Discharge From Treatment for Drug Use

It must be emphasized that methadone maintenance treatment is a

medical treatment for narcotic addiction. Recent research has

found that abstinent former heroin users have irregularities

within their immune and endocrine systems. However, these

irregularities are normalized with methadone maintenance. This further

underscores that methadone maintenance is a medical treatment

for a medical condition that has sociological and psychological

aspects, as do many medical conditions, ie heart disease. No

other treatment for opiate addiction as is successful as

methadone maintenance, resulting in a 92% reduction in heroin use when treatment is

appropriately done. No other treatment

for heroin addiction can boast such a success rate, and in fact

very few other medical treatments have as high a success rate as

methadone maintenance.

Programs who have high rates of illicit opioid use are, put

simply, “not providing proper treatment.” Discharging patients

for heroin use is unethical and usually programs which use such

tactics are not providing adequate dosage or are using the

medication as a tool to manipulate the patient’s behavior. Such

procedures would be considered unethical in every other realm of

medicine, but because drug use has been perceived as a

behavioral problem, discharging patients for drug use has been

tolerated in methadone treatment.

Imagine how this feels to the patient in treatment. What if you

were diagnosed with cancer and went for the usual radiation

treatments. You followed everything the doctor told you to do,

but in the end the cancer was still growing. Now apply this to

methadone treatment: you would be discharged because you did

not respond to treatment. If you had cancer would you not want

the doctor to try something else, like chemotherapy and if that

failed perhaps some new experimental treatment? You would want

the doctor to try everything to save your life. The same is

true for the methadone patient, if 70 mg doesn’t work, then

perhaps 80 or 90 or 200 mg will work. For the cancer patient

perhaps two radiation treatments will work. But imagine the

doctor blaming the cancer patient for not responding to

treatment and then discharging them. “If only you had tried

harder!” This happens to methadone patients every day, they are

blamed for the failures of their programs.

Not only does discharging methadone patients from treatment do a

terrible disservice to the patient, but also to the community.

Think of the repercussions when a patient is discharged. It is

inevitable that they will relapse within a short time and

considering the threat of HIV, strain resistant TB, hepatitis

and endocarditis the effects that the discharge will have on the

family of the patient is tremendous. The patient will no longer

be able to support their family because they will be thrown into

a state of “drug craving.” The crime that one patient will have

to commit to maintain their drug use has been estimated to cost society from

$150,000 to over $300,000 a year. And if this former patient is

arrested, which is very likely, then they will be a ward of the

state costing between $30,000 to $60,000 a year. And should

this former patient become infected with HIV the cost can be as

high as $300,000 a year, and as people with AIDS are living

longer the costs are rising dramatically.

Now I ask you, which is better for the person, the community and

the state? A methadone patient receiving adequate treatment who

supports their family, pays their taxes, pays for their

treatment and is a productive member of the community, or a heroin addict who will cost the

community money that

could well be spent on better purposes?


A Comment on Discharging Patients for Using Cocaine

Many programs have adopted the policy of discharging methadone

patients for using cocaine. Presently there is no treatment for

cocaine use, except hospitalization and counseling and hoping

that this time something works. However, NAMA believes that it

is unethical to discharge patients and thus refuse to them

treatment for their heroin addiction because they have developed

an ancillary problem. In normal medical practice a patient with

diabetes who did not follow medical advise now developed heart

disease because of this would not be refused their insulin.

Neither should a medication that works for heroin addiction be

refused because of another drug problem.

There are programs that discharge for marijuana use. This

simply does not make sense nor does it serve the community or

the patient and their family. Marijuana is used by a

large number of Americans and is associated with neither the high crime rates nor the

significant medical consequences resultant from abuse of other illicit drugs or alcohol. Furthermore,

many AIDS patients use marijuana on medical advice as a means of countering the “wasting syndrome”.

Discharging methadone patients for using

marijuana results in an untreated heroin addict that will cost

the community in crime and money.

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