More than 800,000 people in the United States are addicted to heroin – and about one in five of them receive methadone maintenance treatment to help them fight their addiction.
Methadone works by occupying dopamine receptors in the brain (so that heroine cannot), which results in patient stabilization, withdrawal suppression, craving reduction and biochemical balance. This allows the addict to focus on behavior change. According to the Office of National Drug Control Policy, methadone is a well-tested, highly regulated synthetic medication that is effective and safe when used properly.

However, there is risk of abuse, as there is with any controlled substance. Because methadone doesn’t produce a “high” feeling, some people are concerned those who use it unsupervised may take too much in the hopes of achieving a high, and by doing so, risk an overdose. But clinical studies show that when used under the care of a physician, long-term methadone maintenance is safe and does not adversely impact vital body organs.

At the AATOD conference in New York later this month, the General Accounting Office will reveal results of its independent study on the issue of whether methadone clinics that dispense methadone have any responsibility in relation to four people reported to have died while taking methadone. Industry experts expect the report to indicate there is no link and that the benefit of methadone in helping people regain a healthy lifestyle far outweighs any risk.

Case in Point: Anthony Badger. Nearly two decades ago, Anthony was a high school counselor who became addicted to heroine. After hitting rock bottom, and experiencing severe life consequences, Anthony checked himself into a methadone treatment program. Today, he has regained his life, a successful career and shares his story today with BHC Journal, with the goal of motivating others to have hope. May you and your patients find his interview inspiring:

BHC Journal: This is Robin Jay with BHC Journal. Joining me today is Anthony Badger. He’s the Director of Primary Care Services at the Lower Eastside Service Center. Anthony is an advocate for methadone. He, seventeen years ago, was on methadone for about a year for an addiction to heroine. He has turned his life around and is now using his experience at the center where he actually graduated from many years ago to help others. Anthony, thanks for joining us.

Anthony: Thank you for having me. It is my privilege and pleasure to be here.

BHC Journal: Anthony, tell us a little bit about your background and how you came to be on methadone and how you feel that it helped you.

AB: Okay — if I can condense and give you the abbreviated version. Many years ago, I was working as a high school guidance counselor in New Jersey and started experimenting with marijuana, which quickly accelerated to cocaine use and to heroine. I found myself out of a job, homeless, and pretty much living in the streets. I was living actually in Bellevue Shelter, and a gentleman encouraged me to get on the methadone program because my biggest concern and problem was the rigors of not having heroine. So he explained to me that methadone would stop me from feeling sick.

From that conversation, I went and signed up for a methadone treatment program, and his words of wisdom were very correct. Methadone helped keep me from feeling sick, as it blocks the receptors for those that need opiate in the system in the form of heroine.

BHC Journal: Had you tried other methods of trying to stop, whether it was just trying to stop on your own or counseling? Had you tried anything else before that did or didn’t work?

AB: I had never tried anything in my life up to that point to stop, I suppose, because part of me wasn’t ready to stop, but I reached a point where I was sick and tired of being sick and tired and waking up every day not being able to function and manage my life. So it sounded like a good idea and I found a program and methadone did exactly what this gentleman told me it would do. It stopped me from feeling sick.

BHC Journal: And how quickly did you feel an impact? Is it something that’s quite immediate or is there still kind of an adjustment period?

AB: Well, I would say that it’s pretty instantaneous. The first day that you’re actually given methadone, everyone’s given a small dose of 30 milligrams. And, you know, you sit in the clinic for a while so they can assess you and make sure everything’s okay with you physically and emotionally before you actually leave. But I would say that that day it pretty much stopped the heroine use in its tracks from a physical standpoint.

Now from a psychological standpoint, that’s a whole different ballgame, because what happens — and what happened to me may or may not happen to others — but I went out and used heroine anyway, just from the standpoint that that’s what I was used to doing. It was a behavioral issue that I needed to address at that point.

BHC Journal: You had mentioned when we were talking earlier that at your treatment facility, you not only have programs for opiate treatment that include methadone, but also a program that will help get you off of it at some point when you’re ready. Will you talk about that a little bit?

AB: Correct. Lower Eastside Services is very unique in terms of the array of programs that are offered there to address specific areas of treatment that patients may have. For example, a program I spoke about earlier is a residential program. It’s called “Su Casa.” It’s actually two programs in the same building and I’ll give you a little synopsis of what each one does.

There’s a short-term program which is six to nine months, and in that program, patients come in, they’re assessed, and they will stay on methadone for six to nine months. They’re taken off all secondary substances — whether it be cocaine, benzodiazepines or alcohol — and in some cases their dosage is lowered, because the dose was only increased to try and stem the tide of some of the other substances. That is the short-term program — six to nine months.

The other program in that building is called MTAR, Methadone To Abstinence Recovery, which is a 12- to 18-month program where patients are detoxed off of methadone. It’s a blind detox, so they don’t know what they are getting. Generally, the detox will last anywhere from three to six months depending upon the patient’s dosage coming in, the length of history on methadone, and whatever other circumstances, physiologically and healthwise, they might be going through. The program helps with vocational and housing and support services as far as treatment and having people who understand why it is they came to using heroine in the first place.

BHC Journal: What kind of success rate have you seen?

AB: I would say as far as retention, it’s one of the things we have not been able to measure in the sense of once patients get out as far as tracking them in time. But initially, there’s what we call aftercare groups and so forth, and there’s an alumni group that the program has set up. So I would say there’s about a 40-percent success rate of those people who stay off methadone and other drugs for anywhere from five to six years. I mean, we’re not actually tracking it, but just from my direct observation, that’s what I’ve seen.

