What is methadone maintenance? How does it work (if it does)? Isn't it just substituting one addiction for another?
Methadone, like buprenorphine, is a long-acting opioid medication which can be used for detoxification from opioids or for maintenance treatment of opioid dependence. When used for maintenance treatment, it takes away the two main reasons individuals illicitly use an opioid: to get high and to avoid the extremely uncomfortable withdrawal syndrome of opioid withdrawal.
When used for maintenance, methadone must be dosed in high enough doses to produce tolerance, so that individuals cannot feel any (or at least not very much) of the effect of the usual amounts of opioids they ingest. The medication, given once daily by mouth, prevents withdrawal and eliminates an individual's "need" to get another "fix" of opioid.
It turns out that methadone maintenance treatment of opioid dependence works extremely well. There is a wealth of evidence that methadone maintenance effectively reduces opioid use, decreases transmission of HIV, reduces other medical complications and mortality among heroin users, and improves functioning.
The idea that methadone maintenance simply substitutes one addiction for another equates the presence of an opioid medication continuously in the body with the severe behavioral, medical, and social problems associated with active addiction illness.
Methadone maintenance treatment in many countries throughout the world over the last 40 years has convincingly shown that these are not the same things.