about methadone

8/14/2019 About Methadone

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AboutMethadoneand BuprenorphineR E V I S E DS E C O N D E D I T I O N


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We EN VISION a just society in which the use and

regulation of drugs are grounded in science,

compassion, health and human rights, in which people

are no longer punished for what they put into their

own bodies but only for crimes committed against

others, and in which the fears, prejudices and punitiveprohibitions of today are no more.

Our MISSION is to advance those policies and

attitudes that best reduce the harms of both drug

misuse and drug prohibition, and to protect the

sovereignty of individuals over their minds and bodies.

ILLUSTRATIONSLiz PaganoDESIGN+ PRODUCTION Jeanne Criscola | Criscola Design

PRINTER Gist and Herlin Press, Inc.

Copyright 2006 Drug Policy Alliance

All rights reserved

Printed in the United States of America

ISBN: 1-930517-27-0

No dedicated funds were or will be received from any individual, foundation or corporation in the writing or publishing of this booklet.


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AboutMethadoneand Buprenorphine

R E V I S E DS E C O N D E D I T I O N


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Acknowledgments 3

Introduction 4

Dependency 6

What Is Methadone? 9

Buprenorphine 12

Maintenance 14

After Methadone 16

Myths & Facts 17Drug Interactions 21

Your Other Doctors 24

Methadone & Women 26

Storing Methadone 30

Concerns about Overdose 31

In Case of Overdose 35

Detoxification 37

Detox: How It Works 39

Driving 41

Traveling with Methadone 42

A P P E N D I C E S: State Substance Abuse Agencies 46

Additional Resources 47

Drug Policy Alliance Offices 48

Table of Contents


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Acknowledgments

This is the second printing of this booklet.The first 200,000 copies were

distributed, across the U.S.and internationally, primarily by advocates.We are deeply grateful to all who helped get the booklet out to patients,families, treatment providers and program staff,policymakers and otherinterested members of the community. About Methadone and Buprenorphine has also been translated into Italian, Russian and Spanish.

This second edition has been revised to include information aboutbuprenorphine,an important treatment option that has emerged as an

additional opioid addiction treatment to methadone.Future editions of About Methadone and Buprenorphine will provide readers with morecomprehensive information about opioid addiction treatment usingbuprenorphine.

Many thanks to my collaborators,Corinne Carey, JD,Travis Jordan,Michael McAllister,Sharon Stancliff, MD,Ellen Tuchman,PhD,andPeter Vanderkloot for their invaluable contributions to the research andwriting of this booklet.

Thanks also to Matthew Briggs,Paul Cherashore, Amanda Davila,Chris Ford,MD,Ethan Nadelmann,JD,PhD,Robert Newman,MD,J.Thomas Payte,MD,Shayna Samuels,and Isaac Skelton for theirsuggestions for improvements.

And special thanks to all the methadone patients,advocates,and theirloved ones that I have met and worked with.You are the inspirationfor this.

Holly Catania, JDBaron Edmond de Rothschild Chemical Dependency Institute


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You may be reading this book because you are taking

methadone or because you are thinking about takingmethadoneor because you care about somebodywho is.

People usually enter methadone treatment because theyfeel overwhelmed by their dependence on heroin or otheropioids. But not everyone who comes into methadone

maintenance has the same goals. Some people want tostop taking street opioids for good. Some want totemporarily stop taking street opioids. And some wantto reduce or re-regulate their use of street opioids.

Some people begin methadone with the belief that they will need medication indefinitely.

Others feel that they will only need it for ashort time. Regardless of what you hopeto get from methadone maintenance,

however, all the evidence agrees onthese several points:

Introduction

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People dependent on street opioids who receivemethadone treatment are healthier and safer thanthose who do not. They live longer, spend less time in jail and in the hospital, are less often infected withHIV, and commit fewer crimes.

Longer periods of methadone maintenance arebetter than shorter periods.The longer you stay onmethadone maintenance, the better the overalloutcome. Indefinite treatment often means life-longextension of good health, HIV seronegativity, andfreedom from incarceration.

Methadone maintenance is treatment for people who

are dependent on opioid drugs. It is not a treatmentfor people whose major problems are with otherdrugssuch as cocaine, alcohol,benzodiazepines,or cigarettes.

Opioid drugs include all the drugs that come fullyor partially from opium and synthetic drugs that have

similar effects. Morphine,heroin, codeine, methadone,dilaudid, buprenorphine, LAAM, OxyContin, and fentanylare opioids.

People dependent on street opioids who

receive methadone treatment are healthierand safer than those who do not.


