When addiction treatment means decades on Methadone
Odell Jones describes himself as a “working addict.” For decades, he maintained a career in social work and politics, as well as a family — four children and a wife — while using and selling heroin.
”An individual would not know that I was a drug user, or a drug dealer, for that matter, unless I were to tell you,” he said.
The 68 year old is retired now, and he has been on Methadone for about 20 years, something he said his coworkers at various jobs never knew, even during the early days of his treatment when he had to go to clinics every day. When he moved to a new place — from Jersey City, New Jersey, to Topeka, Kansas, to Baltimore — he had to start over in a new Methadone program.
He’s also been to three different clinics in Baltimore. The first two “didn’t have the things that I needed,” he said. “I needed the counselor that knew what he was doing, the counselor that actually listened, a counselor that took part in my rehabilitation.”
He’s been a patient at Bon Secours’ New Hope Treatment Center in West Baltimore for roughly a decade.
Methadone works by blocking cravings for illicit opioids like heroin and making it harder to get high. For Jones, it fills the space that heroin left behind. Without it, he can’t function.
About four years ago, he went to Kansas to watch his granddaughter graduate from high school, and he forgot to bring his Methadone, he recalled.
“Buddy, that was the worst three days of my life,” he said. “I felt absolutely terrible. I was on a plane. I couldn’t sleep. My body was hurting.
The National Institute on Drug Abuse considers a year the minimum amount of time someone should be in a Methadone program.
But that’s not set in stone, according to Heather Young, the nurse practitioner at the clinic where Jones is a patient. She said there is no minimum or maximum amount of time a patient is supposed to be on Methadone.
“We have some that, you know, start, and they’re on for a year, and then they feel that they want to start to taper off,” she said “So it’s not necessarily saying when you go on, you’re going to be on here for the rest of your life.”
Still, she said she has about 15 patients who treat the drug like a security blanket. They spend decades on a dose so small it has virtually no effect.
Johnnie Davis is one of those patients.
“My problem is right now, if you’re going through the detox, you’ve got to definitely put something in that spot,” Davis said. “This has been a part of your life for so long, … it’s going to be a big blank space there right now.”
The 63-year-old said he developed a “dealer’s habit” while selling Heroin in the 1970s.
He has been at Bon Secours’ Methadone clinic for nearly 20 years. He worries that if he stops taking Methadone and doesn’t replace the daily dose with a new routine, such as a job or school, he will end up back on Methadone, or worse — on Heroin.
Given his current health, he said it’s likely he will be on Methadone for the rest of his life.
“I guess I’m not going to be around for so long,” he said. “Sixty-three ain’t nothing, but I’m blessed every day I got.”
Methadone and Buprenorphine have been used for years to treat addiction to Heroin and prescription narcotics, like Percocet and Oxycodone, and they have proven effective.
But the medications are also opioids, so they’re a less-than-ideal treatment for opioid addiction, especially over the long term, according to Damean Freas, the chairman of the Maryland Board of Physicians and the CEO of a pain management practice.
“I would say in general that, no, none of us want, either in addiction or pain medicine, people to be on lifelong opioids,” Freas said. “To say that for 40 years or 30 years you would be on Methadone is not good medical treatment.”
The drugs can damage patients’ livers, kidneys and other organs, he said, and flaws in the addiction treatment system are encouraging patients to remain in Methadone programs longer than they should.
"The mindset that, ‘I can never get off it. I’ll be here for life,’ is a mindset of someone who always will be there for life,” he said. “I believe that the addiction world could work harder, especially in Methadone clinics, to get people off sooner.”
But a lot of beliefs like those Freas mentioned aren’t rooted in science, according to Ken Stoller, a psychiatrist at Johns Hopkins Hospital who specializes in addiction psychiatry.
For example, he said when Methadone is prescribed properly, there are no real long-term health risks — no more than there might be side effects with any medication.
“This is one area of medicine where it seems like there’s more focus on opinion or philosophy as opposed to the science because the science is really, really clear on this,” Stoller said.
And he said there’s no time limit for how long someone should rely on the drug.
“I look forward to the time when people consider these medications as any other medications in the practice of medicine in that, you know, somebody typically doesn’t ask, … what’s the proper amount of time for somebody to be on an antibiotic or insulin,” Stoller said. “It really depends on the person’s illness that’s being treated.”
He tells his patients that reaching a point when they can stop taking Methadone or Buprenorphine isn’t the goal. Recovery is.
But, he said, if patients who have been on the drugs for many years want to stop taking them, they need to replace the structure of the daily medication with a new routine, such as a job, going back to school or another regular activity.
“The fact is that because of some people’s years of heavy opioid use, at this point it might only be Methadone that can really normalize their brain chemistry to the point where they’re not constantly exposed to cravings for opioids,” Stoller said.
After 20 years spent at multiple Methadone programs, Odell Jones is ready to leave the drug behind completely. A couple of months ago, he began what will likely be a year-long effort to wean off the drug.
“It’s just, you woke up one morning and say I’m tired of this, I’m not doing this anymore,” he said. “It bleeds slowly — ‘Now I'm tired of this,’ ‘I'm tired of this,’ and all of a sudden, ‘I'm damn tired of this.’ And when you get to that point, you know it's time to roll.”
He said so far he doesn’t notice the decrease of Methadone too much. He gets slight pains —in his knees, specifically — but at 68 years old, he isn’t sure if that’s caused by the decreased dosage or getting older.
“To counter that,” he said, “I go to the gym once or twice a week.”