Researchers consider how the placebo effect may actually improve the effectiveness of methadone treatment plans.
By Annie Schulman
Worldwide, over 16 million individuals suffer from opioid use disorder, or an addiction to opioids. Opioid use disorder is a serious condition that can cause severe emotional and physical harm to individuals. As a result, researchers and clinicians are determined to find better ways to treat individuals who are suffering from this disorder. Currently, researchers are interested in seeing to what extent the placebo effect might be able to improve treatment options.
What is methadone and why is it not enough?
Methadone is the first-line treatment for individuals who have opioid use disorder. In other words, methadone is an approved medication for people who are trying to stop their addiction to drugs (such as heroin, morphine, or fentanyl). It is very challenging for individuals who are addicted to these drugs to stop taking them because, when they do not have the drugs in their body, they experience symptoms of withdrawal. Withdrawal symptoms—such as anxiety, nausea, vomiting, and/or abdominal pain—can be painful and very unpleasant. This can cause individuals to take more of the drug to stop the withdrawal. Methadone reduces these withdrawal symptoms.
However, methadone itself can cause health issues for individuals when they require very high doses to stop the withdrawal symptoms. These health issues can include severe nausea, constipation, or heart problems. As a result, researchers are working to discover other medications that can be taken in addition to methadone. These additional treatments might make it so individuals looking to treat their addiction can avoid the bad side effects associated with high doses of methadone, while still reducing symptoms of withdrawal.
Could the next advancement in treatment be a “sugar pill”?
A placebo drug refers to a substance with no true therapeutic effect. A placebo is used in clinical trials to determine the effectiveness of a drug of interest. Scientists compare the actual medication with the placebo medication, to see if the real medication helps relieve the symptoms of an individual more than the fake treatment. The placebo effect refers to when an individual takes a placebo drug and still feels like there is a physical or mental effect, even though the placebo drug could not have caused an effect. Interestingly for researchers, even if individuals know they are taking a placebo drug that is nothing more than a “sugar pill,” some individuals still report experiencing a change in their symptoms.
A recent study aimed to take advantage of this “placebo effect” in an effort to help treat individuals with substance abuse disorders. The study assigned 131 adults seeking treatment for opioid use disorder to two groups: conditioned open-label placebo (C-OLP) or treatment as usual (TAU). After being enrolled in the study, participants received information about placebo pills in general. This included information about the placebo effect and how placebo pills have helped improve patient outcomes in the past. Researchers also informed participants about how believing in the placebo pill’s abilities was not necessary—even “fake pills” had some benefit! Most importantly, participants were instructed on the importance of taking the pill.
Both groups received methadone to treat their opioid use disorders for 12 weeks. However, the C-OLP group also received a placebo pill. Importantly, researchers told the individuals receiving the placebo pill that the extra pill was a placebo pill. This meant they knew it did nothing! Even still, at the end of 12 weeks, more individuals in the C-OLP group had stayed on methadone treatment. This meant that the placebo pill was associated with a higher retention rate. In other words, individuals taking the placebo alongside methadone were less likely to begin using opioids again during this duration of time, and instead remain on methadone treatment. To take a look at the numbers, the TAU group had a retention rate of 61.1 percent, while the C-OLP group had a retention rate of 77.9 percent.
In addition, another important finding to come out of this study had to do with participants’ sleep. Individuals with opioid use disorder often report disrupted sleep. This study used the Pittsburgh Sleep Quality Index, an official test for sleep quality, to determine how individuals in both groups were sleeping. Individuals in the C-OLP group had better sleep in comparison to the TAU group.
So…should all individuals receiving methadone treatment start taking placebo pills?
Well, maybe not quite yet. While this is a very promising finding, further research must be performed to confirm the results of this study. Additionally, this study found there was no difference in the methadone dose required by the participants. This means the placebo pill did not significantly decrease the dosage patients needed, which was the primary goal of the study. The authors suggest this might be because every patient’s methadone dose is incredibly specific—the medication must be tailored to the patient. In this, additional studies are required to further investigate this topic.
This study was published in the journal JAMA Network Open.
The information contained in this article is for informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.
Belcher, A.M., Cole, T.O., Massey, E., et al. (2023). Effectiveness of conditioned open-label placebo with methadone in treatment of opioid use disorder: A randomized clinical trial. JAMA Network Open 6(4), e237099. https://doi.org/10.1001/jamanetworkopen.2023.7099
About the Author
Annie Schulman received her BA in Biology from Colby College. She currently works as a research assistant, and is always interested in reading the newest neuroscience research. When not in a laboratory, she enjoys running, skiing, and attempting to bake homemade bagels.