Methadone is the most effective therapy for heroin addiction

Methadone maintenance therapy has a better track record

As a physician working on the front lines of addiction treatment and research in Baltimore, I read Lisa Lowe's recent op-ed with great interest but also with some perplexity ("Addiction services needed more than statistics," Dec. 18).

I share Ms. Lowe's frustration with the difficulty that many patients and families — especially those with private insurance — have accessing affordable addiction treatment and transitional housing.

However, despite her impassioned advocacy for "evidence-based best-practice therapies," Ms. Lowe's piece contains misleading and frankly false information about effective addiction treatments.

In reality, methadone maintenance therapy is one of the most studied interventions of any medical or psychiatric condition.

Patients enrolled in methadone maintenance are far more likely to stay engaged in treatment and refrain from using illicit opioids, including heroin, than are patients in "abstinence-based therapies."

Many studies have suggested as much as an eight-fold decrease in mortality rates among patients enrolled in MMT. Still other studies have suggested decreased rates of HIV transmission and criminal behavior for patients in MMT.

Although "detox" followed by abstinence is an emotionally appealing concept, persistent brain changes resulting from long-term opioid abuse mean that for most patients addiction is better conceptualized as a chronic illness requiring long-term medical treatment than as an acute illness treatable with a short course of medication.

While it is true that methadone-related deaths increased dramatically in the past decade, the culprit in the vast majority of these deaths was not MMT — a highly regulated and regimented intervention — but methadone pills prescribed in ever-increasing doses for chronic pain.

For the sake of the disenfranchised, suffering people for whom she advocates tirelessly, I would encourage Ms. Lowe to set aside her disdain for statistics and her ideological and impractical rejection of one of medicine's most effective treatments.

Dr. Aaron D. Greenblatt, Baltimore

The writer is an addiction medicine fellow at the University of Maryland School of Medicine.

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