Gavril W Pasternak

METHADONE MAINTENANCE PROGRAMS The history of methadone treatment offers a striking example of the benefits and limits of research findings on public attitudes and policies for methadone maintenance treatment. To understand methadone maintenance treatment, it is necessary to appreciate the profound stigma attached to both patients and treatment providers. This establishes the context for understanding how a modality with the most extensive research base in the addiction treatment field nonetheless can engender passionate dispute.

Methadone maintenance as a treatment modality was developed in the mid-1960s by Vincent

Dole and Marie Nyswander in response to prevailing concerns about epidemic levels of heroin addiction and related health problems, mortality (especially among young people 15 to 35 years old) and high relapse rates. Methadone itself had been synthesized in Germany in World War II as a synthetic analgesic and was studied at the U.S. Public Health Service Hospital in Lexington, Kentucky, after the war. It was approved by the U.S. Food & Drug Administration in August 1947 for use in the treatment of pain. Its initial use in the treatment of addiction was to ease withdrawal in addicts being treated for heroin addiction; it was subsequently determined to be well suited to long-term maintenance treatment. As a treatment tool, methadone provides a safe and effective way to eliminate drug craving, withdrawal, and drug-seeking behavior, and free patients to lead productive lives. In conjunction with educational, medical, and counseling services, it has been thoroughly documented as enabling patients to discontinue or reduce illicit drug use and associated criminal activity, improve physical and mental well being, become responsible family members, further their education, obtain and maintain stable employment, and resume or establish a productive lifestyle. Despite three decades of research confirming its value, methadone maintenance treatment remains a source of contention among treatment providers, the public in general, and officials and policymakers in particular. Unlike controversies based on a difference of opinion between informed parties, debate about metha-done usually involves several common misunderstandings about the drug and its uses.

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