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Opioids have been used for thousands of years,and it has

long been known that many people who have becomedependent on opioids have extreme difficultypermanently ending their use of them.

Suffering through the withdrawal sickness is only part of the problem.The real difficulty has always been stayingoff the drugs once the period of withdrawal is over.

Just as in the case of those who are unable to stopsmoking, it is difficult to explain why it is so hard not toreturn to the use of opioids. Reasons include long-termdepression, lack of energy, drug cravings,and suddenattacks of physical withdrawal sickness. Some people findthat these problems diminish over time and eventually

disappear altogetherbut others continue to suffer thesesymptoms indefinitely, and many of them eventuallyrelapse to their regular use of opioids.

Relapse often has nothing to do with lack of will poweror other personality problems. Instead, it appears thatpeople with a long history of opioid problems haveexperienced changes to the part of their brains thatallows a person to feel and function normally. This partof the brain makes and uses its own natural opioids.

Dependency


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The best known of these natural opioids are thechemicals known as endorphins.The word endorphinliterally means the morphine within. Indeed, thesechemicals are functionally identical to morphineor heroin.

We dont yet understand everything that these natural

opioids do in the body, but evidence suggests that theyare involved with pain control, learning, regulating bodytemperature, and many other functions.

It is possible that people who develop a dependency onopioids were born with an endorphin system that makesthem particularly vulnerable. For example, we know that

addiction appears to run in some families.

Addiction might also be related to changes in the braincaused by the overuse of heroin or other opioids. Or itmay be the result of a complex relationship betweengenetics and the environment.We do not yet knowexactly how this malfunctioning occurs, or even whether

all people who feel unable to stop using opioids have thisdamage.There is, however, an increasing amount of evidence that many people who find it difficult to endtheir use of opioids have experienced these physicalchangeswhich are likely to be permanent.


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There is not yet any test that can determine how muchdamage a person may have to his or her natural opioidsystem,or how hard it may be for that person to stayaway from opioids. All that we know for sure right now isthat relapse is a major feature of opioid dependency.

Methadone is not a cure for the problem of opioiddependency. It is a treatmentand one that is effective

for only as long as a person continues to take itappropriately.

Relapse often has nothing to do with lackof will power or other personality problems.


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Methadone is a long-acting, synthetic drug that was first

used in the maintenance treatment of drug addiction inthe United States in the 1960s. It is an opioid agonist,which means that it acts in a way that is similar tomorphine and other narcotic medications.

When used in proper doses in maintenance treatment,methadone does not create euphoria, sedation, or an

analgesic effect. Doses must be individually determined.The proper maintenance dose is the one at which thecravings stop,without creating the effects of euphoriaor sedation.

Although methadone is not a single product from asingle manufacturer, the active ingredient is always the

same: methadone hydrochloride. All manufacturers addinactive ingredients, such as fillers, preservatives andflavorings. Methadone is dispensed orally in differentforms, which include:

Tablets , also called diskettes. Each one contains 40milligrams of methadone, is dissolved in water, andthen is administered in an oral dose.

Powder is also dissolved in water.

What Is Methadone?


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Liquidmethadone can be dispensed with anautomated measuring pump. Dosages can beadjusted to as small as a single milligram.

Patients have different opinions about the various typesof methadone. Each methadone provider usually offers asingle type of the drug and obtains its supply from onesource, which means that patients generally do not get tochoose which form of methadone they get.

For most people, a single dose of methadone lasts24 to 36 hours.

How is methadone different from heroin and otheropioids (for example,morphine or dilaudid)?

Methadone lasts longer .The body metabolizesmethadone differently than it does heroin ormorphine.When a person takes methadone regularly,it builds up and is stored in the body, so it lasts even

longer when used for maintenance. Most people findthat once theyre stabilized on a dose of methadonethats right for them,a single oral dose will holdthem for at least a full 24-hour day. For some, theeffect lasts longer; for others it lasts a shorter time.


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Stability is easier on oral methadone . Most peoplewho are on a stable, appropriate dose of methadonefor several weeks will not feel any significant sense of

being highor dopesick. Some patients may feel atransitionor temporary, mild glowfor a shorttime several hours after being medicated, however.Others may feel slightly dopesickprior to taking thedays medication,but most will feel very little or noeffect from the proper dose of methadone once theyhave stabilized.


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Buprenorphine, when appropriately prescribed and taken,

is an effective, safe medication approved by the FDA foruse in the treatment of opioid addiction. Buprenorphinerelieves withdrawal, reduces craving and blocks the effectsof heroin in ways similar to methadone. Maintenancedoses are generally between 12 and 32 milligrams but(like methadone) should be individualized.

