Percy Menzies, President of ARCA Midwest, was recently asked to provide insight into the price of addiction concerning the use of methadone in the addiction treatment process. Mr. Menzies provided information about heroin addiction treatment describing the progression of the treatment process starting from Methadone to Suboxone to currently available non-addictive treatment medications like Vivitrol that are used in ARCA’s inpatient residential and outpatient treatment programs. Mr. Menzies’ article can be found in the Portland Business Journal in their series on the Price of Addiction online here: The article is reposted below for easy reference.

Price of addiction: Opioid treatment should go beyond addictive methadone (Series)

Percy Menzies, Guest columnist
Date: Friday, October 11, 2013, 10:45am PDT

Drugs obtained from the opium poppy are among the most extensively studied after alcohol. We now have a clearer understanding how these drugs work in the brain to deaden pain.

We also have a better understanding of the negative aspects of these drugs – addictive properties that have became a major health problem in the country.

Scientists have succeeded marvelously in manipulating the chemical structure to make opioid drugs very potent but have failed to lessen or remove the addicting properties.

It is ironical that the opium poppy so closely associated with pain treatment and drug addiction is also the source of three valuable medications used to treat drug overdose and opioid addiction.

The first heroin epidemic hit the U.S. in the 1960 and ’70s. Like the present epidemic, it was fueled by the widespread use of prescription pain medications. When patients could not get their Percodan and Percocet, heroin filled the void and triggered urban crimes.

There was also the unfounded fear that GIs addicted to heroin in Vietnam would exacerbate the problem when they returned home. Something had to be done and done quickly.

Methadone, a synthetic opioid developed by the Germans during the Second World War as a substitute for morphine, was studied as a possible treatment for heroin addicts.

Clinicians were aware about the highly addictive nature of methadone, but given the circumstances at that time, methadone was a good short term option, especially if the administration of the drug was tightly controlled.

Methadone clinics were the logical answer to minimize diversion. President Nixon was assured that this approach would significantly lower crime, even if it meant keeping patients on methadone for long periods of time. The paramount goal was to protect society.

Research in the chemistry of the opioid drugs led to the development of two other drugs, the polar opposite of methadone. First was naloxone, better known by the brand name Narcan. This drug has been in the news quite a bit. It reverses opioid overdoses, restores breathing and saves lives.

The other drug was naltrexone. This non-addicting drug was developed to protect detoxed heroin addicts from relapsing when they returned home from residential treatment or incarceration. There were practical problems in administering the drug, as heroin addicts were not ready to give up using heroin.

Methadone clinics showed no interest in using this medication, even for a small subset of patients. Naltrexone was restricted to “motivated” patients, like physicians, nurses and business executives.

The practical problems of the daily pills have been eliminated by the introduction of the monthly injection sold under the brand name Vivitrol. Naltrexone and Vivitrol are also approved for the treatment of alcoholism, yet these medications are virtually unknown and rarely used.

The third medication, buprenorphine, better known by the brand name Suboxone, is modified from one of the ingredients found in the opium poppy. This is a safer medication that can be prescribed by a physician who has completed certain requirements and obtained a DEA exemption. The patient does not have to go through the inconvenience of daily visits to a clinic. But like methadone, buprenorphine is an abusable product and some drug addicts have misuse it to continue their heroin addiction.

We have a major crisis at hand with opioid addiction. More people die from drug overdoses than automobile accidents. Treatment centers, Subxone prescribing physicians and methadone clinics have to look at the problem differently. Patients and their families are not aware about treatment options.

Patients and many physicians are not familiar with the pharmacology of buprenorphine, naloxone, naltrexone and Vivitrol. There is confusion as to why naloxone has been added to the formulation of Suboxone.

Methadone clinics have a unique opportunity to offer all three medications instead of just methadone. By doing this, they will truly become disease management clinics akin to a diabetes or asthma clinics, where patients are offered the broadest and most appropriate treatment.

This change will raise the professionalism of the field and give patients a fighting chance to get well. Only by showing better treatment outcomes will we be able to remove the stigma so strongly associated with opioid addiction and, yes, the present treatment.

Percy Menzies, M. Pharm., is the president of the Assisted Recovery Centers of America, a treatment program based in St Louis, MO. He can be reached at: