Dr Ross Colquhoun D H Sc, M App Sc (Neuroscience), BSc (Honours) has published a research paper summarising several recent studies that examined the efficacy, safety and outcomes for opioid-dependent people and the use of medication to facilitate recovery – leading to 12 “very important” conclusions.
SUMMARY from:
Dr Ross Colquhoun D H Sc, Mapp Sc (Neuroscience), BSc (Honours) Executive
Committee Member and Research Consultant, Drug Free Australia
This paper has included several recent studies that examined the efficacy,
safety, and outcomes for opioid-dependent people and the use of medication
to facilitate recovery from this debilitating and life-threatening use and
dependency on these drugs. The 12 very important items clearly outline the
conclusions to be reached are that:
1.Methadone is associated with ongoing use and injection of opioids and
other drugs over long periods of dependence on this drug, It, therefore,
leads to greater levels of harm compared to those who never started methadone
and who quit using opioids.
2. Methadone is associated with cycling in and out of treatment, which is
characterised by high rates of mortality, especially in the period
immediately following induction into a methadone program and in the first
few weeks of ceasing methadone dosing.
3. It is well recognised that most drug fatalities are the result of
polydrug use, especially when people use a combination of respiratory
depressants, such as. other opioids, alcohol, and benzodiazepines. The
advocacy and use of high-dose methadone are common factors in overdoses and
heighten the risk of death, especially when a person uses another opioid and
or other CNS depressants. High-dose methadone is fatal for people who enter
a methadone treatment program, who are occasional users of opioids and who
lack tolerance or for those who do not experience the desired euphoric
effect of the drug who then use another opioid being unaware that the
longer-acting methadone is still in their system and of the synergistic
effect that results in overdose, after they leave treatment.
4. Methadone is a treatment that is not favoured by drug users as it
diminishes the euphoric effect of other opioids, and it often results in
users dangerously injecting the methadone syrup and that they need to be
dosed daily and that it be dispensed from a dedicated facility or from a
pharmacy. Users and advocates complain that it impedes their lives and is
inconvenient, citing the inability to go on a holiday or attend important
family events and that it takes too much of their time. The need to go to
the clinic each day is due to the high rates of diversion 76 and misuse of
the medication, which can result in the overdose and death of others,
including children. These people, who complain about the inconvenience of
daily dosing of methadone, which is subsidised by the government,
disingenuously forget to mention that illicit opioid use is much more costly
and requires the users to dedicate much more of their time acquiring their
drugs through commission of crime, sex work, doctor shopping or selling and
using the drug and doing this four times each day on average, than it does
to attend a methadone clinic.
5. Methadone was promoted as an important preventative measure in the spread
of bloodborne viruses, most importantly the spread of HCV and HIV among
IDUs. This has been shown not to be case, as it is based on false
assumptions. The research shows that the prevalence of HCV is higher among
people who use and attend methadone and needle exchange clinics and
facilities. The changes in behaviour that stemmed HIV infection rates
predated the widespread availability of methadone. Moreover, it is not
protective of the rates of HIV transmission as it is almost exclusively
spread through unsafe sexual behaviour, with studies showing that methadone
does not influence this behaviour, including condom use, which is the major
preventative measure for transmission of this virus.
6. Adverse health effects of sustained chronic, regular use, such as chronic
disease (eg, cardiovascular disease and cirrhosis), blood-borne bacterial
and viral infections, and mental disorders are exacerbated by the long-term
dosing of methadone (Degenhardt and Hall 2012). Advocates for OAT and the
disease model of addiction purport to be experts and maintain that methadone
is a treatment medication, equivalent to insulin in treating diabetes, but
are being deliberately misleading when they infer that methadone is not the
same to the extent as any other opioid is not the same, in its effect on
cognitive functioning and brain structure and the development of tolerance,
withdrawal symptoms, craving for the drug and 77 continued use despite
unwanted and negative consequences. Despite this, they maintain that “like
morphine, heroin, oxycodone, and other addictive opioids, methadone causes
dependence”, but because of its “steadier influence on the mu-opioid
receptors, it produces minimal tolerance and alleviates craving and
compulsive drug use, and that methadone therapy tends to normalise many
aspects of the hormonal disruptions found in addicted individuals” (Ward,
1995; Rankin & Mattick,1997; Kosten & George 2002)
7. Methadone does not facilitate abstinence from these addictive drugs. On
the contrary, because of the very high mortality rates when people leave a
methadone program, and high rates of relapse to heroin injecting behaviour,
it is strongly advocated that people stay on this drug for an indefinite
time. Many people who were coerced into the methadone program and who wanted
to stop their dependency on the drug find that it is virtually impossible to
withdraw from it, and many have been on it for 40 years or more.
8. A CDC report of a study in the US, found that by 2009, prescribed
methadone accounted for nearly one-third of all opioid-related deaths, even
though it represented only 2% of opioid prescriptions. It was thought that
methadone’s long half-life led to overdose deaths. The report also noted
that methadone accounted for 39.8% of single-drug OPR deaths, highlighting
its significant role in overdose fatalities when used alone. This suggests
that while the number of prescriptions was lower compared to other opioids,
the risk was higher as the overdose death rate for methadone was
significantly greater than that for other OPR for multidrug and single drug
deaths. It concluded that “Methadone remains a drug that contributes
disproportionately to the excessive number of opioid pain reliever overdoses
and associated medical and societal costs” and cautioned that “Healthcare
providers who choose to prescribe methadone should have substantial
experience with its use.”.
