In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

Specific harm-reduction practices depend on resources and need. One such practice is the prescription of methadone. These days I write regular methadone scripts for over one hundred patients. The drug is a synthetic narcotic that occupies opiate receptors on brain cells, blocking the access of heroin molecules to the same binding site. When ingested orally, it does not cause a high in chronic narcotic users, but for many addicts it prevents heroin craving and also withdrawal symptoms such as nervousness, pain, diarrhea, and nausea.5 It’s long-acting, so a once-daily dose will see most people through twenty-four hours. It is estimated that there are sixty thousand to ninety thousand illicit opioid abusers in Canada, but only about a quarter are receiving treatment.6 U.S. treatment figures would be much lower given the near impossibility of obtaining this medication in many jurisdictions. We offer methadone maintenance to addicts not to cure them of their narcotic dependence but to transfer that dependence to a narcotic that is legal, that is safe if ingested properly, and that prevents them from having to prostitute themselves, steal, and beg to avoid withdrawal. An addict chooses methadone when he tires of the endless daily scrounging for illicit narcotics and of the consequences of always having to dodge the law. None of my methadone patients would accept abstinence as an alternative to heroin use, and even with methadone the heroin craving remains irresistible for some. ...