Impact of Short-Acting Heroin versus Long-Acting Methadone Admin

Impact of Short-Acting Heroin versus Long-Acting Methadone Administered on a Chronic Basis in Humans

Methadone, as a treatment for opiate addiction, is one of the greatest medical discoveries of the 20th Century.  Discovered by Dr. Vincent Dole, Dr. Marie Nyswander, and Dr. Mary Jeanne Kreek at The Rockefeller University in the 1960s, it has been approved by the World Health Organization, and it is used throughout the planet as a front-line treatment against the scourge of heroin addiction.  While life-saving, it remains tragically misunderstood.

In 1988, Dr. Dole was awarded the Albert Lasker Award – also known as the American Nobel Prize – for the creation of Methadone Maintenance.

His thoughts:

“The practical success of maintenance in rehabilitation of tens of thousands of addicts, now especially important as a measure of limiting the spread of acquired immunodeficiency syndrome, has been documented….”

“Then, as now, it was clear that narcotic addiction could not be eliminated simply by prohibition, however severe the penalties. For a chronic user, the need for narcotic is inelastic. With tens of thousands of such persons as a market, limiting supply without reducing demand increases the price of illicit drugs to the point that black marketers are willing to take the necessary risks. The net result is a highly profitable business for the drug sellers, corruption of government officials, infiltration of legitimate business with laundered money, increase in crime committed by addicts to support their expensive habits, filling of jails, and deaths from injection of contaminated drugs of uncertain potency. The clear lesson to be learned from repeated failures of past policy is that demand must be reduced by effective treatment.

The epidemic of narcotic use has not been extinguished by prohibition, civil commitment, jailing, or other punishments. …”

[In the original studies] “A remarkably different result was seen when, in the course of the scheduled testing, methadone was administered. The fluctuation in clinical state became less and then disappeared. Doses became stable. The patients seemed normal. Most remarkably, their interests shifted from the usual obsessive preoccupation with timing and dose of narcotic to more ordinary topics (Dole, Nyswander & Kreek, 1966).”

“The treatment is corrective, normalizing neurological and endocrinologic processes in patients whose endogenous ligand-receptor function has been deranged by long-term use of powerful narcotic drugs. …With long-term administration of narcotics, the modulating system is downregulated. The receptors become insensitive both to narcotic drugs and to their natural ligands. A new stability is achieved if methadone is given in an adequate daily dose, but at the price of continued dependence on the medication.”

“Objectively measurable physiological disturbances persist after detoxification from heroin or any other narcotic that has been used for a long time.”

“None of these theoretical speculations should divert attention from the fact that methadone maintenance is an available treatment for otherwise intractable addicts. It is effective under a wide variety of conditions provided that an adequate, constant daily dose is given. Like digitalis, methadone can be lifesaving. …

Apart from theory, the most striking fact is the physiological normality of maintenance patients. Persons who have taken a constant daily dose over a period of months to years are indistinguishable from normal peers. Despite a daily dose that would induce a coma in a naive patient, the patients are normally alert and functional; they live active lives, hold responsible jobs, succeed in school, care for families, have normal sexual activity and normal children, and have no greater incidence of psychopathology or general medical problems than their drug-free peers. Surprisingly, considering the constant input of narcotic, they have a normal response to painful stimuli, including specifically the warning symptoms of surgical emergencies.” – Dr. Vincent Dole (1988)

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