Methadone has a long history of being associated with the treatment of heroin addictions and the stereotyped perceptions and consequences surrounding those users. Even more problematic has been the stigma of methadone as a replacement drug rather than a corrective one. With epidemic rises in opiate addictions from controlled prescription painkillers, opiate addictions are on their way to surpass nearly every other type of psychoactive drug and, like heroin, most people are unable to cease their use without some sort of pharmacological help.
Understanding how the stigma of methadone keeps people from treatment and what we should do about it is important. The issue is not limited to the homeless junkies on the street or the criminal characters that so many people have come to relate with drug abuse, but, about saving the lives of those who are most at risk and those we care about.
Throughout history, opiate dependencies have baffled those who are not dependent on these types of drugs. Why someone would want to give up their beliefs, values, and loved ones, risking their lives over and over again and despite any other consequence to themselves or others is unimaginable to most. TheAmerican Society of Addiction Medicine (ASAM)defines addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry” and goes on to say that “dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations… reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”
Those who take opiates regularly develop a tolerance to the drugs that requires them to take more to achieve their desirable effects and to stave off the withdrawals that become more severe as time progresses. Over time, the memory of previous exposures to the opiate rewards leads to biological and behavioral responses to external cues much like those rewards we find in food, sex, and fun. In turn, the responses trigger cravings and/or engagement in addictive behaviors even when the person is not consciously thinking about using the drugs.
Methadone Stigmas in the Public Mind
In the public mind, the debate over whether an opiate addiction is a disease or a moral failure remains unsettled. According to the World Health Organization,” drug dependence has been considered, depending on the different beliefs or ideological points of view: only a social problem, only an educational or spiritual issue, only a guilty behavior to be punished, only a pharmacological problem.”
Over the years, the public fears and negativity surrounding addiction and heroin addicts, in particular, have led to stereotyped conclusions that these individuals are: unable or unwilling to respect the norms of society; unproductive; engaged in criminal and immoral activities; predatory towards others; and influential in the spread of diseases. Treating them with methadone, another opiate medication, is opposed and the public has been reluctant to spend the “treatment” dollars for what they perceive as a substitute drug. These ideas are backed by criminal justice responses to incarcerated addicts rather than linking them to the help they so desperately need.
Methadone Stigmas in the Opiate Dependent’s Mind
Although opiate addictions have been considered a “self-acquired” problem based on an individual’s choice to illicitly or illegally use the drugs, even those who are prescribed opiate pain relievers for legitimate therapeutic purposes have succumbed to their addictive properties. The stigma of methadone paves the way for those who would benefit most from methadone treatments to suffer needlessly for years in the chronic throwbacks of illness and relapse.
Unfortunately, many opiate addicts are ambivalent about using methadone because of the public perceptions or because they perceive it as a delayed route to their recovery. Although they are desperate for adequate treatment, they may not feel that their condition warrants the depicted long waiting lines, daily impositions, and associated character ills of others in a methadone treatment program.
Other sources of stigma among family, friends, and employers can also be influential in preventing the addict from using methadone to treat their addiction. According to the SAMHSA, “In families with substance abuse, family members often are connected not just to each other but also to any of a number of government agencies, such as social services, criminal justice, or child protective services.” With the broad stigmatization of methadone, fear of repercussions from any one of these agencies may deter the addict from methadone treatment.
What We Should Do
According to the Institute of Medicine (US), there are three concerns that provide the rationale for methadone treatment; individual functioning, public safety, and public health. While it’s true that methadone too, can be abused and addictive, the benefits of methadone treatment for detox or maintenance can far outweigh the risks of continuing to use shorter acting opiates.
Education and awareness is the most viable thing we can all do to understand the nature of addiction and how methadone can help. It also gives us an opportunity to get involved in healing the epidemic that continues to take society by storm. Making methadone treatment easily accessible, affordable, and acceptable is just the beginning. Treatments that provide links to sources for medical, psychiatric, vocational, families, social, legal, and other psychosocial services improves outcome success.
Methadone can be used safely under the proper guidance and methadone treatments have been proven to decrease mortality, overdose, crime, and communicable diseases at high rates. It’s a whole new world out there and methadone stigmas are slowly dwindling, so, taking for granted those things learned from the past is no longer an option. Seek help.