Unlike methadone, buprenorphine may be prescribed fortreatment of opioid addiction by any doctor who hasreceived training (available via the Internet or as a one-day course) and a waiver from the DEA.This is its principaladvantage over methadone for most doctors andpatients. Misuse of buprenorphine is less likely thanmethadone to result in death.

Prescribed in the U.S. as Suboxone or Subutex,buprenorphine is usually taken daily as tablets to bedissolved under the tongue.There is little effect from thedrug if it is swallowed. Suboxone contains not justbuprenorphine but also naloxone, an opioid antagonistthat may precipitate withdrawal symptoms if injected.For people dependent on any opioid, taking the first doseof buprenorphine when not in withdrawal can result inacute withdrawal symptoms.

BuprenorphineBy Sharon Stancliff, MD


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Buprenorphine, like methadone, can be used as a short- orlong-term detoxification medication or indefinitely as amaintenance medication.The risks of relapse followingdetoxification appear to be similar whether methadone orbuprenorphine (or any drug-free treatment modality) is used.

A directory of physicians approved to prescribebuprenorphine can be found at

http://buprenorphine.samhsa.gov/bwns_locator/ .

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Methadone maintenance is intended to do three things

for patients who participate:

1. Keep the patient from going into withdrawal.The standard initial dose,as currently recommended,is 30 to 40 milligrams a day. After several days,providers adjust a patients dose as needed.

2. Keep the patient comfortable and free fromcraving street opioids. Having a craving means morethan just having a desire to get high. It means feelingsuch a strong need for opioids that people may haveregular dreams about using drugs, think about doingdrugs to the exclusion of anything else, and/or do

things that they wouldnt normally do to get drugs.

Methadone wont control a persons emotional desireto get high, but an adequate dose of methadoneshould prevent the overwhelming physical need touse street opioids.

Maintenance


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3. Block the effects of street opioids.If the dose is high enough, methadone keeps thepatient from getting much, if any, effect from theusual doses of street opioids.This result is often calledthe blockadeeffect.

If a persons opioid tolerance is elevated high enoughwith methadone treatment, a great deal of heroin

would be required to overcome it and produce asignificant high.

Methadone wont control a persons

desire to get high, but an adequate doseof methadone should prevent the

overwhelming physical need to use street opioids.


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Many people who must take medications every day get tired

of doing so.This is especially true of patients on methadonemaintenance because,in the United States, almost allmethadone patients are also required to make frequentvisits to a clinic to receive their medication.For manyreasons,most methadone maintenance patients decide atsome point that they want to stop taking methadone.

If you do choose to leave maintenance, your providershould reduce your dose at the speed you feel comfortablewith. If it is slow enough you should not experience majorphysical withdrawal symptoms.

But if you have tried withdrawing from opioids many timesand have relapsed, then you may have found that detoxing

is the easier part and staying opioid free over the long termis the harder challenge.Studies find that people who havelong histories of trying and failing to live without opioidswill probably not be able to stay abstinent for long.

It isnt yet possible to predict who will be able to live lifewithout opioids, but it doesnt seem to depend on howtogetheryou are. If you are detoxing and find that youare craving opioids,or you have finished detoxing and youare always thinking of opioids, then perhaps maintenanceshould be part of your life.

After Methadone


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Myth Methadone gets into your bones and weakensthem.

Fact Methadone does not get into the bones orin any other way cause harm to the skeletal system.Although some methadone patients report having achesin their arms and legs, the discomfort is probably a mildwithdrawal symptom and may be eased by adjusting the

dose of methadone.

Also, some substances can cause more rapid metabolismof methadone (see pages 2123 for a list of medications that interact withmethadone). If you are taking anothersubstance that is affecting the

metabolism of yourmethadone, yourdoctor mayneed to adjust yourmethadone dose.

Myths & Facts


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Myth Its harder to kick methadone than it is to kicka dope habit.

Fact Stopping methadone use is different fromkicking a heroin habit. Some people find it harder becausethe withdrawal lasts longer. Others say that although it

lasts longer, it is milder than heroin withdrawal. Myth Taking methadone damages your body.

Fact People have been taking methadone for morethan 30 years, and there has been no evidence that long-term use causes any physical damage. Some people dosuffer some side effects from methadonesuch asconstipation, increased sweating, and dry mouthbutthese usually go away over time or with doseadjustments. Other effects, such as menstrualabnormalities and decreased sexual desire, have beenreported by some patients but have not been clearlylinked to methadone use.

Myth Methadone is worse for your body thanheroin.

