LET US HELP YOU START YOUR JOURNEY TO RECOVERY
The initial goal of methadone treatment is to free an opiate dependent person or heroin dependent person from the periodic withdrawal that prompts the regular use of illicit opiates or heroin. Methadone treatment is not appropriate for those people who are not currently physiologically addicted to heroin or other illicit opiates. A person may be physiologically addicted to opiates if they have been taking heroin or other opiates on a daily basis for extended periods of time and exhibit symptoms of withdrawal when they stop using these drugs. Along with irritability and cravings to use opiates within eight hours of discontinued use, the most common signs of opiate withdrawal are runny nose, large pupils, eyes tearing, sweating, chills, diarrhea, yawning, nausea, cramps, insomnia, joint pain, and gooseflesh. Prior to admitting any new patient for treatment, our physician will conduct a complete physical examination to determine whether methadone treatment is appropriate for that patient.
Methadone is a therapeutic tool of recovery for the opiate dependent person that may or may not be discontinued. For some people, the desired change in lifestyle may occur through a successful detoxification from heroin using decreasing doses of methadone. For other individuals, the use of a methadone maintenance program provides longer-term stability and the opportunity to slowly change many aspects of one’s life. We believe that you can have a happy and purposeful life while on a methadone maintenance program.
What Is Methadone?
Methadone is a long acting synthetic opiate that is taken in a liquid oral form once per day. The proper dose of methadone remains effective for 24-36 hours and does not result in an altering of perceptions or euphoria. A person taking methadone is alert, energetic, able to function well, and feels no withdrawal symptoms between doses of the drug. It is important to note that a person with a pre-existing opiate or heroin dependency does not gain an additional addiction when he/she takes methadone. Methadone satisfies that person’s pre-existing opiate dependency in a safe, legal, and responsible manner under the supervision of medical professionals. Here, patients must participate in treatment as planned and prescribed. Missing a methadone dose may result in discomfort and the start of withdrawal. Once stable on the proper methadone dose, a patient will most likely feel less of a need to inject heroin, thus minimizing the health risks of HIV and hepatitis B and C. Patients who stop using heroin and other drugs can altogether avoid the possibility of overdosing. Methadone treatment is provided in an environment where medical and counseling services are readily available. Here, many methadone patients make changes in their lives and build support systems that allow them to improve their health and stay sober.
Interactions and Side Effects of Methadone
Methadone may be interactive with other drugs and alcohol. Please tell our physician if you are taking any prescriptions or have a dependency or addiction for another drug. The use of other opiates, benzodiazepines, and alcohol may be dangerous in combination with methadone. You may experience some side effects during treatment but these are usually minimal and short-lived. Please read the list below and notify the medical staff if you experience any of the following symptoms: light headedness, dizziness, extreme tiredness, nausea and vomiting, sweating, ankle swelling, skin rash, restlessness, malaise, weakness, headache, insomnia, agitation, disorientation, visual disturbance, constipation, dry mouth, flushing of the face, low heart rate, faintness and fainting, problems urinating, changes in sexual drive, irregular menstruation, joint pain, joint swelling, and numbness.
Warning: (PENTAZOCINE) TALWIN and RIFAMPTIN cannot be used by patients on methadone.
Your Methadone Dose
It is the intention of Organization for Recovery, Inc., to have every client on the correct dosage of methadone. We recognize that a dose too low produces unnecessary withdrawal discomfort and invites the risk of heroin use. We also know that a dose too high produces undesirable side effects and provides no additional benefit to the client. Achieving and maintaining the correct dosage requires cooperation between the client and the staff. All clients will be informed of their dosage upon request. Minor dosage adjustments may be made by the nurse in accordance with the standing orders of the physician.
Where a requested dosage change does not fall within the parameters of the physician’s standing orders, a medicating nurse must receive a new verbal or written order from the program physician to change a client’s dose. If a client is experiencing physical discomfort and believes he/she needs a higher dose, the client may request an appointment with the program physician. If, after reviewing the physical symptoms with the client, the physician supports the need for a dose change, a new medication order reflecting the changed dose would be written and presented to the nursing staff.
In limited circumstances, the program physician may also change a medication order by issuing a verbal order to a nurse. Where a physician is providing a verbal order to change a dose without seeing a client, the client shall be required to meet with other involved staff (Clinical Supervisor or Primary Counselor and Nurse) so that additional information may be provided to the physician prior to his/her decision regarding a change in dosage.
Withdrawal From Methadone
Because methadone has a longer half-life than heroin, withdrawal from methadone takes longer than withdrawal from heroin. With heroin withdrawal, the most substantial symptoms are over within the first three to five days. With methadone, the initial symptoms are frequently less severe, but they can last from ten days to two weeks. The longer duration of methadone withdrawal is not always well tolerated. However, if the patient follows a medically supervised tapering schedule that accounts for and is readjusted to received signs from the patient’s body, withdrawal from methadone may be achieved without extreme discomfort.
