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Not
just in substance abuse, mental health, and AIDS services do
methadone patients face routine discrimination.
San Francisco MUNI will not allow methadone patients to drive its
buses, even though an important legal ruling in New York overturned a
similar policy (Beazer vs New York City Transit Authority, 1975).
Not
just in those instances but in many other instances, there is
discrimination against methadone patients.
Providers of methadone-related treatment routinely ask whether
their patients might be allow access to various services.
The
prejudice stems from many sources.
First, the methadone patient is still considered an addict.
After all, they are still physically dependent upon a substance.
It does not matter to morally righteous people that the methadone
patient no longer feels like or behaves like an addict.
It certainly does not matter to them that methadone may have
saved the persons life and saved society thousands of dollars.
The moralists view methadone patients as morally weak, morally
inferior.
The
substance abuse treatment subculture itself, and especially the 12-step
approach, is probably the main source of prejudice against methadone
patients. the 12-step program began as a voluntary and anonymous
association of people trying to help themselves. It has become a massive
moral crusade, unhesitatingly imposing its will on all others, and has
almost completely cast anonymity aside.
With God and the Higher Power on its side, it has no doubt about
its righteous belief in the absolute necessity for abstinence and the
moral superiority of abstinent people over all others.
The
12-step abstinence uber alles ideology is not prevalent that most
people dont question its claims at all.
Throughout drug and alcohol treatment programs, it is taken for
granted that the 12-step program no only works, but works better than
anything else. Yet, there
is no proof of that in the literature.
If there were such a study, it would be the most widely cited
study in drug and alcohol literature.
Twelve-step programs might be useful, or might not, or they might
be useful for some people with some problems.
The
point is that almost everyone automatically assumes 12-step programs
must work because, they are seen as the morally superior way.
Hardly anyone even thinks proof is necessary for the 12 steps.
Few physicians would prescribe a medication based on testimonial
support, but most of them unhesitatingly do so in the psychosocial
treatment they prescribe.
Many of the myths about methadone, and must of the rampant misinformation
about it are really based on the belief that people
on substances are morally inferior. In fact, this position – the
moral weakness vs disease model viewpoint – is what AA battled
against decades ago. How
ironic that the 12-step and codependency treatment subculture is at the
core of the bigotry against methadone patients.
A
Little History
Two
New York physicians, Vincent Dole, a metabolic specialist, and his
colleague, Marie Nyswander, a psychiatrist,
invented methadone maintenance. They
considered heroin addiction largely a metabolic defect or deficit or
disorder. In other words,
they believed that people who tended to become heroin addicts were
different biologically from other people and that this biological
difference largely contributed to their seeking heroin.
Dole and Nyswander discovered, quite by chance, that methadone
was good at correcting for the deficit, particularly so since methadone
was so long-acting.
As
a metabolic specialist Dole had studied obesity for many years.
Todays theory that obesity can be attributed to a biological
origin and not a weakness of will partly stems from his work. Dole observed that his obese patients craving for food and
relapse to overeating was as if they were addicted. He decided to look at heroin addiction to see if there were
similarities between his obese patients and addicts.
So,
initially, Dole and Nyswander were not trying to solve the American
heroin problem. The study
they had undertaken was to follow the metabolic pathways of morphine
because they hypothesized that heroin addicts metabolized opiates
differently from normal people. Two
addicts were admitted to the morphine study.
First they were given morphine and allowed to increase it as they
pleased. Within three weeks
the subjects were receiving eight injections totaling 600 mgs a day.
They cooperated honestly with the barrage of tests to which they
were subjected. But, much
of their time was spent in front of the television set waiting for the
next injection.
By
law Dole had to detox his two subjects when the experiment was
completed. He switched them to methadone, the approved form of treatment
for detoxification. However, instead of reducing the methadone, Dole and
Nyswander decided to run the same tests as they had on morphine.
This way they could compare morphine to methadone.
Now
something unusual began to happen.
The older subject began to paint and the younger began requesting
to go back to finish high school. The
two subjects continued to take their methadone daily.
Their behavior transformed for the better.
