Stigma on methadone for heroin users is wrong, doctors say

The blanket ban of methadone treatment in residential rehabilitation programmes may be depriving addicts of making use of cognitive skills which may be vital in their progress from addiction, an authoritative study published in the Malta Medical Journal shows.

Methadone is an opioid used for in the treatment of addicts, which allows them to avoid the uncomfortable withdrawal symptoms that result from complete abstinence.

The study sustains the view that methadone treatment results in an improvement in ‘cognitive functions’ among opioid addicts in vital matters like the ability to take decisions, orient oneself, control body movements and plan ahead.

The study concludes that methadone treatment contributes positively to public health by “ensuring compliance of opioid dependent individuals to their treatment plan with fewer relapse rates and a decrease in risky behaviour”.

Impaired cognitive functions like visuospatial skills can result in, for example, poor driving ability because distances are not judged correctly or result in a difficulty navigating in space such as bumping into things. These skills improve among addicts undergoing methadone treatment.

Executive functions are also improved as a result of methadone treatment. Impaired executive functions result in forgetting to complete tasks, an inability to keep track of personal items like keys and cell phones, trouble following conversations, losing train of thought, a difficulty remembering steps in a multi-step processes and an inability to remember names.

Participants who had stopped methadone were significantly impaired in most aspects of cognition tested apart when compared to healthy controls. Participants on methadone did not significantly differ in the other areas of cognition when compared to controls.

The study involves an assessment of cognitive functions of three groups of participants: 22 former opioid dependents receiving methadone maintenance treatment, 21 former opioid dependents withdrawn from all opiates and 22 healthy controls without a history of illicit substance dependence.

The study sustains the view that individuals with opioid dependency who undergo methadone treatment seem to exhibit better cognitive function compared to those who underwent complete detoxification, “at least partially explaining the superiority of methadone maintenance treatment (MMT) over interventions with a drug-free ideology”.

After two months of MMT, improvements in verbal learning and memory, visuospatial memory, and psychomotor speed, were recorded in a sample of persons with heroin addiction.

Unfortunately, according to the authors of the study, the integration of MMT in therapeutic communities is not mainstream, despite reported effectiveness.

“The impact of an intervention with documented harm reduction benefits such as MMT on cognitive function is paramount, especially when one takes an overall view of the process of recovery which warrants the mobilisation of cognitive skills to confront the various individual challenges to re-establish a meaningful existence.”

But despite the effectiveness of MMT, individuals who are on methadone are “frequently stigmatised and encouraged to come off methadone at a stage when risk of relapse is still significant.”

The study questions the “blanket approach” which expected those planning to join a residential drug rehabilitation programme to stop taking methadone.

“For some, methadone detoxification prior to rehab not only lowers their ability to cope with the challenges of the programme due to a possible deterioration in executive function, but exposes them to associated risks”.

The study is authored by Kristian Sant, a specialist in psychiatry, mental health and addiction services, at Mt Carmel Hospital, and by Anthony Dimech and Aloisia Camilleri, consultant psychiatrists in general adult and addiction services, at Mt Carmel Hospital.