9. Methadone is an inferior and unsafe treatment for these people compared
to naltrexone slow-release implants and, to a lesser extent buprenorphine,
and this has resulted in very low numbers of people who have OUD, who are
entering OAT programs despite their availability.
10. However, buprenorphine it was reported in the USA was less popular among
opioid drug users as it blocks the effect of opioids as it is a partial
agonist and precipitates withdrawal symptoms if the user uses other opioids
and does not reverse the brain changes caused by chronic use of opioids.
(NIDA. 2020) The uptake of OAT has stagnated. Recent research has shown a
decrease in methadone uptake (-8.6% over 10 years) and a relative increase
in the use of buprenorphine preparations up by (+78%). Despite the rise in
the misuse of opioids and associated deaths (an increase of 240% over the
last 10 years), OAT numbers have remained the same at about 53,000 (allowing
for population growth), over the same period with the evidence indicating
that those who are on OAT are the mainly the same people who commenced the
program some 30 to 40 years ago, even though many were cycling in and out of
the program and many have died. Moreover, it has been estimated that 18% of
the 300,000 people reporting opioid dependence in 2022/23 indicates that
many are not be engaged in formal treatment programs.
11. The randomised trials and research around the application of naltrexone
slow-release medication, that have been presented in this paper, are
disregarded by methadone advocates, Recent research indicate that naltrexone
implants are a beneficial, effective, and safe, while people are in
treatment, and most importantly when they leave treatment, as they provide
an opportunity to be rid of their dependency, to reverse the debilitating
changes to the brain and to resume a normal and preferred life free of their
addiction.
12. The evidence to date indicates that the use of naltrexone implants is a
superior, more effective, and safer treatment for opioid dependence on most
criteria, including, cessation of illicit opioid use and injecting, crime,
social cohesion, employment, and importantly, a reversal of brain changes,
and dysfunction, compared to methadone. Not surprisingly, it was not
superior in retention in treatment as methadone is highly addictive and
indefinite retention in treatment is the major goal of MMT. It is noteworthy
that none of the methadone studies reported very few as being able complete
detoxification and to attain abstinence from opioids and, presumably, they
remained addicts with no realistic chance of normalising their lives,
whereas this was the stated goal for those entering naltrexone treatment,
which was shown to be highly effective, when combined with ancillary
services, particularly for those who were motivated to do so. An important
insight that has come out of this research, is the critical importance of
the prevention of drug harm by utilising the power of public awareness
campaigns that warn of the dangers of certain behaviours and implementing
widespread and targeted education about the consequences if people don’t.
Most prominent was the campaign in the 1980s that led directly to a halt in
the spread of HIV in Australia and resulted in one of the lowest infection
rates in the world and the on-going awareness campaign to encourage people
to quit smoking. Today, however, there is a concerted effort from sectors of
society that are set on undermining efforts to honestly portray the inherent
dangers of drug use, downplay the health and social issues that result from
this behaviour, and who are trying to normalise drug use. Permissive
attitudes toward drug use run counter to this reality and result in more
people using and being harmed by them. A salient example of this came from
the overprescription of opioids for pain relief in the 80 -© 2025 Ross
Colquhoun USA in the early 1990s with the false belief that they were not
addictive and posed no serious threat to health, with the health experts
remaining quiet, minimizing the danger or, in fact endorsing the
pharmaceutical companies claims as to the efficacy and safety of opioids
which led directly to the tragic loss of hundreds of thousands of lives.
Methadone, which caused a disproportionate number of these deaths, continues
to be prescribed under the guise of treatment for OUD, even after, the
prescribing of methadone for pain relief was banned due to its inherent
tendency to make an ongoing and unacceptable risk for those who are
dependent on it, due to the severity of overdose withdrawal symptoms coupled
with the length of time it remains active in their systems. While
authorities stopped doctors from writing prescriptions for methadone they
did not curtail the supply of the drug to addicts, full well knowing that
methadone was not enabling people to be free of their addiction, it did not
result in the improvement in health and social functioning, it meant that
these people’s lives and functioning were compromised because the toxic
effects of the drug, that they continued to go in and out of treatment in an
effort to be free of it and they were dying at unacceptable rates. Moreover,
these facts were hidden from the public, and false claims were being made
about the virtues of the MMT programs to justify their continued advocacy
for it. To make this so much worse, they exaggerated the risks associated
with the use of naltrexone and ruthlessly prevented the operation of
abstinence-based treatment facilities, which robbed these people of the
chance to be free of the drug and to resume their normal lives. It is
galling, therefore, when academics, researchers and drug and alcohol
clinicians refuse to accept research findings that do not suit their
ideological position and dismiss that which is well conceived and constructed
because it does not fit their worldview or the current political realities.
