Thank you for your thoughtful and thought-provoking post. I can only speculate at the absence of methadone as a replacement for codeine pain meds. Two things c

Thank you for your thoughtful and thought-provoking post. I can only speculate at the absence of methadone as a replacement for codeine pain meds. Two things come to mind. One is the known respiratory depression hazard presented by methadone. This is complicated by the fact that methadone's clearance rate varies by more than an order of magnitude among individuals. In clinical practice, this means that the effective analgesic methadone dose must be established slowly. This isn't a problem in controlled clinical settings with patients who comply with treatment regimens. It's another story entirely in patients who are immersed in street drug polypharmacy situations. So there may be an element of caution, well-placed or not, that biases against use of methadone in place of other opiates. The second is what you touched on - methadone (and all opiates, really) is a complex and emotionally-laden subject. Methadone has a poor reputation from its use in detoxing opiate addicts. Mentioning that you're being treated with methadone nearly never elicits even a neutral response. I think methadone's negative reputation is a serious impediment to its use in situations where it would otherwise be the logical choice. I don't know about addictive properties of methadone. I know that my family member, who has been treated with methadone for chronic refractory migraine for ~17 years, doesn't show withdrawal symptoms when she misses her meds. Her headaches return, but there's none of the sweating, feverish shivers that characterize withdrawal from other opioids. She doesn't experience psychotropic effects, positive or negative. The principal side effect is constipation. In at least this anecdatum, there's no evidence of addiction even after a very long term of use. I agree there's a shortage of rational thought and a great excess of emotion around opioids. I wish the emotional charge could be more directed to Purdue Pharma, the Sacklers, and the like, who have not only killed people in multitudes, but who also have compromised progress in getting effective and safe pain relief to the very many who would benefit. Sometimes, one can only live in hope of better times. Thanks again.