METHADONE

COMMON NAMES: Medicine, dollies, biscuits

Same narcotics, such as heroin, are cloaked in a shroud of crime, degradation, and death, while others, such as opium, evoke images of strange places and exotic rituals. Then there are narcotics, such as methadone, that sound like medicine. Actually, methadone is no less a narcotic than the others, but it is considered the "cure" for opiate addicts, their passport to a taxpaying, middle-class way of life.

Methadone is a synthetic opiate analgesic currently used in America as the leading treatment for narcotics addiction. A soluble white crystalline powder, usually ingested by tablet or mixed in a liquid such as orange juice, it is rarely injected, unless the addict has found some illicit source offering it as an injectable fluid.

First synthesized by the Germans during World War II to substitute for scarce morphine, methadone is only slightly more potent than morphine as a painkiller. Methadone has the distinct advantage over other narcotics of being nearly as effective orally as by injection. In addition, while most opiates must be administered every four to six hours to stave off withdrawal pains and anxieties, an adequate methadone dose lasts a full twenty-four-hour day, and can supplant narcotic cravings for up to forty-eight hours. The drug is manufactured by Ell Lilly & Company, and its legal use is totally restricted to licensed, regulated methadone clinics and hospitals; it cannot be purchased by prescription. As a result of illegal diversion of legally obtained doses, however, it can often be purchased on the street by addicts.

Methadone, a central-nervous-system depressant,' is an effective painkiller and cough suppressant. However, the Federal Drug Administration has not approved its medical use. The drug can only be legally dispensed for treatment of addiction.

The history of addiction treatment is a curious one. At one time cocaine and heroin were thought to be harmless, nonaddicting alternatives to opium addiction, and opium was used for the treatment of alcoholics. Methadone is now prescribed for heroin addiction. A highly addictive substance that chemically blocks the craving for heroin, it does not provide heroin's warm, euphoric rush. Nor is it a drug that creates tolerance in the user. The methadone addict does not need increasingly larger doses to retrain comfortably, "normal." In fact, dosage can usually be reduced after the addict has been detoxified from heroin. The drug' produces a cross-tolerance to heroin. This means that if an addict tries -heroin while on methadone, the heroin will have no effect.

There are some scattered reports of bone-muscle pain, hallucinations, constipation, nausea; mental lethargy, and impotence from methadone use, but the majority of evidence supports the °view that it causes no permanent physiological damage and leaves the addict clearheaded and healthy. Heroin's illegality and high price often cause a disruptive, criminal lifestyle that becomes unnecessary when the addict can get free; methadone at the local clinic. Methadone patients commonly Lead normal, productive lives, taking care of their families and showing up regularly for work.

If the addict does not get his adequate daily methadone dose, he is subject to withdrawal trauma--diarrhea, hot and cold flashes, sweating, insomnia, and stomach pain. The withdrawal phase may be less intense than heroin's three days of horror, but it can last as long as two weeks.

Methadone obliterates what is known as post-abstinence syndrome--that intermittent, gnawing desire for heroin that lingers on after withdrawal. The drug decreases anxiety, `although it is not a potent mood elevator. Methadone creates psychological and physical dependence, which may help explain its success in addiction treatment. In all Cages, prescribing proper dosage should be left to professionals. Addicts with low tolerance levels may require special dosage to avoid potentially lethal results. Non addicts can easily die from using methadone.

Of the approximately 500,000 American opiate addicts, 75,000 to 100,000 are currently undergoing methadone treatment. Large doses of the drug are administered for about , two weeks to detoxify heroin addicts and ease withdrawal pain. A few heroin addicts detoxify regularly, later, returning to the  use of illicit heroin at a lower dosage level and cost. Methadone maintenance clinics have been in operation for over ten years. Their "success rate" is quite impressive, judging by the percentage of patients who do not revert to heroin use. Clinic sources claim that 80 percent of their patients stay in the program, and, of those, 90 percent remain heroin free.

Initially, methadone treatment was envisioned as a temporary therapy that could be discontinued after a patient had received decreasing doses for several months. Methadone maintenance is now believed to be a permanent treatment. The patient must regularly visit a clinic and receive his daily medication or he will revert to his previous opiate addiction. For reasons that may have more to do with human nature than with pharmacology, most heroin-free methadone patients dabble in other drugs, including barbiturates, cocaine, and alcohol; 20 percent become alcoholics. Only Z .pert of methadone patients stay free of other drugs, so methadone's "success rate" must be carefully considered.

Why not legalize and dispense heroin itself if the addict must stay on methadone, another opiate, the rest of his life? Certain advantages to methadone use lead most health professionals to prefer it in the treatment of opiate addiction. Since the drug is fully effective when taken orally, the need for injection is eliminated, along with debilitative diseases such as hepatitis, caused by the use of needles. Methadone is also longer-acting than heroin. The addict need report for a methadone dose only once a day. A new, experimental opiate substitute, LAAM, has the advantage of lasting up to seventy-two hours {see LAAM}.

Although the medical benefits of methadone are real, the primary advantage to the addict is that the drug is free, or available for a small fee. He no longer has to hustle in heroin's gutter, underworld. Without the addict's constant pressure to feed his expensive $50-to-$100-a-day habit, society benefits from a reduced crime rate.

The "best" treatment for opiate addiction would, be an absolute cure, or at least addiction prevention through effective education. Until this happens, methadone seems to provide a relatively safe and economical alternative to the ravages of heroin.

The drug is currently listed and regulated under Schedule II of the Federal Controlled Substances Act.