Heroin Addiction And Methadone Maintenance Research Paper
Heroin Addiction & Methadone Maintenance
Deborah Booth
Psychology 305 – DO4
Liberty University
Heroin Addiction & Methadone Maintenance
Diacetylmorphine, aka: heroin, smack, horse, black tar, china white, and H, the slang names are as numerous as the places you can score this highly addictive narcotic. Heroin, a derivative of morphine, via opium, which comes from the resin of the Papaver somniferum plant has been in use for nearly 3500 years (Doweiko,2012, p.137). To understand the fascination, addiction, and potential therapies of heroin, we must first understand its history.
Before man knew anything about chemicals and drugs, they knew about the land the animals and plants that were used in relieving various …show more content…
ailments. Prehistoric man noticed that if they ingested the resin from the opium poppy there was pain relief. In the late 1800’s, a German merchant named Friedrich Bayer invested in scientific research and with the help of a young German pharmacist call Friedrich Serturner purified the main active ingredient of opium (Doweiko, 2012). Serturner named his new drug “morphium” after the Greek god of dreams “Morpheus”, which later would be renamed morphine. Heinrich Dreser joined Bayer in his hunger for producing chemical based medications, and ended up developing two of the most famous drugs in the world today. By adding two acetyl groups to the morphine molecule, they developed the drug the coined “Heroin”, and a year later, they developed a natural drug of salicylic acid, which they named “Asprin.” Bayer would go on to bottle and distribute a pre-war version named “Heroin”, named after the common word “heroisch” meaning heroic- known to German doctors to mean “power!” The bottle labeled simply “Heroin” was available to the public, containing 5 grams of heroin substance and indications included alleviation of pain to the suffering.
By the early 1900’s, an article entitled ‘The Heroin Habit Another Curse’ was published in the Alabama Medical Journal, drawing attention to the severe withdraw symptoms of those using heroin, but this would not stop other physicians from abandoning the highly effective drug. Another physician (J.D. Trawick), went on to write that “I feel that bringing charges against heroin is almost like questioning the fidelity of a good friend. I have used it with good results” (History Today,Heroin: A Hundred-Year Habit). There was such a success in the reduction of pain in the suffering community that even physicians were reluctant to give up such a successful drug. It seemed that there was evidence that morphine had a huge potential for addiction; so in response they had suggested heroin in its place. Ironically, this would be one of the medical community’s biggest mistakes.
The United States became one of the first to notice the serious problem of addiction as other countries had already enacted controls of dangerous drugs. The U.S. Constitution however, allowed this to be monitored on a state-by-state level, making each state responsible for the regulation of the drug. This would lead many states to putting the restrictions upon the people and giving the physicians the decision to prescribe it as necessary, leading to what would be a “black market” for the highly wanted drug. Even with the Pure Food and Drug Act of 1906, that demanded all drugs be labeled with the contents of their products, there was opium, cocaine, or even cannabis (U.S. Dept. of Health and Human Services). This new addition of the labeling seemed to carry some weight, as many people began to worry about addiction; not before however there was an estimated quarter of a million Americans suffering from it.
Jump ahead into the twenty-first century and the statistics may have changed somewhat, but not drastically.
What has been a significant factor is the crime rate increase in order for those addicted to stay “well.” Communities faced with how to treat the opiate addicted; beyond the obvious by placing them in jail or prison. The behavior of crime may be rehabilitated, but not the addiction itself, which for most was the only driving factor. It’s a vicious cycle, and for most the frustration is bigger than their habits. Some countries, such as the United Kingdom do have physicians who will prescribe heroin (although rare) for the addict unable to reap the benefits of methadone maintenance, or the terminally ill suffering extreme pain. Specialized “injecting centers” are available to addicts trying to dodge the street heroin complexity, in countries such as Switzerland, Germany, Holland, Australia and even Canada. There are still very strict laws enforced with the purchasing or smuggling of heroin in these countries, thus rigid program regulations must be followed. Methadone maintenance treatment (MMT) remains the preferred form of treating opiate addiction, and “has demonstrated strong efficacy in the outpatient treatment of opiate dependence (Hettema et al, …show more content…
2009).
For those familiar with MMT, usually those who suffer from opiate dependence, healthcare professionals, and the rehabilitation community, there are mixed feelings. The term MMT can be misunderstood, “perhaps miscategorized when called a treatment for opiate (narcotic-analgesic) addiction, is simply systematic dispensation of a synthetic Opioid” (Meyers & Salt, 2013) that curbs the withdrawal symptoms. For many, these programs have allowed the addicted to return to social stability, stop criminal activities, and enter back into the workforce or educational world. The HIV/AIDS community has really shown significant advantages to the MMT programs, thus reducing the number of IDU (intravenous drug users) contracting the virus via hypodermic needles and tainted “works.”
