Recovery involves more than just drugs

I read in the Bangor Daily News that yet another methadone clinic is planning to open in Bangor. While the “Close to Home” public awareness campaign on opiate addiction attempts to educate area residents, I can’t help but think that it is really trying to clear the way for still more methadone treatment in a community that already has more treatment capacity than any other in the state. While I am not trying to minimize the problem of opioid abuse in northern Maine, I wonder why Bangor is willing to settle for what many regard as the easy way out of a complicated problem.

I have worked in the substance abuse and human services field for my entire career, in adult outpatient treatment, adolescent treatment, dual diagnosis, therapeutic communities, and a methadone maintenance clinic. I have a master’s degree and have dedicated my life to the prevention and treatment of substance abuse and related issues in Maine and throughout the country. So I do believe I have an informed opinion when I say that methadone as the front-line, and too often the only, treatment response to opiate addiction is not necessarily in the community’s best interest.

The initial goal of methadone maintenance is to achieve dose stability. Dose stability is achieved when opiate receptor sites are saturated with methadone, allowing an addict to go a full 24-hour period without experiencing craving or withdrawal symptoms. If sedation occurs, the dose is too high. At optimum levels, methadone causes no euphoria and actually blocks the effects of other opiates the addict may take in an attempt to get high.

Dose stability can usually be achieved within the first 30 to 90 days of treatment, and there is no question as to the benefits of this initial phase. At this level, methadone treatment can indeed be a lifesaver because it allows an immediate respite from an extremely high-risk and dysfunctional lifestyle, including the cessation of activities (particularly illegal activities) needed to support an opiate addiction. The addict is no longer driven by the need to obtain more drugs to prevent withdrawal. This allows the individual to return to a fairly normal lifestyle and employment – provided that he or she has the personal motivation to do so and is also addressing other drug and alcohol use that may affect the recovery progress.

Federal and state regulations require individuals receiving methadone therapy for addiction to participate in one hour per month of therapeutic counseling. This amount of therapy does not even constitute substance abuse treatment; it can best be considered dose monitoring. It is this lack of meaningful treatment that concerns me most about using methadone as the primary strategy for addressing the opioid problems in the community.

Some people receiving methadone may need only replacement drug therapy to get their lives back on track, but I can tell you they are by far the exception. Many addicts receiving methadone treatment continue to use cocaine, benzos, marijuana, alcohol and other drugs, yet only receive one to two hours of counseling per month to address their addiction. Given the depth of physical, psychological, emotional, family, employment, legal, financial and spiritual problems most addicts face, one to two hours of counseling per month will hardly matter, particularly when they are still actively using other drugs. Sure, they are stable regarding their opioid dependency, and the clinics can count on their steady business for the next four to five years, if not longer.

More and more people are entering methadone treatment at a young age, often after only a year or two of opiate use. And while they are surely suffering from some degree of dependency, the cure in this case may be worse than the sickness. Any addict who has tried to discontinue methadone therapy will tell you that the withdrawal from methadone is much worse and lasts much longer than withdrawing from other opioid drugs.

People in daily methadone treatment can never live too far away from the clinic, as the maximum number of take-home doses in Maine is limited to six in a week. And liquid methadone diverted from those take-home doses, taken illicitly in combination with other drugs, is frequently implicated in overdose deaths.

It all boils down to values. To medically manage the physical dependency of an opioid addict without addressing his or her other drug use, and without treating underlying psychological conditions, is an exercise in futility with many associated problems. Yet it seems to be the extent of Bangor’s response to the growing problem of opiate addiction.

When Acadia Hospital opened the first methadone clinic in Bangor, there was a tremendous community outcry. When it tripled its capacity, there was little notice taken. When a second clinic opened, there was only mild opposition. When Discovery House announced its plans, there was none.

Before allowing further expansion of the profitable methadone maintenance treatment industry, the city of Bangor should invest more in the full recovery of those afflicted by substance abuse, not simply the medical management of their opioid dependence.

Methadone maintenance, by itself, is not the answer.

– NAME WITHHELD BY REQUEST

Please join our weekly conversation about Maine’s substance abuse problem. We welcome stories, 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.