Methadone’s Unredeemed Promise

I suspect readers of a certain age–maybe in their twenties and thirties–don’t know much about methadone, the substitution drug used pretty heavily to deal with an earlier heroin epidemic. But now that the country has seen a resurgence of heroin addiction, along with a new and very big problem of abused prescription opiates, it’s time for methadone (and a similar, newer drug, Suboxone) to make a big comeback, too. So argues psychiatrist and AEI scholar Sally Satel in the new issue of the Washington Monthly.

But there are abiding cultural and political inhibitions to use of substitution drugs for opiates, exemplified by the “just say no” attitude of the War on Drugs, sometimes rationalized by relatively high relapse rates for people using methadone and Suboxone. As Satel explains, however, the substitution drugs are ideal for “coerced abstinence” programs run by the criminal justice system where the long-term consistent use of methadone and Suboxone that tends to produce drug-free outcomes can be supervised and encouraged.

Half a century ago, long-term opiate substitution became a viable practice as the nation found itself in the midst of a blossoming heroin epidemic. Today, we know that substitution medications, relapse prevention skills, and other rehabilitation efforts can improve the lives of addicts, and save society both money and sorrow. The most promising arena for this effort is the criminal justice system: faced with the rewards and sanctions of drug court, participants are less likely to bolt. Although the criminal justice system is off to a slow start, merging these elements could be a winning prescription for our current opiate problem.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.