I'm mostly against it, but I think that there are some people that can legitimately benefit from at least a 6-12 month taper. I think that more of a focus should be put on detox facilities instead of methadone clinics. The reason being that a persons mind frame drastically changes once they are no longer dependent on a drug, and I think that most people that get on methadone do so while they are heavily dependent on opiates, so therefore are still in the mind frame of being dependent on opiates to function.
I haven't seen enough people on methadone that are actually taking their treatment seriously (not taking benzos, alcohol, cocaine, or amphetamines, and actually working on their recovery) to convince me that it's the best option for the addicts that choose this course of treatment. In 2007-2008 I was on suboxone for 18 months, and although I stopped getting high on heroin and oxycodone, I drank a lot of alcohol and took a lot of xanax.
Since then I have taken several 4-6 month breaks, but recently I have still been using heroin, but 1-2x a week, and at times I have come across enough free drugs to get dependent, but after kicking I can take a few weeks off of opiates without much difficulty. Although my continued use is not ideal, I think that it's far better than getting on methadone or going back on suboxone, but of course everyone is different, and therefore addiction should be treated on a case by case basis. In due time something should click, and I will hopefully put down the dope for good, but until then I will stay focused on not catching a habit, and trying to limit my use more and more.
Now there are some people that I know that use daily, spending all of their money on heroin, with no end in site. For people like that I can see methadone being beneficial, but I think it should be used for a 6-12 month taper instead of long-term maintenance. It's hard to quit heroin when you are broke from spending all of your money on staying well, so methadone can at least help with that so they can save their money to improve some aspects of their life (paying off debt, taking care of legal issues, getting a car and/or apartment). Otherwise it's just too easy for most addicts to say "fuck it, I'm in debt, have a few warrants out for my arrest, no savings or hopes of getting a car, so I might as well just keep getting high so I don't have to think about my shitty situation." If they were to just go to a 5 day detox then they would be too vulnerable to relapse soon after getting out since it's a lot of stress to handle for someone that just got clean, and it's so easy to just pick up as an escape.
Overall I think that there should be more options for people to detox. In the US it's pretty hard for a lot of people to get into a detox facility. Between not having health insurance or the money for the detox, and having to wait for an open bed at a detox, it's just easier for some addicts to get on methadone and pay what they would be spending for one hit of smack for a week at the clinic. But then weeks turn into months, and months turn into years, and 60mg/day turns into 200mg/day (I'm not sure about Australia, but in the US the 100mg/day limit was lifted a while back, and patients are now allowed to continue to increase their dosage every 2-3 days if they want, which results in some patients being on dosages in the 200-400mg range.)
I haven't heard enough methadone success stories to make me a supporter of it, and most of the arguments for it aren't really that solid. For instance, some will say that methadone maintenance will keep addicts from doing illegal things to support their habits, but anyone that has been to the clinic knows that a lot of illegal drug dealing goes on there, whether it be benzos, heroin, or other drugs. Another argument for MMT is that when people get on methadone they won't be doing illegal street drugs, therefore making them less likely to OD. Now I don't know the statistics, but a lot of people on MMT fatally overdose, especially from the methadone/benzos combination, so I don't think that argument holds water. As with anything though, a few bad apples shouldn't spoil it for the people that are taking their recovery on MMT seriously, but then again I wouldn't be surprised if the people on MMT that are taking their recovery seriously are in the minority. Either way, people should not be deprived of treatments that can be beneficial to them, and at the end of the day an individual needs to be held accountable for themselves and their own recovery.
Perhaps it's not opioid maintenance in general that I think is not very beneficial, but more of the choice of drug that they use for maintenance that is the problem. I understand that methadone has a long half-life thus making it appealing for these programs that want to control the treatment by giving a daily dose without having to worry much about withdrawal. However, I think that the persons DOC would work a lot better as their maintenance drug. A person is going to get high until they are ready to quit, so only allowing them methadone or buprenorphine is only taking care of keeping the person out of withdrawals. If they still wish to get high, they will find a way to do so, and in the case of methadone the measures that people will go to in order to get some kind of high are usually more dangerous than if they were just allowed their DOC. A person can't be forced to get clean if they don't want to, and if they wish to continue to do their DOC (either for maintenance, tapering, or a high) without going to illegal measures to do so, they should be allowed the option to obtain their DOC instead of having to settle for an alternative that could cause more problems than their DOC.
We all know that most heroin overdoses are a result of a more potent batch, or a person doing their normal dose after a break, so allowing patients to take a known dose of their DOC for maintenance would eliminate some of the risk of OD. The other common cause of OD is drug combinations, but they still occur on methadone, arguably more so than with opiates such as heroin, and most people on heroin usually take these combinations if they can't afford to get high on heroin, a situation that would not be as much of an issue if a patient was allotted a known dose that they needed.
So overall I think that the current maintenance drugs being used are the main issue why opioid maintenance is not that effective in lowering the amount of problems involved with the addicts lifestyle. The other issue that I see is the lack of resources for detoxes, which force people that do not require maintenance for the treatment of their addiction to enter into these maintenance programs, which may just prolong the amount of time before they are off of opiates, or may also cause their addiction to become worse since methadone harder to come off of compared to heroin and other common opiates/opioids.
