Methadone is not one of the most abused drugs, as your story asserts. It's way down the list among misused opioids, and cannabis use disorders are clearly more common conditions requiring professional help than are opioid use disorders. The biggest drug problem in our nation, and on UW-Madison's campus, is tobacco addiction; alcohol addiction is next. Methadone misuse and addiction pale in comparison to other illegal drug use and addiction.
6. Opioid use, in the form of VicodinA,Ar and OxyContinA,Ar and even heroin, is still rising among college age groups. Young people mistakenly view the ""snorting"" of heroin as fun and safe, often being scandalized at the idea of someone using a needle in their arm while viewing with equanimity the idea of oral or nasal use of the same drugs. Many of your readers or their friends will engage in ""recreational"" pill use or even regular nasal use of heroin or pain pills and develop an addiction which will interfere with academic progress or occupational stability. Your writer alluded to this: How many college students know acquaintances who use various euphoriants and are quick to offer testimonials to the quality of the high, while often adding disclaimers about the riskiness of use.
7. Many young persons who have developed opioid addiction have been helped tremendously by SuboxoneA,Ar treatment of their addiction and are able to resume the activities of a fully functional live with this treatment. Others have used methadone maintenance through one of Madison's licensed clinics to get back their lives after developing a disabling addiction.
8. The topic of opioid overdose deaths is an important public health topic that has been vexing for experts from around the nation. Data collection systems are not well enough developed to specify which deaths are due to opioids alone or opioids used in combination with sedative-hypnotics and/or alcohol; to specify which opioid overdoses are clinically significant because of methadone in a person's system or other opioids simultaneously present; or to specify whether methadone that was used in opioid overdoses has come from methadone clinics, specialized pain clinics, or primary care physicians or oncologists using methadone as an approved analgesic. It is not appropriate to slam methadone clinics or the methadone maintenance treatment approach for managing opioid addiction just because we know that methadone overdoses are on the rise in our nation's emergency rooms.
9. Your article quickly deteriorated, from some well quoted paragraphs based on the author's research, to mystifying commentary about overdoses on nicotine patches and graffiti about heroin being an ""anti-drug."" Heroin doesn't heal anyone of anything - it isn't trivial, and it is tragic when young people jokingly or otherwise try to trivialize it. Methadone is not a ""big killer"" compared to other ""street"" drugs, but its unique pharmacological properties make it quite dangerous in overdose situations and require doctors who prescribe it to be quite knowledgeable about how it can be used safely.
10. The bottom line: Methadone and SuboxoneA,Ar maintenance therapies can indeed be life-saving, and truly are so for many Madisonians, including college-age persons with opioid addiction. Persons recommended for such treatments should not be scared away from considering them due to misconceptions such as those fostered by your recent irresponsibly, sloppy student journalism.
NB: I am not affiliated with any methadone clinic and do not practice pain medicine using methadone as an analgesic. I refer patients to Madison's two methadone clinics when their condition warrants it, and I prescribe SuboxoneA,Ar to several dozen patients through Meriter Hospital's NewStart Clinic.
Michael M. Miller, M.D., FASAM, FAPA
Medical Director
NewStart Alcohol/Drug Treatment Program
Meriter Hospital, Madison, WI
Associate Clinical Professor, UW School of Medicine and Public Health
President, American Society of Addiction Medicine