Fact Methadone is not worse for your body thanheroin. Both heroin and methadone are nontoxic,yet bothcan be dangerous if taken in excessbut this is true of everything, from aspirin to food. Methadone is safer than

street heroin because it is a legally prescribed medicationand it is taken orally. Unregulated street drugs often


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contain many harmful additives that are used to cutthe drug.

Myth Methadone harms your liver.

Fact The liver metabolizes (breaks down andprocesses) methadone,but methadone does notharmthe liver. Methadone is actually much easier for the liverto metabolize than many other types of medications.People with hepatitis or with severe liver disease can takemethadone safely.

Myth Methadone is harmful to your immunesystem.

Fact Methadone does not damage the immunesystem. In fact, several studies suggest thatHIV-positive patients who are takingmethadone are healthier and live longerthan those drug users who arenot on methadone.

Myth Methadone causespeople to use cocaine.

Fact Methadone does notcause people to use cocaine. Manypeople who use cocaine started taking

it before they started methadonemaintenance treatmentand manystop using cocaine while they areon maintenance.

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Myth The lower the dose of methadone, the better.

Fact Low doses will reduce withdrawal symptoms,but higher doses are needed to block the effect of heroinandmost importantto cut the craving for heroin.Most patients will need between 60 and 120 milligramsof methadone a day to stop using heroin. A few patients,however, will feel well with 5 to 10 milligrams; others will

need hundreds of milligrams a day in order to feelcomfortable. Ideally, patients should decide on their dosewith the help of their physician,and without outsideinterference or limits.

Myth Methadone causes drowsiness and sedation.

Fact All people sometimes feel drowsy or tired.Patients on a stabilized dose of methadone will not feelany more drowsy or sedated than is normal.


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Like any medication,methadone can interact with othertypes of medicines and with street drugs.The body is acomplex system,and its possible that foods,hormones,weight changes, and stress may each also affect the way inwhich methadone works in your body.

We know about some of the substances that may interactwith methadoneand some of them are listed here.

Others may yet be discovered.

These medicines cause the liver to metabolizemethadone more quickly and may cause a need for anincreased methadone dose: Carbamazepin (Tegretol) Phenytoin (Dilantin) Neverapine (Virammune) Rifampin Efavirenz (Sustiva) Amprenavir (Agenerase)methadone also

significantly reduces the level of amprenavir. Ritonavir (Norvir)less of an effect

Drug Interactions


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Some medicines slow the metabolism of methadone.Sometimes people will feel the effect of methadonemore strongly when they take these medications,andsometimes they experience withdrawal symptomswhen they stop taking these medications: Amitriptyline (Elavil) Cimetidine (Tagamet) Fluvoxamine (Luvox) Ketoconazole (Nizoral)

Some medications are opioid blockers and may causewithdrawal.These block the effect of methadone andSHOULD NOT BE TAKEN if you are taking methadone: Pentazocine (Talwin) Naltrexone (Revia) Tramadol (Ultram), in most cases

Some medications initially interact with methadoneto cause sedation, but then the opposite occurs,and they can cause withdrawal symptoms.These medications include: Benzodiazepines such as Xanax and valium Alcohol Barbiturates


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Other medications with interactive effects: Cocaine can increase the dose of methadone

required. Methadone increases the level of AZT and

desipramine in the blood.

Two things should always be kept in mind regardingmethadone interactions:

Methadone is not responsible for every new feeling you have, and it wont be affected by mostmedications or changes in your life conditions.

If your methadone dosage doesnt feel right, itprobably isnt right. You are the expert when it comesto how much methadone is enough. Talk to yourdoctor about how youre feeling.

For more information about drug interactions,go to: http://www.hivguidelines.org .Search under methadone.

If your methadone dosage doesntfeel right, it probably isnt right.


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Methadone patients are sometimesreluctant to tell their otherdoctors that they are takingmethadone.They are afraidthat these doctorsorother health-careproviderswilldiscriminate

against them.Unfortunately,they are oftenright.

Find a primary-careprovider whom you

can trust. The idealsituation is to makesure all your doctorsknow that you are takingmethadone. If you choose not to tell them, however, keepthese important things in mind:

Your Other Doctors


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If you are having surgery for which you may be put tosleep, the anesthesiologist might use a type of medication that will cause abrupt methadonewithdrawal. Be sure you know which medicationsinteract with methadone (see pages 2123)even if your doctors know that you are taking methadone.

It is illegal for your methadone provider to

communicate with your primary-care doctor oranyone else without your written permission.(Title 42 of the Code of Federal Regulations Part 2[42CFR part 2] protects against disclosure of drugtreatment records.)

Ideally, though, open communication among all the

doctors who are treating you may assist you in gettingthe best possible health care.