They went from the street to stable living and better housing,
from the jailhouse to the school house, from sickness unto health.
These
facts were important, of course, to Dole and Nyswander, but were
completely crucial in their long battle
to get government to go along with the idea of methadone maintenance. Government reflects Americans practical tendency as well
as its moralistic, judgmental tendency, and in this case the practical
tendency can out on top.
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In
reality, methadone treatment is barely tolerated by government. The main
reason being that in out society people who are on drugs are
considered morally inferior to others.
Due to the AIDS epidemic methadone treatment has been given a
temporary bit of breathing space. Still
it is difficult to gain access to methadone maintenance. Staying in
treatment is much, much harder than getting into treatment. The
regulations and restrictions relating to methadone maintenance are so
numerous that it is amazing that anyone can make it work.
- DOLOPHINE WAS NAMED
- AFTER ADOLF HITLER
Dolophine
is the name under which Eli Lilly Company markets methadone. When methadone was first used for maintenance treatment of
heroin addiction, Dolophine was the common brand name of methadone.
It was dispensed as a wafer.
Certain problems became apparent in the use of the wafers.
It is quite difficult to dispense small increases or decreases in
milligrams of methadone.
For
this and other reasons, when methadone became available in a stable
liquid suspension (Methadose), most clinics dropped Dolophine and went
to it. Dolophine is
practically history now. Some
younger methadone patients and staff may have never heard of it, much
less the myth about its having been named for Adolf Hitler.
The connection, by the way, is that the Dolph- of Dolophine
is supposed to be the dolf of Adolf.
A
minor myth about methadone is that Methadose is not real methadone. All methadone is the same chemical. Methadose is just a brand name. (1)
The
Germans invested in methadone during the second world war when their
supplies of opium were cut off. (2)
During war the Germans of course needed more painkillers than usual, so
they got to work synthesizing opioids.
Meperidine, its brand name is Demerol, was another analgesic they
invented, along with several hundred others that didnt become famous.
Youll
notice that there
are no myths about Demerols having been named for Nazis.
The reason methadone unlucked-out has to do with the fact
that methadone did emerge as a maintenance treatment for heroin addicts.
In
short, the myth is that since Adolf was a bad person who wanted to
control people and was against freedom of choice, they gave his
name to a bad drug used to control people.
The
myth is colorful and just happens to tie in with the prejudice against
methadone, but what is the truth about Dolophine?
In Latin dolor means pain, suffering.
In English (look it up in an unabridged dictionary) the dol means
a unit in pain measurement and there are such words as dolorimetry.
The dol in Dolophine was from dol, dolor (Goldstein, 1992).
The
-phine in Dolophine comes from morphine, which was from Morphin,
which was its German trademark name from the early 1800s.
Morphin came from Morpheus, the god of dreams of mythology, who
was a son of Hypnos, who later begat hypnosis.
The
Germans also invented heroin, which English word came from the German
trademark, Heroisch, from their word meaning heroic.
The German pharmaceutical company that manufactured heroin was
named Bayer of aspirin fame.
Heroins
chemical name is diacetylmorphine, sometimes shortened to diamorphine.
After morphine and heroin, and before methadone and Meperidine
(Demerol), the Germans also invested the all-time painkiller, which we
still know by the German trademark name, Aspirin!
- METHADONE IS ADDICTING
It
is not substances which addict, it is people who addict themselves to
various feelings and experiences. Some
of these feelings and experiences are produced by substances.
Notes
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Methadone is not a brand name, it is the generic. This is another myth that many respected professionals have
believed.
-
Methadone was synthesized by Max Bockmhl and Gustav Ehrhart at I.G. Farbenindustrie. They named it
Hoechst 10820 or polamidon. Basically they were searching for an
analgesic with a low addiction properties. The patent for methadone was
not applied for until 1941 and only reasech was undertaken during this
period until World War 2 was over. After the war the US controlled
Hoechst the town where I.G. Farbenindustrie was located. Since the US
took control of any German patents methadone became a spoil of the war
along with many other substances. (See Methadone and Congeners in Education Series 5.2, The Pharmacology
of Opioids, Basic Pharmacology: How Methadone Works?)
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