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As a part of the neuroadaptation to the constant injection of large
doses of opiates, the brain renders the opiate receptors less responsive
to the continuing external heat of heroin doses, making them
insensitive to the relatively small amounts of endorphins released by
the brain. The addicted brain realizes the imbalance and the lack of
response and interprets this as a deficiency of opiates which causes
craving. So unless and until the endorphin-receptor system has been
completely rehabilitated by prolonged abstinence, the system won't be
effective in producing the proper response in a time of stress. The
constant heat of addiction has damaged the system, which is the
protection against the onset of stress.

So how long does it take to rehabilitate the endorphin system, and how
can we tell when it is fully recovered? The answer to both questions is
that we just don't know. It is important to keep in mind that because
methadone is continuing to interact with the opiate receptors
throughout treatment, the endorphin system cannot be rehabilitated
while on therapeutic doses of methadone. In order to discontinue
methadone treatment, the patient must have the methadone dose
slowly decreased so that the brain can recalibrate to each new level. If
the taper were proceed too swiftly, the patient will begin to have
withdrawal symptoms. Each patient is different, and the pace must be
adjusted to the individual's tolerance.

Conclusion

It should be noted that for most of the long history of man's
cohabitation with the juice of the poppy on this planet, most societies
were able to integrate the use of the material into their culture without
significant disruption. China in the nineteenth century is an exception.
In contrast, our current struggles to deal with the societal impact of
individuals using opiates and other illicit substances, including
steroids, demonstrates that in a fundamental way, we have not been
able to figure it out. But, for the sake of this presentation, we will
leave that to the philosophers and politicians.

The focal point of methadone treatment is not society at large, but
rather the individual who has made the decision to try and free him