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Is it true that women sometimes stop getting theirperiods when they begin taking methadone?

Yes,but there are also many other reasons whywomens periods become irregular or stop:

Pregnancy Stress Poor diet Weight gain and loss Menopause Other medical problems Other medications

Remember: You can still get pregnant even if you

dont get your period. You can conceive and have normal

pregnancies and normal deliveries while you are receiving methadone.

You may have heard that you should not takemethadone when pregnant.This is not true.

Methadone & Women


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Methadone is not harmful to the developing fetusbut detoxing is.

Methadone is the treatment of choice for heroin andopioid dependency during pregnancy.

The effects of methadone on pregnancy have beenwidely studied.

Methadone has been used successfully duringpregnancy.

When properly prescribed for pregnant women,methadone provides a non-stressful environment inwhich the fetus can develop.

Taking methadone during pregnancy may preventmiscarriage, fetal distress, and premature labor.

Decreasing the dose of methadone during the firsttrimester increases the risk of miscarriage.

During pregnancy, your dose should be sufficient toavoid cravings, avoid street drugs, and preventwithdrawal.


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If you are pregnant, be sure to talk with your doctor,because:

When youre pregnant, your body metabolismchanges, so you may need to adjust your dosage.You may need to increase your dose of methadone,or split your dose and take smaller amounts two or

three times a day.

You may have heard that your baby will be born addictedto methadone or will suffer other side effects, but hereare the facts:

Methadone does not cause fetal abnormalities.

No harmful effects to a fetus have been found inthe study of methadones effect on pregnancy.

Premature birth and low birth weight can beassociated with cigarette smoking and/or poornutrition and are not attributed to methadone.

Babies born to mothers dependent on methadonewill have methadone in their systems, but studiesshow that the children can be weaned successfullyand safely with no adverse effects.

If you are pregnant, be sure totalk to your doctor.


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You may have heard that you shouldnt breast-feed yourbaby if you are taking methadone, but here are the facts:

Breast-feeding is now considered safe for the babiesof women who are taking methadone, but notsafe for women who are HIV+.

Small amounts of methadone in breastmilk can pass to the baby.

Methadone levels in breast milk arevery low.


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While at home, always keep your methadone in a safe

placepreferably in a locked box or cabinet out of thereach of children and clearly marked to prevent anyoneelse from taking it accidentally.

Remember: Methadone is a very strong drug. A smallamount can kill a child or an adult who does

not have a tolerance to it. If anyone in

your home accidentally drinks yourmethadone, call 911 or an ambulanceimmediately.

Store your methadone away from extremeheat or cold.The methadone that you take

home is often mixed with waterand

sometimes mixed with other additives,depending on where you get yourmethadone.The solution typically lasts

for weeks.

When you are traveling or away from home,keep your methadone in the prescription bottles

that were given to you by your methadoneprovider to prevent any trouble with the law.

As with any prescription drug, it is illegal topossess methadone without a prescription.

Storing Methadone


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Methadone treatment reduces the chance of overdose forthose who are using or are addicted to heroin.

Methadone is a pure drug and is individually prescribed.It does not contain the harmful cuts that are mixed into

drugs bought on the street. Concerns about overdoseremain,however, especially if you continue to use streetdrugs or if you resume regular heroin use after stopping your methadone treatment.

If you stop taking methadone and start using street drugsagain, your chance of overdose increases because you

now have a lower tolerance for the drugs. Toleranceincreases when your body has gotten used to having thedrug in its systemin other words, your body toleratesthe presence of the drug.

If anyone in your home accidentally

drinks methadone, call 911 or an ambulanceimmediately.

Concernsabout Overdose


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If you stop using regularlyor if you have detoxedittakes a smaller amount of the heroin, methadone, orother opioid to cause an overdose. Also,mixing pills suchas benzodiazepines, barbiturates and/or alcohol withmethadone or heroin increases the risk of overdose.

Frequently Asked Questions

Can I overdose on methadone? It is possible tooverdose on methadone, but providers work to adjustdosages so that they are safe for each individualpatient. It is important to be honest with the clinic

staff about how much heroin or other opioids you areusing so that they prescribe a dosage that is rightfor youtoo little wont be effective; too muchcould cause you to overdose. Methadone is a strongmedication, so you need to build up the dosageslowly to be sure that your body is handling themedicine well.

Can I overdose on buprenorphine? Misuse of buprenorphine is less likely than methadone to resultin death (see page 13).


