Methadone treatment is not and never has been intended as a cure for opioid addiction. It is a medication to treat and control a chronic and largely uncureable condition. Simply being abstinent from drugs does not mean a person is cured. They may still live with cravings, depression, lethargy, etc. This is due to the biochemical occurances within the endorphin systems of long term opioid addicts. Long term opioid use causes derangements in the production of natural opiates(ENDORPHINS) that keep us all feeling normal levels of happiness and contentment, and control minor aches and pains. Even with years of abstinence, some users will never experience a return to normal endorphin function. These people require exogenous opioid supplementation to feel normal--not high, just normal. Methadone is best suited to this due to it's long half life, lack of euphoric side effects, very slow rate of tolerance building. and low cost. It is a very safe drug to take physically speaking. The founders of MMT, Dr.'s Dole and Nyswander, knew and expected from the outset that many patients would require life long maintenance on this drug. Yes, methadone IS a substitute, but NOT for heroin, etc--it is a substitute for the endorphins the addicts brain no longer makes. No amount of residential rehab, prayer, meditation, and step working will cure this biochemical, medical disease in these people. Short term addicts may benefit from such therapy, but most long term, heavy users will not do well there. Many of these addicts were actually BORN with a malfunctioning endorphin system, struggled all their lives with depression and misery, and in seeking a cure stumbled into opiates and finally felt normal. For these folks, even if a return to normal function IS possible with abstinence, normal for them is still pretty awful. They too need opioid supplementation. Standard anti depressants are not effective for endorphin deficiencies--they work on serotonin.

The fact is that for those who remain in treatment on MMT, the success rate, as measured by a return to a productive life, employment, and not using illicit drugs, is about 65%. Those who taper off MMT have a relapse rate approaching 90%. Please remember this is a chronic medical condition, and as such, requires chronic therapy for some people. The goal of insulin therapy is not to wean diabetics off insulin, and no one judges it's success by seeing how many diabetics are "insulin free" in 3 years. This is just as ludicrous.

First thing to say is that there is no cure for addiction! To give addicts the false hope of a cure is cruel, dis-honest and irresponsible.
In saying this I certainly am not a bringer of doom and fatalism. People do recover and lead normal and productive lives "if they have the capacity to be honest themselves". Methadone simply postpones the chances of people being honest with themselves, like telling an alcoholic that if he/she only has a couple of drinks every now and then he/she will be fine.
Coming off drugs in a controlled enviroment such a rehabilitation hospital is not easy but it is manageable. Nobody, unlike alcohol, dies from the withdrawl from drugs if it is done in a protected enviroment. The way forward from there is again not easy but it is attainable and many people have acheived it. There is hope but only if it is a realistic and honest one, not a false horizon such as given by methodone.
One last point. To try and compare diabetics and their use of insulin with the use of methadone is both erroneous in the extreme and again completely dis-honest

It is most certainly NOT "erroneous". Addiction is a disease of the brain chemistry. Diabetes id a disease of the body chemistry. Addict's brain's do not produce adequate endorphins at a normal level. Diabetic's pancreases do not produce insulin at a normal level. Some diabetics require insulin therapy to restore the chemistry to normal. Some addicts require exogenous opiates (methadone) to restore the brain's chemistry to normal. Diabetics on insulin need their medication daily or they will become quite ill. Endorphin deficient patients need their medication daily or they will become quite ill. Why is that "erroneous"?