Because of an abstinence-only mentality that pervades much of our society, there has been a fair amount of opposition to the idea of methadone maintenance as a treatment for heroin addiction. Opponents claimed that it would merely substitute one addiction for another and that the only legitimate goal was to get users off opiates completely. They predicted that non-heroin users might gain access to methadone and become addicted to heroin. They argued that heroin users might use methadone instead of abstaining from opiate use altogether. They also argued that methadone clinics would bring with them increased crime to neighborhoods where they were located. Finally, they argued that there is no proof that methadone is safe and that its long-term effects have not been fully studied.
None of these predictions or fears turned out to be true. Methadone use is strictly controlled and only heroin users have access to it. Those who go on to methadone would almost uniformly not have quit using heroin had the methadone not been available. They would have continued using heroin. Methadone abuse is not a problem among youths. Crime has decreased, not increased, due to these methadone programs. Long-term methadone use has been found to be relatively safe and certainly much safer than even short-term heroin use.
If anything, the main limitation of these programs is that physicians have been reluctant to prescribe high enough doses of methadone to be effective in keeping their clients off of heroin. Too little methadone use, not too much, is by far the most serious problem in addiction medicine today.
And while it is true that methadone maintenance substitutes one drug for another, methadone is far less serious because it avoids a host of complications from the injection of heroin, from infection to acute disease to chronic disease to crime and violence. I have seen hundreds of clients live essentially normal lives on methadone, something that would have been impossible without it.
In order for one's world view to accommodate the possibility that methadone maintenance might be a literally life-saving treatment, however, one has to go beyond the abstinence-only mentality. One has to look beyond the concept of whether a drug is "safe," and be willing to re-frame the question has whether one drug is "much safer" than another. Harm reduction, rather than harm elimination, must be considered. Most importantly, one must be willing to put aside ideology, politics, and undocumented and overhyped predictions about the effects of programs and rely upon science and empirical evidence.
The cognitive and ideological trap in which methadone opponents were caught appears to be exactly the same one that has now caught the major anti-smoking groups, which have called for a ban on electronic cigarettes. These groups include the Campaign for Tobacco-Free Kids, American Heart Association, American Lung Association, American Cancer Society, and Health Canada.
The arguments being used are the same ones that were put forward against methadone: it is going to attract non-users to start using the drug, it is going to entice youths to start using the product, it is going to keep people from abstaining completely who otherwise would have done so successfully, it has not been proven that the alternative product is safe, and so forth.
And unfortunately, anti-smoking groups have been unable to put aside ideology, politics, the influence of money, and a reliance on undocumented and overhyped predictions about the effects of programs. They have been unwilling to rely upon science and empirical evidence.
And, I'm afraid, the result is a potential public health catastrophe that would be analogous to what the situation would have been if we had allowed methadone opponents to carry the day.
Frequent Rest of the Story commenter Iro Cyr recently published a wonderful piece in The Metropolitain which eloquently explains the rationale behind the electronic cigarette and the absurdity and hypocrisy of anti-smoking groups' demands that this product be taken off the market.
Cyr writes: "Apart from the public reacting negatively to coercion, another likely reason why the remaining citizens who smoke may be reluctant to quit their habit is the lack of realistic alternatives to the act of smoking itself. Public health authorities tend to see smoking as a function of addiction to nicotine, and pharmaceutical companies have cashed in on that perception by marketing various nicotine replacement therapy (NRT) devices. These products, in the form of variously flavored chewing gum in colorful packaging, or lozenges, patches, or even inhalers, are advertised extensively in all media. No doubt NRT sales are high and profitable, but the long term success rate of quitting smoking by use of NRT products as they are marketed now is a dismal 1.6%."
"Electronic cigarettes are seen by many as a more attractive alternative to the NRT products available from the pharmaceutical industry and a viable alternative to those who wish to continue profiting from the benefits of nicotine. The use of the e-cigarette simulates the physical acts and sensations characteristic of smoking, including holding a cigarette-shaped device, inhaling nicotine vapor from it, and exhaling propylene glycol vapor. This vapor is a relatively inert gas which is odorless and does not linger in the air around the e-smoker. There is no environmental smoke produced by e-cigarettes therefore there is no annoyance to by-standers."
"The popularity of the e-cigarette has spread virally through means such as word of mouth and internet forums. Large numbers of people around the world claim that use of e-cigarettes has helped them quit or cut down on their smoking and that it provides a degree of comfort, satisfaction, and convenience to those who do not wish to give up nicotine intake for various reasons."
"In light of all of this, it is beyond disappointing to see that Health Canada is calling for a ban on the sale and distribution of electronic cigarettes in this country. It is absurd that Health Canada would keep it legal to smoke tobacco and ban the marketing of e-cigarettes, which offer an effective alternative and we are not alone to feel this way. ..."
"What is it in the combination of nicotine and propylene glycol that has Health Canada thinking that e-cigarettes are more hazardous than tobacco and NRT products such as inhalers? Surely e-cigarettes, which are neither tobacco products nor pharmaceutical products, should be permitted to be marketed and distributed freely providing they are not advertized as therapeutic devices."
"Unable to comprehend what motivated Health Canada to ban e-cigarettes while keeping tobacco and pharmaceutical nicotine replacement therapy as well as the dangerous drug Chantix legal, I can only conclude that the only parties worthy of protection from Health Canada are the pharmaceutical and tobacco industries whose profits are threatened with the advent of this smart invention that had the potential of reestablishing harmony between smoking and non-smoking citizens and bringing much needed business back in our hospitality sector. Health Canada should rethink its e-cigarette policy immediately, in the interest of the people they represent as opposed to the financial interests of powerful corporate lobbies."