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What if I use other drugs while I am takingmethadone? The correct dosage of methadoneblocks the effects of heroin. If you take opioids whilealso taking methadone, you may not feel the effectsof the opioids. You may then decide to take even moreof the opioid, which could cause an overdose. Somedrugs also interact with methadone and can changehow your medications affect you (see pages 2123).Taking too much of a sedative or drinking a lot of alcohol while you are taking methadone can also bedangerous because each substance makes the othermore powerful, increasing your risk of overdose. Beextremely careful if you mix these drugs.

Can I overdose on heroin while I am takingmethadone? Yes. Even while taking methadone, if you take too much heroinespecially if the heroin isunusually strongyou could overdose.You increasethe odds of overdosing on heroin while youre takingmethadone if you mix it with sedatives,alcohol,orother drugs.

What if I stop going to my methadone program? If you stop taking your methadone and return to usingstreet drugs,you can overdose more easily than when you last used.When you stop taking methadone, yourbody will rapidly develop a lower tolerance for theheroin. As soon as your methadone completely wears


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off (a couple of days), your tolerance for heroin willbe lower than it was when you began takingmethadone. So, if you decide to use again, you needto be very careful.Take some precautionsalways besure there are other people with you when youreusing, in case you need medical attention,and testthe effect of the drug on you before you take an

entire dose.

What happens if I start taking methadone againafter I have stopped? If you stop taking methadoneeven for a few days, you need to be careful when youstart taking it again.Your body may have lost someof its tolerance for the methadone, so you could

overdose.You need to restart at a lower dose andwork back up to the level you were at when youstopped.The doctor at the clinic can help youdetermine the right dosages.

The correct dosage of methadoneblocks the effects of heroin.


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If you suspect that someone has overdosed on

methadone, lay the person on his or her side in therecovery position and call 911 immediately.

If medical professionals arrive quickly, they can treat theindividual with an antagonist, such as naloxone, thatwill help them come out of the overdose. It is importantto tell the medical professionals what drug the overdose

victim took so they know which drug to use to counteractthe overdose.

The person who overdosed will need to be watched fora few hours. Methadone is a long-acting drug.Themedications that are used to treat the overdose are short-acting. If the antagonist wears off before the methadone

level decreases enough, the patient may go back into astate of overdose and require medical attention again.

What should I do if someone overdoses? Immediately call 911 and remain with the person. Do not force the person to vomit. Do not make them take a cold shower. Do not inject salt water into their veins.

In Case of Overdose


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What are the signs of an opioid overdose? Unresponsiveness Drowsiness Cold, clammy, bluish skin Reduced heart rate Reduced body temperature

Slow or no breathing

What might happen if an overdose is not treated? Brain damage Paralysis (temporary or permanent) Death


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Doctors do not advise that people quickly taper off of

their dose of methadonebut there are,unfortunately,many situations where this occurs. For example, amethadone patient may be in jail or in a hospital wheremethadone is not prescribed. Or the person may becomplying with a demand from family court in order tobe reunited with children who are in foster care. Publicpolicy is slowly changing, but some methadone patients

are still being forced to detox from their medication.

If you are being administratively detoxedby yourmethadone provider, you should find another providerquickly. If your provider is not helping you find another,contact a harm-reduction program,needle exchange, or your states health department for assistance. A directory

of state alcohol and drug-abuse agencies can be found athttp://www.treatment.org/states/ .

Some people also use gradually tapering doses of methadone for a short period of time (three to sevendays) to relieve the initial discomfort of heroinwithdrawal.This method may be successful for peoplewho havent been dependent on heroin or other opioidsfor a long time.

Detoxification


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If you do start using drugs again after your detox, you arenot a failure. Time that you spent away from streetdrugs was a period of reduced riskrisk of arrest,exposure to disease, and overdose. But remember, if you relapse, the first weeks of use (again) are a time of higher risk of overdose.


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Methadone patients have two options: inpatient and

outpatient treatment.

With inpatient treatment, the patient is admitted forovernight care to a clinic or hospital.The patient usuallymust spend several days and take medication to relievethe withdrawal symptoms. Inoutpatient detox, medication

also provides relief fromwithdrawal symptoms.Themedication is administeredduring daily clinic visits over aperiod of several weeks orlonger. Often methadone isused in doses that are

gradually reduced.

Anycross-tolerant opioidsuch as morphine, dilaudid,methadone, heroin,or LAAMcan suppress withdrawal.Methadone is used because itis long-acting, gentle,

Detox: How It Works

Methadone & PainSevere pain has long been under-treated in theUnited States.This is partly because of ignoranceand prejudice,but also because of the laws thatmade drugs like heroin illegal. The governmenthas actively pursued and prosecuted physiciansfor prescribing opioids.