Pregnancy and Methadone
Federal Treatment Improvement Protocols state the following:
Pregnant women users who are in treatment with methadone deliver healthy babies. It is true that babies born to women on methadone sometimes experience some withdrawal symptoms during the first several days after birth. The symptoms are routinely treated by the baby’s pediatrician and do not result in any long-term damage. In addition, babies born to women on methadone tend to have a slightly lower birth weight than babies of non-addicted control mothers. The most important comparison, however, is not how these babies compare with non-addicted controls, but rather how they compare with babies of mothers addicted to heroin. Studies that have compared babies born to mothers in methadone treatment with babies born to mothers who use heroin have demonstrated tremendous benefits from methadone.
Methadone treatment allows the mother to be followed in prenatal care, to receive nutritional supplements, information and to participate in parenting classes. The vast weight of evidence supports the use of methadone with heroin-addicted women to reduce the risk of miscarriage, increase birth weight, reduce infection and HIV risk to fetus, and generally produce a much greater chance for a healthy baby.
Methadone maintenance has been used in the United States for approximately 50 years as an effective treatment for opioid addiction. Yet many myths about its use persist, discouraging patients from using methadone, and leading family members to pressure patients using the treatment to stop.
Dr. Vincent Dole of Rockefeller University in New York, who pioneered the use of methadone as an opioid addiction treatment, found his patients no longer craved heroin. They were able to return to work and school, and participate in family life and community affairs.
As methadone’s use grew, the federal government decided it should only be dispensed in licensed treatment programs, which would provide a whole range of services such as counseling, vocational help and medical and psychiatric treatment.
This creation of the clinic system developed into a double-edged sword. On the one hand, it was advantageous to have many services available in the methadone clinic, but very stringent regulations came along with the clinic concept, including the requirement that patients come to the clinic daily for their methadone. Clinic hours often conflict with patients’ work schedules, and make it very difficult to take a vacation. In some areas of the country, the clinics are few and far between, requiring traveling many miles each day. The biggest and probably most important obstacle has been the stigma associated with being seen entering or exiting a methadone clinic.
In an attempt to reduce that stigma, I present the six most common myths about methadone and explain why they are incorrect.
Myth #1: Methadone is a substitute for heroin or prescription opioids.
Methadone is a treatment for opioid addiction, not a substitute for heroin. Methadone is long-acting, requiring one daily dose. Heroin is short-acting, and generally takes at least three to four daily doses to prevent withdrawal symptoms from emerging.
Myth #2: Patients who are on a stable dose of methadone, who are not using any other non-prescribed or illicit medications, are addicted to the methadone.
Patients taking methadone are physically dependent on it, but not addicted to it. Methadone does not cause harm, and provides benefits. People with many common chronic illnesses are physically dependent on their medication to keep them well, such as insulin for diabetes, inhalers for asthma and blood pressure pills for hypertension.
Myth #3: Patients who are stable on their methadone dose, who are not using other non-prescribed or illicit drugs, are not able to perform well in many jobs.
People who are stable on methadone should be able to do any job they are otherwise qualified to do. A person stabilized on the correct dose is not sedated, in withdrawal or euphoric. The most common description of how a person feels on methadone is “normal.”
Myth #4: Methadone rots teeth and bones.
After 50 years of use, methadone remains a safe medication. There are side effects from taking methadone and other opioids, such as constipation and increased sweating. These are usually easily manageable. If patients engage in good dental hygiene, they should not have any dental problems.
Myth #5: Methadone is not advisable in pregnant women.
The evidence over the years has shown that a pregnant woman addicted to opioids has the best possible outcome for herself and her fetus if she takes either methadone or buprenorphine. A pregnancy’s outcomes are better for mother and newborn if the mother remains on methadone than if she tapers off and attempts to be abstinent during pregnancy. Methadone does not cause any abnormalities in the fetus and does not appear to cause cognitive or any other abnormalities in these children as they grow up. Babies born to mothers on methadone will experience neonatal abstinence syndrome, which occurs in most newborns whose mothers were taking opioids during pregnancy. This syndrome is treated and managed somewhat easily and outcomes for the newborn are good—it is not a reason for a pregnant woman to avoid methadone treatment. Mothers on methadone should breastfeed unless there is some other contraindication, such as being HIV-positive.
Myth #6: Methadone makes you sterile.
This is untrue. Methadone may lower serum testosterone in men, but this problem is easily diagnosed and treated.
These myths, and the stigma of methadone treatment that accompanies them, are pervasive and persistent issues for methadone patients. They are often embarrassed to tell their other physicians, dentists and family members about their treatment. They may feel they are doing something wrong, when in fact they are doing something very positive for themselves and their loved ones. These misperceptions can only be corrected with more education for patients, families, health care providers and the general public.
Edwin A. Salsitz, MD, FASAM, is Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center in New York.