Methadone

In 1964 Doctors Dole and Nyswander gave twenty two hospitalized heroin addicts increasing doses of methadone until they reached a “stabilized state,” meaning that they had neither withdrawal symptoms nor a craving for further increases in the dosage: With repeated administration of a fixed dose, methadone loses its sedative and analgesic powers. The subject becomes tolerant.

The patients were then released, but they returned each day for an oral dose of methadone. The following year a research report by Dole and Nyswander (1965) revealed extraordinary results from this approach, which they ascribed to methadone’s ability to provide a “pharmacological block” against heroin. Furthermore, it was theorized, heroin abuse in certain addicts results in a metabolic disorder that requires the continued ingestion of narcotics if the person is to remain homeostatic. With such disorders methadone acts like any prescribed medicine, normalizing the patient’s functioning.

The typical methadone program begins with a period of inpatient care, during which low doses of methadone are substituted for heroin. (The patient is not informed of the dosage he or she receives.) The methadone is usually mixed with orange juice (which helps to reduce its bitter taste) and is consumed in front of a nurse. Slow increases in dosage reduce the high, which disappears once tolerance develops. Addicts subsequently report daily on an outpatient basis and are given take-home doses for weekends. As they progress, less frequent than daily pickups are permitted. Patients usually provide a urine specimen before they are given methadone. Castorama.

Furthermore, research revealed that the figures given out by Dole and Nyswander were deceptive: The rate of “cure” attributed to methadone was better explained by the screening mechanisms that were used—older and more motivated addicts were preferred—and by the fact that unsuccessful cases were simply dropped from the program and from the final tabulations. Methadone clinics came under severe attack by those associated with the drug-free therapeutic communities (discussed below), and by 1979 they were operating at about 90 percent of capacity (Blackmore 1979). Robert Newman (1977: xx) states that “proponents of specific treatment approaches rarely missed an opportunity to make exaggerated claims for their own modality and to vilify publicly other therapeutic efforts.” Residents also strongly opposed the opening of methadone treatment centers in their communities—the NIMBY (not-in-my-backyard) syndrome.