Methadone controversy goes on: Swapping one addiction for another?


Type the words “methadone” and “controversy” into your Google search engine and you’ll quickly come up with more than 213,000 hits that demonstrate that methadone maintenance, as it is commonly called, is not the simple, safe and effective answer to addiction its’ proponents claim.

Even though leading health organizations promote methadone maintenance as a cost-effective tool to prevent HIV transmission and save lives from overdose and other drug-related activity, these programs continue to face criticism from traditional recovery groups, medical providers, and even users themselves.

“A motivated patient on replacement therapy can make astounding changes in a year,” Dr. Logan Graddy, who runs a maintenance program in North Carolina, recently told the Huffington Post. “Many change careers, go back to school, and turn their lives around to where they might have been before they started taking drugs. I’ve seen miracles happen.”

Former New York City mayor and one time presidential candidate Rudolph Guiliani has been one of the most vocal critics of methadone maintenance.

”I think methadone is an enslaver. It’s a chemical that’s used to enslave people,” Guiliani said. ”If it’s necessary for transition, then of course it should be used for transition. If you’re going to keep somebody permanently enslaved to methadone for the rest of their lives, then I have real questions about your common sense.”

When methadone was first introduced as a treatment for those addicted to heroin and other opiates in the early 1950s, it was used for a short time to lessen the effects of withdrawl during the detoxification process.

Later, when large numbers of American servicemen began returning from Vietnam seriously addicted to heroin, the maintenance programs sprung up, replacing one illegal addiction with another, state sponsored one.

”The goal of our society should be self-reliant people — not normalizing dependency,” Guiliani said. ”What’s happened is, the treatment of choice now among all of these doctors is methadone.”

A recent Canadian study conducted by a team under the direction of Dr. Aslam Anis of St. Paul’s Hospital in British Columbia found that just giving street heroin addicts prescribed heroin is more cost effective and has less risk of mortality and relapse than any methadone program.

“The treatment actually saves money and provides better outcomes,” said Anis. “The retention rate in heroin was double what it is in methadone.”

Recent medical studies have revealed that methadone addiction can cause sudden cardiac arrest. Prior to 2001, federal law did not allow methadone clinics to prescribe methadone doses higher than 100mg/day. Successful lobbying from methadone doctors and businessmen who own methadone clinics changed the law allowing methadone clinics to use their judgment and push methadone doses much higher.

Florida Dr. Rick Sponaugle, who has spoken at the White House about methadone addiction, called methadone clinics “glorified drug dealers.”

Today, about a half million people in the U.S. are participating in methadone maintenance treatment programs.

“Many believe highly profitable for- profit methadone clinics create an unjustifiable conflict of interest, since they profit, from reducing counseling and medical treatment, while maintaining methadone dependency,” Sponaugle wrote.  “Numerous methadone patients complain methadone clinics do not provide adequate methadone detoxification, to methadone addicted patients wishing to decrease or eliminate their methadone dependence.” 

Today, about a half million people in the U.S. are participating in methadone maintenance treatment programs.


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  1. peter moinichen says:

    Confusion arises when terminology is misused. Addiction does not involve drugs! It is the behavior of the individual and their relationship to a substance that determines addiction. Dependence would be more correct since it describes the physical state. Addiction equates to pain, not drugs; recovery equates to forgiveness, not abstinence. When the endorphin system has been disrupted either from the use of short acting opiates or there is a genetic component, then exogenous opiates (methadone, bupe, in old days LAAM) help to stabilize that individual until their endogenous endorphin system can re-stabilize. There are some whose endogenous system will not get back on track. They will need to remain on exogenous opiates FOREVER or choose to feel that here is a missing piece to the inner workings of their body. Many who may need long term maintenance still detox due the punitive, intrusive nature of MMT. No one should be handcuffed to treatment, this defeats the purpose of self-directed recovery. If you feel that you no longer need the support of medication (and methadone is medicine) then slowly lower that dose. I would recommend 1 mg. a week. once dose is cut in half allow a few weeks to stabilize at lower dose and then continue. Your body will tell you if it’s own endogenous endorphin system is working to fill those receptors or if you can tolerate the way you feel. Good luck on whichever path seems appropriate. And when you disparage MMT you directly impact my patients by contributing to the stigmatization. My patients were blasted for addiction and some still blast them for their recovery. Where in that world are my patients allowed to feel good about themselves?

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  57. Well said Peter Moinichen!
    I am a counselor at an outpatient MMT program. I have loved ones very close to me that have used and are using MMT as a pathway to sobriety and recovery. I have seen many success stories firsthand. I appreciate your response. It is so true. Addicts that try so hard and are constantly bombarded my negative comments have a much harder time doing the right thing and not giving up on their path to a better life for themselves and so many of those in the realm of influence, whether it be tieir family or friends or onlookers who are struggling silently. Compassion and Hope are the best things for them. People that understand that have the power to change a life. I believe that the clinic I work for is one that truly cares for their patients and by your words I have no doubt that the clinic you oversee is the same. I think the stigmatization is mostly due to the lack of education. So many people draw conclusions based on their own thoughts. I will be the first to admit that I did not know much about methadone and had my own internal stigmas as a young christian man, when I began working here as an adminisrative assistant. It did not take long for me to realize that this MMT was good stuff if used properly by people that really do want the help they are capable of receiving. I think that it is human nature to focus on the negative and not give enough credit to the positives. Those that do not educate themselves and are judging things outside of their realm of expertise really need to educate themselves before they throw about opinions on things so controversial. I wish more politicians and leaders would spit more words of hope instead of hate. Even the most helpful of things can do harm of course and there are definitely certain patients who do “Swap one addiction for another.” It is the role of professionals to take what they do seriously to influence and educate addicts in behavioral modifaction, etc. There will always be critics and there will always be stigma around MMT. It is what it is. Keep hope alive though Peter. I laud you for your attemtps to give your patient’s hope and the ability to feel good about themselves. Keep doing what you do and do it better tomorrow.

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