The Ultimate Guide to Methadone Maintenance Treatment: Effective Strategies for Opiate Addiction Recovery - Essential Handbook for Providers, Patients & Families | Support for Long-Term Sobriety & Wellness

I just finished reading this book. The tone of the author is angry (from start to finish). I agree wholeheartedly that patients with opioid use disorders have been stigmatized and often discouraged from seeking effective treatment with methadone. However, I do NOT agree with many of the medical statements made in this book.1) The author argues that benzodiazepines are often a "necessary" medication for treatment of anxiety in patients on MMT. This is wholly false. There are dozens of effective, safe medications for anxiety which are NOT benzodiazepines. Benzodiazepines are best only for SHORT-TERM treatment of anxiety (regardless of whether or not a patient is on MMT). Research has now proven that benzodiazepines are neurotoxic. Long-term use of benzodiazepines increases memory problems and risk of dementia (in ANYONE). Add to this to the fact that combining benzodiazepines with long-acting opioids (like methadone) increases respiratory depression, overdose risk, and overall mortality, and it doesn't seem that benzodiazepines are a good choice for treatment of anxiety in patients on MMT. (Please note: Patient who are on benzodiazepines should be tapered off slowly.)2) The patient characterizes marijuana use as harmless. This is not always true. It should be noted that there is a difference between patients who occasionally use marijuana and patients with a marijuana use disorder. If marijuana use decreases social functioning (interferes with employment, relationships, etc.), it is a problem. Patients in MMT who meet criteria for a marijuana use disorder have worse outcomes (lower retention in treatment, more legal issues, etc.) than those who do not. It is negligent not to try to address marijuana use in patients on MMT if they meet criteria for diagnosis of a marijuana use disorder.3) The author has a very classic view of narcotics as a treatment for chronic pain (i.e. high-dose narcotics can be helpful and patients with "real" pain rarely develop addiction). The BEST treatment for chronic pain is to use a combination of treatments (anti-inflammatories/steroid injections, exercise/physicial therapy, anti-epileptic medications, nerve stimulation or ablation, and judicious/limited use of narcotic pain medications). Raising doses of narcotic pain medication higher and higher leads to increased morbidity/mortality (but DOESN'T decrease pain scores). Patients with chronic pain who are placed on narcotics should be CONTINUOUSLY monitored for development of addiction. (Do you ever take more than prescribed/run out early? Do you ever "snort" or inject your pain medication to get an increased effect? Do you spend a lot of time thinking about/using/savoring your narcotic medication?) Patients who develop addiction should be transitioned to MAT. (Unfortunately, the knee-jerk reaction is usually just to dismiss the patient from pain treatment and not acknowlege/address the fact the patient now has an opioid use disorder.) A significant fraction of my MMT patients started out as "legitimate" pain patients.