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My pharmacology knowledge is basically non-existent, but I understand two things: 1) clinical addiction is a physiological dependency and can only be effectively treated through physiological means, and 2) in general, step-down treatment is a valid and more effective approach than total withdrawal.
Those two points taken together, I believe methadone scratches the same physiological itch that other opioids do, but without as many side effects. And if those side effects are more biological (eg causes vomiting or high blood pressure; idk) than physiological, then a treatment plan can include conventional medications to treat those side effects. Overall, the complex problem of opioid treatment is transformed into a smaller, manageable problem, which doctors know how to tackle.
Is it not-great that methadone is still in the family of opioids? Yes, but my concern is more about availability in some countries: in places that heavily restrict all opioids without regard for therapeutic uses, this can result in the unavailability of methadone to treat opioid addiction, something that otherwise has a wealth of research supporting its use for that purpose.
I see...that actually makes a lot of sense and it's well-put. I guess I'm kinda starting to get it...
Thanks!