If you are on methadone maintenance,yourregular maintenance dose of methadone will

provide little or no pain relief. You will still feelpain, just like everyone else. In fact, you may needmore pain-relief medication than people who arenot taking methadone.

Greater public awareness of how many peoplehave needlessly suffered because of thisundertreatment of pain is beginning to forcechanges.To manage pain,doctors are beginningto more freely prescribe opioidsincludingmethadone, which has been recognized as aneffective pain medication.


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eliminates craving, and does not produce a highwhen itis used properly.

Other medications, including drugs such as buprenorphineand clonidine, are also usedand may be used morewidely in the future.

The usual detox program for methadone requires thatthe patient use it as a tapering dose for 21 to 30 days.During induction, the doctor determines the right dose toovercome withdrawal. Afterward, the dose you takegradually becomes smaller, until you no longer needthe methadone.The medical and counseling staff in your program can help you develop a plan for further

treatment if you need it, and will guide you throughthe physical changes you experience during thedetox period.


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Driving

Study after study has shown that people

who are maintained on a correct doseof methadone can do anything thatpeople who are not using anymedication can do.

Researchers have conductedlaboratory and field studies since 1964. They have

consistently found that methadonewhen used in thetreatment of heroin addictionhas no adverse effects ona persons ability to think and function normally.

Methadone patients still experience a great deal of discrimination by employers, however, especially whenthey seek to get or keep jobs that involve driving.

Discrimination persists, despite the fact that peoplemaintained on methadone are no different from thegeneral population in their motor skills, reaction times,ability to learn, focus, and make complex judgments.

Of course,your ability to think and function normallydepends on your having the correct dosage of methadone.If you feel groggy, tired, or unable to focus, you should notdrive. Be sure to consult your clinician about whether youare receiving a correct amount of methadone.


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Traveling in the United States

It can be very stressful for methadone patients to plan atrip. Rules vary from place to place throughout theUnited States, and many of them are unclear.

If you are traveling within the United States,decidewhether you want to travel with your medication orobtain it when you arrive at your destination.

To be sure that your methadone treatment is notinterrupted,you will either need to get enoughmethadone from your provider to cover you for the entire

time youre awayor your provider/clinic will needto arrange for you to be guest medicatedat a

methadone clinic located in the area where youwill be staying.

In either case, it is wise to make yourarrangements as early as possible before

you leave.

Traveling withMethadone


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Keep in mind that federal,state,and clinic regulationslimit the amount of methadone that you can takewith you.These rules differfrom place to place, so check with your provider to find

out about the rules in the areas you plan to visit.

A comprehensive Methadone MaintenanceTreatment Directory listing contact information foroutpatient methadone maintenance facilities in theUnited States can be found on the Internet at:http://www.findtreatment.samhsa.gov . If you do not

have access to the Internet, see the directory of statesubstance abuse agencies on page 46.

Traveling Abroad

Methadone is a prescribed medication,and most countries

allow visitors to bring whatever prescription medicationsthey need with them.In some places, however, methadonemay be considered an exception to this policy.


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In many countries,methadone is not available, and somecountries prohibit bringing it in. Some countries also havelaws prohibiting former addicts or people with criminalrecords from entering. It may be difficult to find out whichlaws are in effect in which countriesand whichlaws are actually enforced.

There are some resources that patients can check todetermine the laws that apply to methadone at theirdestinations. Ultimately, however, patients are responsiblefor determining whether it is legal and/or safe to bringmethadone with them when they travel.

An excellent place to start is the INDRO Web site at:

http://www.indro-online.de/methadoneindex.htm .

For more information about Europeanmethadone providers, go to:http://www.q4q.nl/methwork2/home.htm .

You can also check with the consulate of the country

that you are traveling toalthough not all consulateswill be well informed about methadone.

Whichever country you travel to, you will need to decidewhether you will carry your own methadone (wherepermitted) or find a methadone provider there whowill treat you (if one is available).

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Whichever option you choose, you will need to bring your prescription for methadone,and, if you are guest-medicating, a letter from your home provider, explaining your prescription/dosage. Make these arrangements asearly as possible before your trip.

What should you do if methadone importation isprohibited at your destination?

Knowing that their medication is legal,most simply do not declare itat customs unlessthey are specifically

asked to do so.There are,however,severe penalties forimportation of evensmall, prescribedamounts of medications in

some countries (forexample, the death penalty inSingapore!).

Each patient will have to weighthis decision very carefully.Many methadone patients havetraveled to various parts of theworld without experiencing anyproblems.