MMT has shown to be effective because of its ease of administration of the synthetic Opioid, which is generally liquid and taken once per day at a highly regulated center. The runny nose, chills, stomach cramps, nausea and vomiting, skin crawling that many heroin users suffer from while trying to “kick it” are absent when taking methadone. The program doses the client with a leveled amount of methadone, allowing the patient to attend to “normal activities” such as driving, studying, working, without the worries of sickness.
These programs generally have very strict rules and are governed by the government, specifically the Drug Enforcement Agency. Psychotherapy along with MMT is the choice of most clinics, and people generally feel strongly one way or the other about such programs. In a 2013 research project, the behaviors concerning MMT were becoming more positive, as the research becomes more readily available to the general public. For the U.S. and other countries, MMT has remained “controversial for a long period of time” (Yu, L., et al..). For many years, public viewed MMT as simply a trade out for the heroin user, and thus did not change their addictive behaviors, only their cravings. “A combination of counseling and psycho-pharmaceutical support to methadone detoxification is most effective” (Milby, 1988 – via Myers & Salt, 2013), although many chronic long term heroin users may be in such a program on a maintenance level of treatment, just as a diabetic takes his insulin, thus the heroin addict take his methadone. This is where many critics of MMT occupy its strongest argument. MMT has been called the “outcast stepsister in the addictions field” (Myers & Salt, 2013); with MM clients being stigmatized by everyone from peers to the entire healthcare system, even the addictions field itself. Today’s communities seem to be changing, as a current 2013 Brown University research report indicates; “The choice of treatment has to be individualized to their risk factors and the overall conditions as they enter the MMT” (Psychopharmacology Update, 2013). For many heroin addicts, the addiction is the beginning of a long line of difficulties, thus the program often helps with a great deal more than dosing and addiction counseling. Many addiction counselors find themselves being solicitors of social services such as housing, food stamps, medical care, and often many doors remain closed to the addict using MMT. Again, it is a misrepresentation of program that is making changes in the lives of those suffering from addiction, no matter the path leading to it. The percentage of “no use” clients within the MMT program show a 48% recovery rate during the first 90 days, however relapse commonly takes place within the first six months of treatment (Dept. of Addictive Behavioral Medicine-Europe). This is considered a “bump in the road”, as relapse is part of the healing process when talking addictions.
“Despite the effectiveness and widespread use of MMT, and the demonstrated benefit of combining MMT with other more intensive forms of treatment, integration remains a controversial topic” (Hettema, et al, 2009).
Many traditional treatment centers such as those who utilize the 12 Step philosophies, assert that MMT is incompatible with recovery and the abstinence-based treatment models, thus creating a division among them. This kind of thinking is yet another pitfall that carries the heroin addict seeking MMT, into “secretive
mode.
In conclusion, heroin addiction and the steps it takes to reach recovery, is anything but uncomplicated. Heroin has the stigma of being the drug that carries names like “junkie” and “channel swimmer” referring to the needle users of heroin, and the works of “chasing the dragon”, “kickin’ it”, or “having a monkey on my back”. For years, it was considered the poor man’s drug, and today, it’s the middle class women and youth that favor its warm, soothing effects. No matter the hundreds of names it’s called from china white, to black tar, it’s a universal problem with America being one of its number one customers, consuming over 60% of the heroin hitting the streets worldwide (Meyers & Salt, 2013). Its epidemic and programs such as methadone maintenance being available is a Godsend for many. No matter the stigma’s that MMT faces, it has been successful in slowing HIV/AIDS, as well as slowing the crime rates , and sending the people back into a society in which they can work, attend school, and begin living again.
Resources
Best treatments for young people with heroin addiction: No rule book (Cover Story). Brown University Child & Adolescent Psychopharmacology Update, 15(8), 1-6.
Doweiko, H. (2012). Concepts of chemical dependency (8th ed.). Belmont, CA: Brooks- Cole.
Meyers, P.L., Salt, N.R., (2013). Becoming a addictions counselor (3rd ed.). Burlington MA: Jones & Bartlett Learning, LLC.
Yu, L., Longhui, L, Yahai, Z, Wenwen, S., Huachong, X., &…Wenhua, Z. (2013). Assessment of attitudes towards methadone maintenance treatment between heroin Users at a compulsory detoxification centre and methadone maintenance clinic in Ningbo, China. Substance Abuse Treatment, Prevention & Policy, 81-8. Doi: 10.1186/1747-597X-8-29.
U.S. Food and Drug Administration . Retrieved via: http://www.fda.gov/Drugs/default.htm . Retrieved on: Apr. 10, 2014.
