Is Methadone Really Such a Killer?

30/09/2011 10:00 BST | Updated 29/11/2011 10:12 GMT

Many Britons are understandably concerned about recent deaths related to methadone. The rhetoric has become so intense that even allowing someone to take home a prescription rather than use it under supervision has been deemed a "loophole".

Similar voices can be heard in America

Let us start with the obvious: many potentially lethal prescriptions are taken home by millions. Beyond that, people take home their booze, and some drive drunk and engage in other dangerous behaviors. Not only are the deaths related to methadone few by comparison, it is naïve to assume that further restriction would do any good. Quite simply, anyone deprived of meth could acquire an illegal substitute - one that would be more likely to cause harm.

People take issue with methadone for another reason, one that underlies much of the rhetoric: they object to drug dependence of any kind, and hence do not consider methadone maintenance a proper solution to opiate addiction. I wish to shed light upon this one matter, the misunderstanding of which has led both to confusion and to misdirected policies.

First, however, I want to emphasize that I do not belittle the pain of anyone who lost a loved one to irresponsible methadone use. Over a year ago I also experienced a death related to this issue, though one can view it as a counter-example: an opiate addicted woman to whom I was very close had been convinced (bullied, badgered) by preachy souls into abandoning the methadone and trying it "clean". It was hard for her, she began to inject other substances erratically, and one night when she was at my home I found her body in the bathroom. You can find the story right here.

So let us try to think clearly. One person's pain is no more important than that of another, and the issue at hand requires a level head.

Objections to "dependence" really miss the mark. Diabetics depend on insulin, and all of humanity depends on air, water and food. One might, for this reason, claim that we are all addicted to air, to food, and so on. Yet such statements are irrelevant. So, when should the term "addiction" be invoked? How can we give it meaning? In one respect it's quite simple: if what you depend on is also ruining your life, then we have an issue to consider. Conversely, if you depend upon something and can function contentedly then there is little need to speak of "addiction" in the sense that identifies a problem. Whether you depend on food, insulin, methadone or spirituality, there really is no issue as long as the dependence ruins neither your life nor that of those around you.

If you can live with it, fine. If you can leave it (live without it), fine. If you can't live with it, and at the same time find it near impossible to let go, then we can speak of addiction in the sense of pathology, affliction, disease, or whatever we wish to call it.

Some of the confusion stems from the scientific currency of the term "dependence". The term was put forward in the 1980s not for scientific reasons, but because the experts involved thought that the term "addiction" would entail stigma. This "dependence" model of substance addiction involves much more than physical dependence. Themes such as loss of control over behavior, obsession, and lack of life satisfaction come into play. That's right - it takes more than physical dependence to warrant a "dependence" diagnosis.

For this reason, official bodies are likely to bring back the term "addiction". Good thing too - it's what many of us in the field are pushing for. All this talk of dependence has simply muddled the issue, leaving confusion and destruction in its wake.

Here's a recap: whether you depend on food, insulin, water, methadone, or the Lord, it's not a problem unless it causes real difficulty. Recovery must be understood as being content and living decently. Whether that's done with or without chemical assistance is irrelevant. So my (seemingly radical) point is that something is not a problem unless it's a problem.