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State Substance Abuse Agencies

Alabama(334) 242-3961Alaska(907) 465-2071Arizona(602) 381-8999Arkansas(501) 280-4505California(800) 879-2772Colorado(303) 866-7480Connecticut(860) 418-7000Delaware(302) 577-4460District of Columbia(202) 442-9152Florida(850) 487-2920Georgia(404) 657-2135Hawaii(808) 692-7506Idaho(208) 334-5935Illinois(800) 843-6154Indiana(317) 232-7800Iowa(515) 281-4417Kansas(800) 586-3690Kentucky(502) 564-2880

Louisiana(225) 342-6717Maine(800) 499-0027Maryland(410) 402-8600Massachusetts(617) 624-5111Michigan(517) 335-0278Minnesota(651) 582-1832Mississippi(877) 210-8513Missouri(573) 751-4942Montana(406) 444-3964Nebraska(402) 479-5583Nevada(775) 684-4190New Hampshire(800) 804-3345New Jersey(609) 292-5760New Mexico(505) 827-2601New York(518) 473-3460North Carolina(919) 733-4670North Dakota(701) 328-8920Ohio(614) 466-3445

Oklahoma(405) 522-3877Oregon(503) 945-5763Pennsylvania(717) 783-8200Puerto Rico(787) 764-3795Rhode Island(401) 462-4680South Carolina(803) 896-5555South Dakota(605) 773-3123Tennessee(615) 741-1921Texas(512) 349-6600Utah(801) 538-3939Vermont(802) 651-1550Virginia(804) 786-3906Washington(877) 301-4557West Virginia(304) 558-2276Wisconsin(608) 266-2717Wyoming(307) 777-6494


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For more information about methadone, please visit:

Addiction Treatment Forumhttp://www.atforum.com

The Baron Edmond de Rothschild Chemical Dependency Institute

http://www.opiateaddictionrx.info

Centers for Disease Controlhttp://www.cdc.gov/idu/facts/Methadone.htm

Drug Policy Alliancehttp://www.drugpolicy.org/library/meth_maintenance.cfm

The National Alliance of Methadone Advocateshttp://www.methadone.org

Substance Abuse and Mental Health Services Administrationhttp://www.samhsa.gov/centers/csat/csat.html

For information about buprenorphine, please visit:

Substance Abuse and Mental Health Services Administrationhttp://buprenorphine.samhsa.gov


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DPA HEADQUARTERS70 West 36th Street, 16th FloorNew York,NY 10018P (212) 613-8020F (212) 613-8021

[email protected]

DPA OFFICE OF NATIONAL AFFAIRS925 15th Street NW, 2nd FloorWashington, DC 20005P (202) 216-0035F (202) [email protected]

DPA NEW JERSEY119 South Warren Street, 1st FloorTrenton, NJ 08608P (609) 396-8613F (609) [email protected]

DPA NEW MEXICO104 S. Capitol Place, Suite 8Santa Fe,NM 87501P (505) 983-3277F (505) [email protected]

DPA CALIFORNIA CAPITAL OFFICE1225 8th Street, Suite 570Sacramento, CA 95814P (916) 444-3751F (916) 444-3802

[email protected]

DPA OFFICE OF LEGAL AFFAIRS819 Bancroft WayBerkeley, CA 94710P (510) 229-5211F (510) [email protected]

DPA SOUTHERN CALIFORNIA610 South Ardmore AvenueLos Angeles, CA 90005P (213) 201-4785F (213) [email protected]

DPA SAN FRANCISCO2233 Lombard StreetSan Francisco, CA 94123P (415) 921-4987F (415) [email protected]

Drug Policy Alliance Offices


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The Drug Policy Alliance published About Methadone and Buprenorphine to helppatients make healthy and informed treatment decisions with their doctors.As part of our broader mission, we also seek to end the prejudices and policiesthat cause discrimination against all people in maintenance therapies.

By educating thousands of readers, About Methadone and Buprenorphine hashelped advance both of these goals, so were pleased to offer it for just the cost of production. As a private, nonprofit organization, however, the Drug Policy Alliancerelies solely on our members and contributors for financial supportboth toadvance drug policies based on science, health, compassion and human rights,and to aid in the distribution of About Methadone and Buprenorphine andpublications like it.

Please join our fight for the rights and dignity of methadone patients and themillions of others who suffer the consequences of the failed war on drugs.Join the Drug Policy Alliance today.

To become a member and help end the war on drugs, please contact:

MembershipDrug Policy Alliance70 West 36th Street16th FloorNew York, NY 10018Tel: (212) 613-8020Fax: (212) 613-8021E-mail: [email protected]://www.drugpolicy.org/join

For additional copies of About Methadone and Buprenorphine ,

please contact the above address, email us at [email protected]

or call (212) 613-8020.


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