Over the years many have made the same observation that “blockade” is an unlucky term (so is “antinarcotic agent” which dole and nyswander plus used in a paper presented in London in 1967 and reprinted in Br J Adict, 1968, vol. And the other 20% who do receive methadone treatment have far far more serious problems - problems associated with the exercise of capability by “program” staff who all too often demand they accept “contracts,” manufacture medication a operate of meeting “contingencies,” videotape their urination and terminate patients whose urines are “dirty” - etc. Two specific words that have been criticized are “blockade” and “substitution.” Here are some thoughts - and comments are welcomed as always. Don’t mean to generalize - but God knows these are not issues to trivialize either. 63, pp55-57. Blockade is not an action of methadone; it is an unscientific (and probably misleading) term that simply refers to tolerance, a phenomenon that any 1st or 2nd year med student understands and virtually all physicians have experienced to their frustration and their patients’ pain.

As for “substitution” - D and N criticize in the paper cited the term in a very specific sense: “…it needs to be well understood that methadone can be used as an antinarcotic agent, blocking the euphorigenic action of narcotic drugs rather than substituting for them.” So certainly, they condemned the notion that methadone treatment provided a substitute high I doubt, though, that D or N would have cared in the least (they nearly certainly would have applauded)

advocates who shouted from the rooftops that methadone maintenance substituted a legal medication that enhances and prolongs life for an illegal substance that is associated with horrendous costs of suffering, sickness and death (as well as terrible consequences for the community). And I do respectfully propose they should be far, far higher on the list of priorities to criticize than semantics. By the same token, i’m convinced their horror by the therapeutic tyranny practiced in so very many USA “programs,” and the severe limitations on access to humane and respectful community-based treatment, would not have been mitigated in the slightest by virtue of the strong and indignant campaign to get rid of the term “substitution.”

Sure, in the best of all worlds where we had no major concerns except semantics, we could all push for the most unmistaken and precise terminology.

I know it’s presumptuous of me, but based on my long-standing and close relationship with D and N I am convinced they would focus on practical issues: they’d be thrilled that in Germany and Switzerland, for example, care is available to all who need it, from community-based generalists as well as “programs,” with relatively modest constraints - even though in those countries the term “substitution” is nearly universally used. But in USA, with virtually no one seemingly giving much of a damn about the fate of the estimated 80% of heroin dependent folks having no access to care, I feel a semantic preoccupation is a diversion.

Original post by RGNewman, MD