Is it a lifelong solution?
June 8, 2015 9:00 AM   Subscribe

A good friend of mine is participating in methadone replacement theory to deal with opiate pill addiction. She tells me that she can't ever see herself attending an inpatient rehab to get off both opiates and methadone, as it would require her to take significant time away from her job and her child, and she would always worry about relapsing. Instead, she plans to continue with MRT for the rest of her life. Is this a healthy and realistic plan? Can someone stay on methadone for the next fifty years of her life?

The past several months of methadone therapy have done her a world of good. She's happier, she can hold down a job, she's cut the people she associates with drug use out of her life, etc. I can't argue with the positive results of MRT. I suppose I'm just wondering if there was some medical reason why it would be unhealthy to stay on methadone for a very long time, or if there's a serious advantage to doing the inpatient thing and going off both opiates and methadone permanently.
posted by Chuck Barris to Health & Fitness (9 answers total)
Many, many former opiate addicts do this. I was dubious at first, but a former addict explained to me, "Without methadone, I will CONSTANTLY be worrying if I'll slip up and relapse, and CONSTANTLY be worrying about cravings hitting me. With the methadone, yeah, it's pain to have to visit the clinic, but I feel safe and secure and confident I won't use again." That was enough to convince me (well, that plus the fact that opiates are actually pretty damned safe, physiologically. They may wreck your LIFE, but they are unlikely to ruin your BODY the same way that certain uppers can).
posted by julthumbscrew at 9:14 AM on June 8, 2015 [3 favorites]

It sounds like you know this, but the most important thing is that your friend will choose to do whatever she chooses to do, and it sounds like this is working for her so far. Also, now is probably not the time for her to accurately predict what will/won't happen for the rest of her life--that is subject to change in any number of ways (obviously) and it sounds like she's just enthusiastic about the new direction in her life thanks to MRT. That said:

There is a compilation of oral history interviews with lifelong addicts, many of whom remained on methadone treatment for decades, called Addicts Who Survived. It's really fascinating and could be worth checking out to see how this worked in the mid-20th century.

Also, check out "harm reduction" as an alternative to the all-or-nothing approaches to addiction that don't work for everyone. Googling that phrase will turn up some really interesting, nuanced articles that might offer perspective or ideas.
posted by witchen at 9:16 AM on June 8, 2015 [3 favorites]

IANAD, but you should trust your friend to trust her doctor. In the right dosage (which you likely can't discern), long-term use is considered very safe.
posted by whoiam at 9:17 AM on June 8, 2015

Response by poster: Thanks for the responses, everybody. Essentially, I was hoping that no one would respond with anything along the lines of "Your friend's plan is unrealistic. Here's medical proof that being on methadone for decades is an extremely bad idea." I feel much better knowing that MRT can be a lifelong solution for her.
posted by Chuck Barris at 9:21 AM on June 8, 2015 [2 favorites]

The best thing about MRT beyond it's obvious benefits that you are already seeing in your friend, and that yes, you can do it for the rest of your life, is that unlike inpatient programs, which feel "all of the sudden", methadone allows you to get your life feeling normal again in the real world.

I've known people who felt the same way your friend does, but who, after years of methadone decided that maybe they should start weaning off of it, and they are no longer on it and have successfully not relapsed. I am sure of this because I know these people very well, wink wink nod nod.

(Your friend is lucky to have a friend who cares enough to ask and especially one who is kind enough to ask someone else so she does not have to explain her own choices.)
posted by MCMikeNamara at 9:25 AM on June 8, 2015 [13 favorites]

I read this a few days ago:

If she can get off of it eventually, that would be best. Maybe when her daughter is older and can go without her for long enough for her to go through the treatment center. Whatever she does, she does need counseling and support now.
posted by myselfasme at 9:34 AM on June 8, 2015

The biggest cause of concern for me would be if your friend is still drinking alcohol.
posted by TheCavorter at 9:38 AM on June 8, 2015

I'm glad your friend is doing better. As those above have described, many people stay on methadone for decades. Eventually she may want to get off MRT and in that case she can work with her doctors to taper her dose gradually and get off opiates altogether without needing an inpatient stay, but the data show that people have much lower rates of relapse to addiction if they don't try to do this quickly.
posted by The Elusive Architeuthis at 10:31 AM on June 8, 2015

Many people successfully stay on methadone for many years. There is a wealth of evidence supporting the benefits of long-term methadone maintenance. For many people, the longer they stay on it, the better the outcomes. Here's a pdf of information about methadone, written for patients and their family members.

Doctors or others pushing people to get off methadone faster than they want to are not basing their advice on clinical evidence.
posted by gingerbeer at 12:12 PM on June 8, 2015

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