Stigma

 

I must be honest. I used to be one of those people who had strong opinions about methadone. And it was not a good one. Actually, I am not even sure that I put much thought into methadone until I became a mental health clinician, working in a chronic pain medical clinic. I knew that some of the physicians were using it as a form of treatment for pain management. And, I knew it was out there to treat people who were struggling with heroin addiction. For those who were using methadone as some sort of treatment for addiction, they were immediately put in the category of “hopeless junkie.” I would continue down this path of thinking until I began to get educated on the uses of methadone. I fully admit the level of ignorance and judgement was filled with assumption, speculation, and suspicion of those who were going to methadone clinics. I viewed this group as a hopeless bunch that were just replacing one drug for another. How many times have we heard that about this drug? “You’re not clean. You’re still getting high off that methadone junk!” So many times, I would hear these mantras out in the public. “These people are nothing but a bunch of loser junkies who have found a way to get their fix legally.” I am ashamed about my judgment of people who are genuinely suffering and are brave enough to reach out and get help. I could not have been more wrong.
Let’s explore some of the myths and facts about methadone:
• Myth- Methadone is just a substitute for heroin. Therefore, the person who is using methadone is still a “junkie” and not clean.
• Fact- Methadone is a treatment for opioid addiction, not a substitute for heroin. Methadone is long acting, requiring one daily dose, while heroin is short acting and generally takes at least 3 to 4 daily doses to prevent withdrawal symptoms. Also, methadone is a legal drug under the careful supervision of medical staff. Heroin is illegally sold by people involved in crimes.
• Myth- People using methadone are still addicts, even if they don’t use other drugs.
• Fact- People taking methadone are physically dependent on it but no more addicted than people taking insulin for diabetes. Given the proper stable therapeutic dose of methadone, people go on to live happy, healthy, productive lives. Addiction is defined as a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequences.
• Myth- Methadone causes sedation and drowsiness. See, you’re high!!
• Fact- When methadone is introduced to the patient by medical staff, a slow titration increase is provided. As the patient is increased in dose amounts, a medical team will be taking both objective and subjective measurements to establish a person’s therapeutic dose. If there are signs of sedation, then we know the person is on too high of a dose. This informs us to reduce the dose amount as the objective is to get to an amount that provides the patient relief from cravings and withdrawal. When you’re on the right dose of methadone you won’t feel any more sedated than normal. You should feel like your normal self before abusing opioids.

Stigma is defined as: a mark of disgrace associated with a particular circumstance, quality, or person.
Knowing what we know about addiction, in 2018, I am disheartened to know that this stigma is not just out there within the general public. It also resides within the professional communities of medicine. Many physicians I have encountered or hear about their approach to treating patients, puts these very stigmas and labels on our patients. There are physicians within so called addiction treatment facilities, who refuse to use methadone as a form of treatment for opioid addiction, because of their misinformed ideas about methadone. Surprise, physicians are flawed when it comes to this treatment. Unless a physician is an expert in this area, their preconceived notions may be harming someone who could greatly benefit from this medicine.

My hope is that people are willing to get educated and learn about this drug as a medicine. We need to reshape our ideas about addiction and it’s form of treatment. Right now, our culture is in the middle of a challenging transition, when it comes to addiction. In a later blog I will discuss this. It is about the fact that research, and evidence from that research, is showing us that abstinence only models are largely ineffective and have horrible recidivism rates. The evidence is beginning to bear out that the use of medicines such as methadone and buprenorphine in conjunction with rigorous therapy/counseling, is a much more effective form of treatment than abstinence only models. I believe we need to have open minds about drugs such as methadone and buprenorphine because I have seen it transform and save lives.

Why does the addict continue this behavior?

Why do we continue to engage in a behavior that we know is killing us and ruining our relationships with those we love?

The answers will come in later blogs. I want to shed just a glimpse of light on the pain of addiction. In future blogs I will attempt to address the stigma that comes with addiction.

We are at an interesting point in our country’s history when it comes to addiction. We see and hear all over the news that there is an opioid epidemic in this country. Many well-meaning people are crying out that we need to do something about it.

All you need to do is look up the CDC’s current reports on opioid addiction in this country, and you will see alarming numbers of overdose and deaths as it relates to these powerful drugs.

And at the same time, we live in a culture where those who are not suffering from this disease, or are yet seemingly unaffected by it, are yelling back, “stay out of my backyard! Don’t bring that trash anywhere near me.Go get treatment but don’t do it anywhere near me. I’m sick of watching these junkies hang around at the highway exit or in the downtown area where I like to sit and have my coffee!”

What they don’t understand is that they are in fact, already being affected. And the chances are, they will have a loved one who falls prey to this dehumanizing experience.