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The Potential Disadvantages of MMT

From: Chapter 3: The Fundamentals of Methadone Maintenance Treatment, in Methadone Maintenance: A Counsellor's Guide to Treatment (© 2003).

The disadvantages of regularly taking methadone compared with abstinence from all opioids, including methadone, are as follows:

  • Methadone can have side-effects. Common and persistent side-effects include sweating and constipation.
  • Methadone clients may find certain practices carried out by some programs or clinics degrading and demeaning. An example is the practice of an attendant observing clients voiding urine for drug screening.
  • MMT can be inconvenient. Clients must attend the clinic or pharmacy at least once a week to take an observed dose and pick up take-home doses. They may be called into the pharmacy on short notice and asked to produce their empty and full take-home dose bottles, and random urine samples must be provided on request. Clients are required to make regular visits to the physician and counsellor. Given the limited number of physicians, clinics and pharmacies participating in MMT in Ontario, clients may have to commute some distance or relocate. Should clients want to go away on vacation or travel for business, they may be limited by the need to guest dose at another pharmacy if they do not have full take-home (carries) privileges or are planning to be away for more than two weeks. In addition, MMT clients must remember to take their dose at the same time every day, and if they abruptly stop taking methadone, they will experience opioid withdrawal and craving.
  • Methadone clients may be stigmatized as "still addicted." Methadone treatment is not widely understood, and clients may face discrimination from a range of people, including former drug users in abstinence-based mutual help groups, and some health, social service and substance dependence treatment providers. MMT clients may also encounter discrimination in obtaining and retaining employment and in accessing public and private services.
  • Attending the methadone clinic can put clients into regular contact with others still using opioids, alcohol and other drugs. Clients who see a family doctor for their prescription, and who pick up their dose from a community pharmacy, are less likely to be exposed to active drug users.
  • Methadone is an ongoing expense. Although it is far less expensive than illicit opioids, there is still a direct cost to clients without insurance.
  • Methadone clients become dependent on their prescriber. A client in MMT is physically dependent on methadone, and his or her prescriber controls the access to it. The power imbalance gives the methadone-prescribing physician a great deal of control that can be misused.
  • In many jurisdictions, methadone clients who are detained by police for any reason may not be able to access their methadone because of police policy.