Deborah Booth
Psychology 305 – DO4
Liberty University
Heroin Addiction & Methadone Maintenance
Diacetylmorphine, aka: heroin, smack, horse, black tar, china white, and H, the slang names are as numerous as the places you can score this highly addictive narcotic. Heroin, a derivative of morphine, via opium, which comes from the resin of the Papaver somniferum plant has been in use for nearly 3500 years (Doweiko,2012, p.137). To understand the fascination, addiction, and potential therapies of heroin, we must first understand its history.
Before man knew anything about chemicals and drugs, they knew about the land the animals and plants that were used in relieving various …show more content…
ailments. Prehistoric man noticed that if they ingested the resin from the opium poppy there was pain relief. In the late 1800’s, a German merchant named Friedrich Bayer invested in scientific research and with the help of a young German pharmacist call Friedrich Serturner purified the main active ingredient of opium (Doweiko, 2012). Serturner named his new drug “morphium” after the Greek god of dreams “Morpheus”, which later would be renamed morphine. Heinrich Dreser joined Bayer in his hunger for producing chemical based medications, and ended up developing two of the most famous drugs in the world today. By adding two acetyl groups to the morphine molecule, they developed the drug the coined “Heroin”, and a year later, they developed a natural drug of salicylic acid, which they named “Asprin.” Bayer would go on to bottle and distribute a pre-war version named “Heroin”, named after the common word “heroisch” meaning heroic- known to German doctors to mean “power!” The bottle labeled simply “Heroin” was available to the public, containing 5 grams of heroin substance and indications included alleviation of pain to the suffering.
By the early 1900’s, an article entitled ‘The Heroin Habit Another Curse’ was published in the Alabama Medical Journal, drawing attention to the severe withdraw symptoms of those using heroin, but this would not stop other physicians from abandoning the highly effective drug. Another physician (J.D. Trawick), went on to write that “I feel that bringing charges against heroin is almost like questioning the fidelity of a good friend. I have used it with good results” (History Today,Heroin: A Hundred-Year Habit). There was such a success in the reduction of pain in the suffering community that even physicians were reluctant to give up such a successful drug. It seemed that there was evidence that morphine had a huge potential for addiction; so in response they had suggested heroin in its place. Ironically, this would be one of the medical community’s biggest mistakes.
The United States became one of the first to notice the serious problem of addiction as other countries had already enacted controls of dangerous drugs. The U.S. Constitution however, allowed this to be monitored on a state-by-state level, making each state responsible for the regulation of the drug. This would lead many states to putting the restrictions upon the people and giving the physicians the decision to prescribe it as necessary, leading to what would be a “black market” for the highly wanted drug. Even with the Pure Food and Drug Act of 1906, that demanded all drugs be labeled with the contents of their products, there was opium, cocaine, or even cannabis (U.S. Dept. of Health and Human Services). This new addition of the labeling seemed to carry some weight, as many people began to worry about addiction; not before however there was an estimated quarter of a million Americans suffering from it.
Jump ahead into the twenty-first century and the statistics may have changed somewhat, but not drastically.
What has been a significant factor is the crime rate increase in order for those addicted to stay “well.” Communities faced with how to treat the opiate addicted; beyond the obvious by placing them in jail or prison. The behavior of crime may be rehabilitated, but not the addiction itself, which for most was the only driving factor. It’s a vicious cycle, and for most the frustration is bigger than their habits. Some countries, such as the United Kingdom do have physicians who will prescribe heroin (although rare) for the addict unable to reap the benefits of methadone maintenance, or the terminally ill suffering extreme pain. Specialized “injecting centers” are available to addicts trying to dodge the street heroin complexity, in countries such as Switzerland, Germany, Holland, Australia and even Canada. There are still very strict laws enforced with the purchasing or smuggling of heroin in these countries, thus rigid program regulations must be followed. Methadone maintenance treatment (MMT) remains the preferred form of treating opiate addiction, and “has demonstrated strong efficacy in the outpatient treatment of opiate dependence (Hettema et al, …show more content…
2009).
For those familiar with MMT, usually those who suffer from opiate dependence, healthcare professionals, and the rehabilitation community, there are mixed feelings. The term MMT can be misunderstood, “perhaps miscategorized when called a treatment for opiate (narcotic-analgesic) addiction, is simply systematic dispensation of a synthetic Opioid” (Meyers & Salt, 2013) that curbs the withdrawal symptoms. For many, these programs have allowed the addicted to return to social stability, stop criminal activities, and enter back into the workforce or educational world. The HIV/AIDS community has really shown significant advantages to the MMT programs, thus reducing the number of IDU (intravenous drug users) contracting the virus via hypodermic needles and tainted “works.”
