Detoxification after methadone maintenance treatment

TLDR: 15 years later it is instructive to examine what happens to methadone treated narcotic addicts, including how often do spontaneous remissions occur?

Abstract: Methadone has been administered to thousands of opiate dependent persons since its acceptance as a standard maintenance treatment for opiate addiction in the 1960s. Extensive studies have recorded the impact of methadone maintenance on the drug use reduction in criminal activities,* improvement in the adverse health consequences, including lowered mortality rates of the methadone recipients compared to the untreated opiate addict controls.S Few medical efforts have been so amply documented regarding the effectiveness of treatment in health, behavioral and pharmacological terms. Nevertheless, controversy continues to rage over this not-well-understood treatment process. Much concern centers around the concept that drug dependent persons should be supplied a substitute drug for extensive periods of time. Most accept the pragmatic aspects of opioid maintenance treatment but greatly prefer its cessation after a term of treatment to the concept of indefinite maintenance. Thus patients’ desires to detoxify are augmented by ubiquitous external pressures. Pressures come from the local and national regulatory bodies, which have set up regulatory requirements periodically to justify continuation of methadone treatment for each individual patient. In addition other pressures come from treatment persons themselves.s Now 15 years later it is instructive to examine what happens to methadone treated narcotic addicts. How often do spontaneous remissions occur? Are those in treatment better or worse than those who left? What problems do the methadone treated patients experience during and after detoxification? What factors, if any, can be identified as predictors of the capability to refrain from extensive opiates after detoxification? By mid-1979 in New York City, which has had the largest treatment experiences with addicts, about 27,000 persons were actively taking methadone according to the methadone maintenance registry of the Community Treatment Foundation (CTF).T Yet another 58,000 individuals or 68.2% of all those who had ever been registered as methadone maintenance recipients in greater New York area were no longer in active treatment. Thus the majority of 85,000 methadone recipients had received methadone temporarily. The CTF records showed readmissions outnumbered the new admissions to treatment by 2: 1 . Since the incidence of narcotic addiction had dropped recently,* the high rates of readmissions indicated that former methadone recipients did not always do well.