Methadone maintenance treatment, or MMT, is a commonly used course of treatment that has been proven effective for those addicted to heroin and other opiate-derived narcotics (a class recently expanded to include man-made analgesics such as oxycontin and oxycodone). The ultimate goal of this type of treatment is to gradually wean patients off these drugs altogether, which usually happens through a course of methadone maintenance in conjunction with traditional therapy, attendance at 12-step program meetings, prescribing of other medications, or some combination thereof.

Methadone is a synthetic narcotic medication that minimizes the severe pains of craving and withdrawal common to all who have grown dependent on heroin It works through a process of approximation.

The hormonal flood created by heroin use is so dramatic that users go through severe withdrawal due to the near-total dopamine void formed in the drug’s absence. Methadone works by satiating the brain’s opioid center, but it does not provide the high associated with heroin and other opiates because its primary elements bond to receptors that prohibit the release of glutamate, the neurotransmitter most responsible for exciting the central nervous system. In summary, it affects the body in a manner much like heroin while blocking the transmitters that facilitate the initial high and subsequent tolerance for the drug. A patient medicated with methadone is both shielded from severe withdrawal symptoms and unable to achieve the familiar state of intoxication from true opiate abuse. With time, doses can be reduced without inducing withdrawal.

Despite its proven effectiveness, methadone is in no way a benign substance. Consider:

• It may prove fatal when consumed in large quantities or combined with benzodiazepines.
• Opiate-free individuals will become intoxicated if they ingest it, and its side effects resemble those created by heroin and related drugs.
• Methadone withdrawal is also just as real as that associated with the drugs themselves, but because it dulls the severity of adverse symptoms and remains in the body far longer than heroin or other opiates, patients can be supplied with increasingly smaller doses for periods of months or even years until their dependence has been eliminated.

For these reasons it is only appropriate for the treatment of longtime opiate users and is only available at specific locations with a prescription.

Alternatives to methadone also exist. Buprenorphine, initially marketed as a painkiller for cancer patients, is a partial opioid antagonist that was also approved for use as an opioid addiction medication in 2002 and is currently marketed as Subutex or Suboxone. When bonding to related receptors, the substance is only partially activated, meaning that buprenorphine is ultimately easier to quit than methadone due to its longer half-life and milder withdrawal symptoms. This diminished potency also leaves it less conducive to recreational use and, in its Suboxone form, it contains doses of anti-overdose drug Naloxone to prevent intravenous use.

Unfortunately, buprenorphine is a good deal more expensive than methadone, and opiate addicts who switch from methadone to buprenorphine may suffer withdrawal because the latter is not strong enough to satisfy their dependencies. The benefits of each drug must be weighed by physician and patient before any treatment decisions are made.

MMT alone does not constitute sufficient treatment for the opiate-dependent patient. He or she must be carefully monitored and, in most cases, will benefit from psychotherapy or additional medication to counter the anxieties and lifestyle challenges that accompany the recovery process. Many patients attending methadone clinics are provided with on-site psychological consultation; such treatment is compulsory in some states.