The Potential Benefits of MMT
From: Chapter 3: The Fundamentals of Methadone Maintenance Treatment, in Methadone Maintenance: A Counsellor's Guide to Treatment (© 2003).
Many of the benefits of methadone maintenance treatment involve helping clients to avoid the harmful consequences of illicit opioid use and the lifestyle associated with illicit opioid use.
The potential benefits of MMT are the following:
- Methadone is pure. Illicit opioids may contain unsafe fillers, additives and solvents, which when administered may cause phlebitis or other harmful medical conditions.
- The exact opioid content of methadone is known. This means that a stable dose can be maintained. Because the opioid content of illicit opioids can vary from day to day, even when purchased from the same supplier, it is not uncommon for a surprisingly potent dose to lead to overdose.
- Methadone is legal. Possessing illicit opioids can lead to arrest and incarceration.
- Methadone is dispensed in pharmacies. Illicit opioids are purchased from drug dealers — whose transactions involve much more potential for violence.
- The stabilizing effect of methadone can make it easier for clients to care for family members, to attend school and to engage in a greater variety of work.
- Methadone can reduce needle sharing and help prevent the spread of infectious blood-borne diseases such as HIV infection and viral hepatitis. When methadone (taken orally) is substituted for fast-acting opioids such as heroin (usually injected), clients are less likely to inject opioids and share needles. Needle sharing exposes the user to disease, which may then be further spread to others through needle sharing or sexual activity. In this way, methadone helps to protect the client and the community.
- Methadone can help to normalize neuroendocrine function (e.g., by restoring normal menstrual periods in women who are dependent on opioids). Because methadone has a slow onset and is long-acting, its use as an alternative for other opioids, which have a fast onset and are short-acting, has a normalizing effect. MMT can help to normalize physical and psychological functioning through the day by alleviating the repeated cycles of intoxication and withdrawal experienced by people who use opioids. This normalization is particularly important for women who are pregnant and use opioids; opioid withdrawal can result in spontaneous abortion and premature labour, and developing babies share the stress of the ups and downs that characterize opioid use. This normalization is also important for clients suffering from other illnesses, such as acquired immunodeficiency syndrome (AIDS) and chronic hepatitis C infection.
- Methadone is affordable. As a prescription drug, the cost of methadone is usually less than $10 a day. For those who qualify, the cost may be covered by private health insurance or, in Ontario, by the provincial drug benefit plan. The high price of illicit opioids, in combination with the urgent craving associated with opioid dependence, leads some people to resort to crime (e.g., sex trade work, theft, burglary and/or drug dealing) to get enough money to buy illicit opioids. This puts them at risk of arrest, incarceration and/or violence.
- Methadone treatment can increase client contact with health care and social service systems. This gives treatment providers regular opportunities to offer medical care, counselling and case management to marginalized people who would not otherwise seek out these services. In general, opioid use puts people at a higher than average risk of injury, infections and other diseases. Psychiatric disorders are common among people who use opioids, as are histories of physical, emotional and sexual abuse.
- Methadone can be of benefit to opioid-dependent workers in the sex trade. This is because methadone is affordable, and because integral to an MMT program are an array of associated psychosocial services. Sex trade workers often have none of the protection society provides to other workers; they may suffer physical, emotional and sexual abuse through their work. They may be arrested and incarcerated for "communicating." If they work while intoxicated, the risk of unwanted pregnancy and exposure to sexually transmitted diseases increases. Methadone reduces the need for the high income needed to maintain an opioid dependency, which can be earned through prostitution. Once on methadone, opioid-dependent sex trade workers are more able to choose conventional employment. For those who choose to work in the sex trade, methadone can help clients avoid working while intoxicated and have access to psychosocial services that offer support and education in harm reduction.
- Methadone can reduce the costs to the community of policing, courts, prisons, health care, social services and support for the unemployed.