Methadone Maintenance Therapy: A Review
Opioid use disorder is a growing public health concern in the United States, and methadone maintenance therapy (MMT) is an effective and safe treatment for opioid use disorder. MMT has been used for over 50 years to treat opioid addiction and to prevent overdose and death. This review examines the evidence on MMT and provides an overview of how MMT works, its benefits and risks, and its current place in the opioid addiction treatment landscape.
Background
Opioid use disorder is a chronic relapsing disorder characterized by compulsive opioid use, resulting in significant physical and psychological impairment. It is estimated to affect over 2 million people in the United States, with more than 130 people dying each day from an opioid-related overdose (Centers for Disease Control and Prevention, 2018).
Methadone is a long-acting synthetic opioid that is used in MMT to treat opioid use disorder. It is an opioid agonist, meaning that it binds to opioid receptors in the brain and produces similar effects as other opioids. Methadone has a long duration of action and is taken orally, which allows for consistent dosing and prevents the patient from experiencing the rapid onset and short duration of effects associated with other opioids (e.g. heroin).
Mechanism of Action
MMT works by reducing cravings and withdrawal symptoms associated with opioid use disorder. When methadone is taken orally, it is slowly absorbed into the bloodstream and binds to opioid receptors in the brain, producing similar effects as other opioids. However, because of its long duration of action, methadone produces a sustained effect that prevents the patient from experiencing the rapid onset and short duration of effects associated with other opioids. This sustained effect reduces cravings and prevents withdrawal symptoms.
Benefits and Risks
MMT has been shown to be an effective and safe treatment for opioid use disorder. Studies have found that MMT is associated with improved treatment outcomes, including reductions in opioid use, improved quality of life, and increased retention in treatment (Fiellin et al., 2019; Mattick et al., 2014). In addition, MMT has been shown to reduce the risk of overdose and death due to opioid use (Fiellin et al., 2019).
Although MMT is generally considered to be safe, there are some risks associated with its use, including the potential for methadone misuse, dependence, and addiction. Therefore, it is important that MMT is only prescribed by a physician and that patients are carefully monitored throughout the course of treatment.
Conclusion
MMT is an effective and safe treatment for opioid use disorder. It has been shown to reduce cravings, withdrawal symptoms, and the risk of overdose and death. However, it is important to note that there are some risks associated with MMT, including the potential for misuse, dependence, and addiction. Therefore, it is important that MMT is prescribed and monitored by a physician.
References
Centers for Disease Control and Prevention. (2018). Opioid Overdose: Understanding the Epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
Fiellin, D. A., O’Connor, P. G., Chawarski, M. C., & Pantalon, M. V. (2019). Methadone Maintenance Treatment for Opioid Use Disorder. Annals of Internal Medicine, 171(8), 594-604.
Mattick, R.P., Breen, C., Kimber, J., Davoli, M. (2014). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews, (7). doi: 10.1002/14651858.CD002209.pub3