BHC Journal: When the patients are being assessed for the type of program they should be on, since methadone is such a highly regulated medication, is there a type of person, or are there any indications about who is the best candidate for methadone versus who may be at risk at not following the procedures properly?

AB: Well, you know that’s an interesting question and I can use myself as an example. The way the program is set up, they don’t determine whether or not a person goes to short stay or long stay. That’s up to the individual. And I use myself as an example, because when I came to the program I was pretty oblivious — drug-seeking, drug-using, etc. I had no idea of the difference between short and long stay. The only thing I knew was that long stay was longer and my motivation was to be in a program where I had a bed for a longer period of time. That’s why I chose the long-term program.

As it turns out, for me it was the best choice. In our methadone treatment program, we have patients that are on one- and two-time pick-up schedules that have been on methadone for 20 and 30 years very successfully. The program doesn’t actually determine which modality is best for you. It’s up to the individual. And just sort of an FYI: A patient can come into our short-term program, and if they at any point, once they’ve completed that, determine that they want to go to our long-term program, they can then do that.

BHC Journal: How about financial issues? Back when you were dealing with it so many years ago, did you have the means to pay out-of-pocket, or was it somehow financed for you?

AB: It was financed for me through Medicaid.

BHC Journal: Is there still coverage for that sort of service if people don’t have the means to cover it?

AB: Yes, that payer source is still in place, and with our residential program, one of the unique things is that patients can come in and not have Medicaid, and there are entitlement specialists and Medicaid specialists in the program that are assigned to ensure that patients get escorted to their appointments and that they get the necessary insurance to pay for their stay while in treatment.

BHC Journal: I see. Do you have any words to indicate the importance of someone who’s on methadone, especially if it’s the very first time, having supervised care while they’re starting that?

AB: Yes. Very important point. And, again, I remember when I got on methadone the treatment program and the outpatient methadone program provided an array of services — support services, counseling, vocational services, groups that one can attend — which are all needed. The methadone is a medication that in and of itself will not cure a person; a person needs to participate in the other aspects of treatment. Now, I must say when I got on methadone I did not participate in those other areas of treatment. So even though it did in fact stop me from craving and using heroine and brought a certain stability to my life, I was still drug-seeking, and my drug-seeking went on to include benzodiazepine, taking pills, etc. But as my story unravels, it was those things that led me to the residential program, so methadone was an agent to lead me to where I needed to be.

BHC Journal: When you have a new patient coming in, they probably are at a point where they realize that the time has come and they might be motivated to want to get off heroine, but how do you use your experience to motivate them?

AB: Well, one of the things we do when they first come in is we ask them, in terms of designing a treatment plan, how can we help them. So we engage the patients and we let them know that we’re going to do 50 percent of the work and they have to do 50 percent of the work. So the treatment plan is individually catered to that person’s needs. They help with the treatment plan, so if later on as we’re going through treatment, a person begins to wander and sway from the original goals and objectives we can point back to the fact that this is what they in fact wanted us to help them with.

BHC Journal: And do you get the family involved? Is that an important part of the program? Or many times, do you get the candidates in and the family doesn’t even know they’re in it?

AB: Well it sort of depends. Again, we have a variety of different programs and so for each one of our programs there may be a different approach. For example, outpatient methadone — that’s not something that our agency does — but in our residential program as in our mental health program, we have family therapy set up so that family members are brought into play. It depends on which modality we’re working with and what sort of mechanisms we have in place. But the answer is, yes in some of our programs, not so much in some of our other programs.

BHC Journal: Well, Anthony, is there anything else that you’d like professionals listening to this to know, who may have someone they feel is a potential candidate for methadone? And also, can you give us some contact information for your particular facility?

AB: Sure. Contact information — let me throw that out there first. Again, my name is Anthony Badger. I can be contacted at Lower Eastside Service Center Primary Care Unit. My telephone number is (212) 343-3684. That’s a direct line to my office, and to the reception area, it’s (212) 343-3681. One of the things I can do is plug you into the various programs at our agency if, in fact, there is such — residential, we have a pregnant woman’s unit, mental health services, Chinese day treatment, HIV housing — we have a ton of programs.

As far as advice I would give for professionals or anyone who may fall victim to addiction is for folks that are out there not to give up on them. That’s one of the key things to saving someone’s life. And to try to get people to understand that they have a value in life, and that if things have not gone their way for whatever reason — I mean, I think back on myself and what led to my addiction and most people when I share my story with them, they can’t believe it and sometimes I can’t believe it — but just not to give up on people, because in everyone, in every adversity or every setback or every failure, there’s a seed of greatness and it’s up to us to unearth that seed of greatness.

So I encourage people, don’t give up on anyone. No matter how dire or bleak things may look, don’t give up.

BHC Journal: Well you can certainly speak from experience that you were able to get back to — even though you went into a new profession — you were able to get back on your feet and turn your life around. It’s proof-positive that help is out there and that it works. I want to thank you for your time and for what you do to motivate others, and congratulations on your achievements. Anything else you’d like to say in closing?

AB: I hope that this has been helpful and again, our agency is unique and I’m sure there are programs out there that are specific to address patient’s needs if it’s an opiate addiction, and there are methadone treatment programs available that can help people. So keep the faith; don’t give up; don’t give up on anyone; every life is worth saving. I’m proof-positive of that, and I want to thank you for giving me the opportunity to share my story with you.

BHC Journal: Well thank you very much for that Anthony. Take care.