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With the rise in heroin as a popular drug among young, upscale users, many are now looking for treatment that will address the debilitating physical and social effects of long-term heroin use. For users who have tried treatment and failed, methadone maintenance programs have been a popular way to control the negative effects of opiate dependence.

Developed in the 1940s by German pharmacologists as a synthetic pain-killer, methadone has since become common in the United States and elsewhere as a means of reducing both the cravings for opiates and the potential harm to users from street drugs and needles.

Maintenance treatment typically begins after multiple attempts to get other kinds of treatment, such as detox, rehab, and outpatient treatment, have failed. Users should be dependent only on heroin and not cocaine, alcohol, or other drugs in addition to the heroin.

A nurse or social worker conducts a psychosocial assessment and drug use history. If the patient is not in the acute stages of opiate withdrawal and there are no medical problems which would interfere, he or she is examined by a medical professional and given a start date, which can range from immediately to within several weeks of the evaluation.

Treatment consists of a prescribed daily dosage of methadone, based on patient's weight, usage, tolerance and withdrawal symptom history, and medical history. The methadone comes in liquid form, which the patient drinks. Methadone may be used in conjunction with some combination of 12-step meetings or counselor-led recovery groups or therapy groups which take place after patients get their medication.

Methadone has been shown to reduce cravings for heroin while not altering a person's mood. A person could, therefore, go to the local clinic early in the morning for his or her daily dose of methadone and proceed on to work, where he or she will be able to function unimpaired. The person will experience none of the unpleasant withdrawal symptoms associated with heroin.

Advocates of methadone maintenance treatment say that it's a good way to control an addiction, especially when a patient has tried everything else without success. Indeed, most studies are agreed that it is often safer to use than heroin. For many patients who have gone through many detoxification programs, inpatient rehabilitation, residential treatment, and outpatient group counseling, methadone maintenance is often their last chance. Methadone maintenance is also relatively inexpensive--the cost can range from $50 to $150 per week, and is low compared to the price of a lengthy hospital stay in a detox or rehab program. It allows people to function on a day-to-day basis and reduces the risk of overdose. In addition, since it is given orally and not injected, it reduces the spread of HIV among intravenous users.

There are, however, a number of problems associated with methadone use. Among these is the obvious risk of substituting one addiction for another. Although methadone is safer to use and legal if taken in a clinic, an addiction to methadone is harder to break than one to heroin. If a patient decides after several months on methadone maintenance to discontinue it, the detox is generally longer and more uncomfortable. Use of methadone reduces cravings for heroin, but methadone maintenance, unless combined with counseling, will do nothing to alleviate the social and emotional consequences of long-term use. Also, methadone's side-effects can include orthostatic hypotension (low blood pressure), nausea, insomnia, constipation, and allergic reactions. Although methadone maintenance is inexpensive, as a maintenance therapy it is frequently not covered by insurance companies. Finally, because dosages are administered daily, patients need to arrange their day around their program. Only after a patient has been shown to be compliant with treatment and abstinent from other drugs will he or she be allowed to take multiple doses to carry with him on, say, a vacation or a business trip.

Methadone maintenance treatment can be an effective, inexpensive, and convenient way to manage an addiction to opiates, especially for people who have tried other means of addressing their addiction. Used alone, however, it doesn't address the core issues surrounding addiction. For that, one needs counseling and other solutions that address a patient's behaviors and in the context of the social and emotional causes of dependence.