Journal of Medical Toxicology

, Volume 12, Issue 1, pp 58–63 | Cite as

Pharmacotherapy of Opioid Addiction: “Putting a Real Face on a False Demon”

  • E. Salsitz
  • T. WiegandEmail author


Methadone maintenance therapy (MMT), a pharmacological treatment for opioid use disorder for the past 50 years, continues to remain controversial. Despite consistent and overwhelming evidence confirming the effectiveness and safety of MMT, misconceptions and myths persist regarding its legitimacy as a treatment for opioid addiction. This often results in the underutilization and limited availability of this treatment modality. Despite successful outcomes, the controversial nature of MMT, and the stigma experienced by the patients on methadone, has been a particularly difficult obstacle to overcome. We present the history of MMT, review the evidence for its efficacy in the treatment of opioid dependence, and explore the origins of the stigma and misconceptions related to MMT.


Methadone Addiction Medication assisted treatment Drug dependence Opioid addiction 


  1. 1.
    Federal Narcotic Farm. Cal West Med, 1935. 42 (3): p. 228-9.Google Scholar
  2. 2.
    Administration, S.A.a.M.H.S. Federal guidelines for opioid treatment programs. Rockville: Substance Abuse and Mental Health Services Administration; 2015.Google Scholar
  3. 3.
    Control, U.S.D.o.J.O.o.D. Title 21 Code of Federal Regulations Part 1306: Prescriptions. 2015 [cited 2015 7/18/2015].Google Scholar
  4. 4.
    Courtwright DT. The prepared mind: Marie Nyswander, methadone maintenance, and the metabolic theory of addiction. Addiction. 1997;92(3):257–65.CrossRefPubMedGoogle Scholar
  5. 5.
    Alcoholism, N.Y.O.o. and S.A. Services, methadone treatment works: a compendium for methadone maintenance treatment. 1994: New York State Office of Alcoholism and Substance Abuse Services.Google Scholar
  6. 6.
    Dole VP, Nyswander M. A medical treatment for diacetylmorphine (heroin) addiction. A clinical trial with methadone hydrochloride. JAMA. 1965;193:646–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Stimmel B, Kreek MJ. Neurobiology of addictive behaviors and its relationship to methadone maintenance. Mt Sinai J Med. 2000;67(5-6):375–80.PubMedGoogle Scholar
  8. 8.
    Kaufman MJ et al. Cerebral phosphorus metabolite abnormalities in opiate-dependent polydrug abusers in methadone maintenance. Psychiatry Res. 1999;90(3):143–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Langleben DD et al. Acute effect of methadone maintenance dose on brain FMRI response to heroin-related cues. Am J Psychiatry. 2008;165(3):390–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Sees KL et al. Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA. 2000;283(10):1303–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Nicholls L, Bragaw L, Ruetsch C. Opioid dependence treatment and guidelines. J Manag Care Pharm. 2010;16(1 Suppl B):S14–21.PubMedGoogle Scholar
  12. 12.
    Kreek MJ et al. Methadone use in patients with chronic renal disease. Drug Alcohol Depend. 1980;5(3):197–205.CrossRefPubMedGoogle Scholar
  13. 13.
    Atkinson TJ, Fudin J., Wegrzyn EL, Bettinger JJ. Dialysis, opioids, and pain management: where’s the evidence? Practical Pain Management, 2014. 1-14.Google Scholar
  14. 14.
    Krambeer LL et al. Methadone therapy for opioid dependence. Am Fam Physician. 2001;63(12):2404–10.PubMedGoogle Scholar
  15. 15.
    Centers for Disease, C. and Prevention. Vital signs: risk for overdose from methadone used for pain relief—United States, 1999-2010. MMWR Morb Mortal Wkly Rep. 2012;61(26):493–7.Google Scholar
  16. 16.
    Chou R et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–30.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Medicine, t.A.A.o.P. The evidence against methadonea as a “Preferred” analgesic: a position statement from the American Academy of Pain Medicine. 2014. the American Academy of Pain Medicine.Google Scholar
  18. 18.
    Justo D et al. Methadone-associated Torsades de Pointes (polymorphic ventricular tachycardia) in opioid-dependent patients. Addiction. 2006;101(9):1333–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Katchman AN et al. Influence of opioid agonists on cardiac human ether-a-go-go-related gene K (+) currents. J Pharmacol Exp Ther. 2002;303(2):688–94.CrossRefPubMedGoogle Scholar
  20. 20.
    Bliesener N et al. Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab. 2005;90(1):203–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Hallinan R et al. Erectile dysfunction in men receiving methadone and buprenorphine maintenance treatment. J Sex Med. 2008;5(3):684–92.CrossRefPubMedGoogle Scholar
  22. 22.
    Kreek MJ. Rationale for maintenance pharmacotherapy of opiate dependence. Res Publ Assoc Res Nerv Ment Dis. 1992;70:205–30.PubMedGoogle Scholar
  23. 23.
    Gottheil E, Sterling RC, Weinstein SP. Diminished illicit drug use as a consequence of long-term methadone maintenance. J Addict Dis. 1993;12(4):45–57.CrossRefPubMedGoogle Scholar
  24. 24.
    Gronbladh L, Ohlund LS, Gunne LM. Mortality in heroin addiction: impact of methadone treatment. Acta Psychiatr Scand. 1990;82(3):223–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Ball JC, Ross A. The effectiveness of methadone maintenance treatment. New York: Springer Verlag; 1991.CrossRefGoogle Scholar
  26. 26.
    Kleber HD. Methadone maintenance 4 decades later: thousands of lives saved but still controversial. JAMA. 2008;300(19):2303–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Novick DM et al. Absence of antibody to human immunodeficiency virus in long-term, socially rehabilitated methadone maintenance patients. Arch Intern Med. 1990;150(1):97–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Metzger DS et al. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr. 1993;6(9):1049–56.PubMedGoogle Scholar
  29. 29.
    Des Jarlais DC et al. HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. JAMA. 1989;261(7):1008–12.CrossRefPubMedGoogle Scholar
  30. 30.
    Novick DM et al. Methadone maintenance patients in general medical practice. A preliminary report. JAMA. 1988;259(22):3299–302.CrossRefPubMedGoogle Scholar
  31. 31.
    Novick DM, Salsitz EA, Joseph H, Kreek MJ. Methadone medical maintenance: an early twenty-first century perspective. J Addict Dis. 2015;34(2-3):226–37.CrossRefPubMedGoogle Scholar
  32. 32.
    Salsitz EA et al. Methadone medical maintenance (MMM): treating chronic opioid dependence in private medical practice—a summary report (1983-1998). Mt Sinai J Med. 2000;67(5-6):388–97.PubMedGoogle Scholar
  33. 33.
    Lawlor J. Many resist LePage administration’s bid to drop methadone as MaineCare benefit. Portland Press Herald: Portland, Maine; 2015.Google Scholar
  34. 34.
    Bukten A et al. Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort study. Addiction. 2012;107(2):393–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Krupitsky E et al. Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial. Lancet. 2011;377(9776):1506–13.CrossRefPubMedGoogle Scholar

Copyright information

© American College of Medical Toxicology 2015

Authors and Affiliations

  1. 1.Mount Sinai Beth IsraelNew YorkUSA
  2. 2.Emergency MedicineUniversity of Rochester School of Medicine and DentistryRochesterUSA

Personalised recommendations