Quote from Maevish
Also, maybe I'm being slow (I'm actually curious), but how are opiates used to get off other opiates? That makes no sense to me.
Heroin (and other commonly abused opioids) has a v. short half-life, and methadone has a v. long
half-life. With heroin, you shoot or snort it, you get a big rush and get high, the high wears off pretty quickly, and you start craving the next high pretty quickly (and going into withdrawal). Methadone you take once a day, you don't get any kind of "rush" or high from it, and it (is supposed to, depending on the dosage) prevents cravings or withdrawal all day long and into the next day.
Sort of like the difference between burning a bunch of newspaper in your fireplace vs. your central furnace to heat your home. It's winter, your house is cold, and you're miserable. You pile up a bunch of paper in the fireplace and light it, it burns like crazy, you get big flames and lots of heat, you get toasty warm right away, but it burns out quickly and, ten minutes later, you're feeling cold again (where's more paper???) Your central furnace doesn't make any pretty flames or big blasts of heat, but it keeps the house consistently warm all the time.
Methadone maintenance treatment (MMT) works by substituting the addiction to heroin or other short-acting opioid with an addiction to methadone, which is legal, monitored, and doesn't provide the "rush" or high of the illicit opioids (and, therefore, also avoids the subsequent "crash")
Using methadone as a taper to get off opioids entirely works by, again, eliminating the highs and lows of getting high on a short-acting opioid, crashing afterwards, getting high again, crashing afterwards, always thinking about where, when, and how you're getting your next fix, and getting people on a level path day to day, and then tapering them slowly down on the methadone until they are able to get off the methadone entirely. It's a lot easier to taper off that steady state than it is to taper down in a high/crash/high/crash pattern.
Neither method is any kind of "miracle cure" and they both require that the individual be motivated and willing to participate in the treatment. And, yes, methadone can be, and frequently is, abused, too.