In a recent column, “Anonymous” – a soon-to-be-released inmate at the Mountain View Youth Development Center in Charleston – described her path to addiction and her fears about re-entering society from a drug-free environment. Bangor psychologist Jack Keefe responded to her letter in the same issue. We received several responses, most of which assumed Anonymous was a young man.

The poignant appeal for help occurs thousands of times a year from people leaving jails and prisons and going back to an environment filled with cues that can trigger drug cravings and lead to relapse. This young man is going to experience cravings triggered by the sights, sounds, places and people associated with past drug use.

There is a medication specifically for detoxed opioid patients returning to a cue-rich environment. The medication is called naltrexone. Naltrexone was approved by the FDA in 1984 to treat heroin addiction. It is an ideal medication for people returning home from jails, prisons and inpatient treatment programs.

Naltrexone is nonhabit-forming and nonaddicting. It protects the patient from accidentally or impulsively using any opioid like heroin, OxyContin, Vicodin etc. If the patient uses any of these drugs, he will not experience a “high” and is therefore less likely to relapse. The patient needs to take two tablets every other day to be fully protected.

The key to successful naltrexone therapy is taking it under supervision. Somebody must watch the patient ingest the medication. This can be done at a local pharmacy, a health center, a probation office etc.

We have treated hundreds of opioid addicts with naltrexone and the results are amazing. This young man should ask the prison infirmary to start him on naltrexone one to two weeks before release and continue the medication for a minimum period of six months. He should also attend self-help groups one to two times a week. If he goes back home on naltrexone, the Pavlovian “bell” of craving can ring but the drug-taking response will not occur because he knows that the naltrexone will not allow the heroin to act in his brain.

– Percy Menzies, pharmacist, Assisted Recovery Centers of America, St. Louis, Mo.

Don’t dismiss methadone

After reading last week’s letter from the young man who is soon to be released from prison and feeling nervous, I know I would be nervous also. But I was disappointed that [psychologist Jack Keefe] did not provide a more favorable discussion of methadone.

He was right on the mark about how we destroy our endorphin system, which is so important to leading a fulfilling life. He is right that there is no medication on the market to replenish our endorphins except another opiate. Methadone is one such medication.

After nine months of white-knuckling it, my endorphin system had not replenished itself. Plain and simple, methadone saved my life whereas Alcoholics Anonymous and Narcotic Anonymous, inpatient care or outpatient treatments did not work. I am not addicted to methadone, but I am dependent on methadone. I do not experience any euphoria from using methadone.

Sure, the new drug buprenorphine is a godsend, but it is often only good for those in the earlier stages of addiction.

I wish the stigma and all the negativity about methadone would go away and it would just be accepted as an effective medication for the treatment of opiate addiction.

– Skip, Ocala, Fla.

This letter came in response to last week’s column by Barbara Royal, director of the Open Door Recovery Center in Ellsworth.

Long-term methadone treatment best for many addicts

Buprenorphine (i.e. Subutex or Suboxone) is an alternative treatment for opiate addiction; however, it is not as effective in treating some opiate addictions as methadone. There are significant differences in the way each medication works in the brain’s opioid receptor site.

Research on cost versus benefit for society when a patient is in methadone treatment shows that there is an average of $38 saved in social and health costs for every dollar spent on methadone maintenance therapy. This is based on a lifetime of maintenance therapy rather than temporary dosing for purpose of detoxification. With detoxification, the benefit decreases to an average of $7 for every dollar spent.

Some people argue that methadone maintenance is nothing but a crutch. Dr. Vincent Dole, the pioneer of methadone maintenance treatment, said in an interview that if a man lost his leg, the best case scenario would be to re-grow the leg. But that is not feasible, so the next best thing would be to give him a crutch (or an artificial leg), so he may be able to manage and have a more fruitful life.

To say that all patients in addiction treatment should aim for total abstinence is naive at best. It is an opinion that has detrimental consequences to patients, their families and society at large.

– Ericka R. Lear, Acting Director, Pennsylvania chapter of the National Alliance of Methadone Advocates

Please join our weekly conversation about Maine’s substance abuse problem. We welcome comments or questions from all perspectives. Letters may be mailed to Bangor Daily News, P.O. Box 1329, Bangor 04401. Send e-mail contributions to findingafix@bangordailynews.net. Column editor Meg Haskell may be reached at (207) 990-8291 or mhaskell@bangordailynews.net.