MMT has shown to be effective because of its ease of administration of the synthetic Opioid, which is generally liquid and taken once per day at a highly regulated center. The runny nose, chills, stomach cramps, nausea and vomiting, skin crawling that many heroin users suffer from while trying to “kick it” are absent when taking methadone. The program doses the client with a leveled amount of methadone, allowing the patient to attend to “normal activities” such as driving, studying, working, without the worries of sickness.
These programs generally have very strict rules and are governed by the government, specifically the Drug Enforcement Agency. Psychotherapy along with MMT is the choice of most clinics, and people generally feel strongly one way or the other about such programs. In a 2013 research project, the behaviors concerning MMT were becoming more positive, as the research becomes more readily available to the general public. For the U.S. and other countries, MMT has remained “controversial for a long period of time” (Yu, L., et al..). For many years, public viewed MMT as simply a trade out for the heroin user, and thus did not change their addictive behaviors, only their cravings. “A combination of counseling and psycho-pharmaceutical support to methadone detoxification is most effective” (Milby, 1988 – via Myers & Salt, 2013), although many chronic long term heroin users may be in such a program on a maintenance level of treatment, just as a diabetic takes his insulin, thus the heroin addict take his methadone. This is where many critics of MMT occupy its strongest argument. MMT has been called the “outcast stepsister in the addictions field” (Myers & Salt, 2013); with MM clients being stigmatized by everyone from peers to the entire healthcare system, even the addictions field itself. Today’s communities seem to be changing, as a current 2013 Brown University research report indicates; “The choice of treatment has to be individualized to their risk factors and the overall conditions as they enter the MMT” (Psychopharmacology Update, 2013). For many heroin addicts, the addiction is the beginning of a long line of difficulties, thus the program often helps with a great deal more than dosing and addiction counseling. Many addiction counselors find themselves being solicitors of social services such as housing, food stamps, medical care, and often many doors remain closed to the addict using MMT. Again, it is a misrepresentation of program that is making changes in the lives of those suffering from addiction, no matter the path leading to it. The percentage of “no use” clients within the MMT program show a 48% recovery rate during the first 90 days, however relapse commonly takes place within the first six months of treatment (Dept. of Addictive Behavioral Medicine-Europe). This is considered a “bump in the road”, as relapse is part of the healing process when talking addictions.
“Despite the effectiveness and widespread use of MMT, and the demonstrated benefit of combining MMT with other more intensive forms of treatment, integration remains a controversial topic” (Hettema, et al, 2009).
Many traditional treatment centers such as those who utilize the 12 Step philosophies, assert that MMT is incompatible with recovery and the abstinence-based treatment models, thus creating a division among them. This kind of thinking is yet another pitfall that carries the heroin addict seeking MMT, into “secretive
mode.
In conclusion, heroin addiction and the steps it takes to reach recovery, is anything but uncomplicated. Heroin has the stigma of being the drug that carries names like “junkie” and “channel swimmer” referring to the needle users of heroin, and the works of “chasing the dragon”, “kickin’ it”, or “having a monkey on my back”. For years, it was considered the poor man’s drug, and today, it’s the middle class women and youth that favor its warm, soothing effects. No matter the hundreds of names it’s called from china white, to black tar, it’s a universal problem with America being one of its number one customers, consuming over 60% of the heroin hitting the streets worldwide (Meyers & Salt, 2013). Its epidemic and programs such as methadone maintenance being available is a Godsend for many. No matter the stigma’s that MMT faces, it has been successful in slowing HIV/AIDS, as well as slowing the crime rates , and sending the people back into a society in which they can work, attend school, and begin living again.
Resources
Best treatments for young people with heroin addiction: No rule book (Cover Story). Brown University Child & Adolescent Psychopharmacology Update, 15(8), 1-6.
Doweiko, H. (2012). Concepts of chemical dependency (8th ed.). Belmont, CA: Brooks- Cole.
Meyers, P.L., Salt, N.R., (2013). Becoming a addictions counselor (3rd ed.). Burlington MA: Jones & Bartlett Learning, LLC.
Yu, L., Longhui, L, Yahai, Z, Wenwen, S., Huachong, X., &…Wenhua, Z. (2013). Assessment of attitudes towards methadone maintenance treatment between heroin Users at a compulsory detoxification centre and methadone maintenance clinic in Ningbo, China. Substance Abuse Treatment, Prevention & Policy, 81-8. Doi: 10.1186/1747-597X-8-29.
U.S. Food and Drug Administration . Retrieved via: http://www.fda.gov/Drugs/default.htm . Retrieved on: Apr. 10, 2014.