Methadone



Methadone 828
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Definition

Methadone is classified as an opioid (an analgesic that is used for severe pain). In the United States, methadone is also known as dolophine, methenex and methadose.

Purpose

Methadone is used in the long-term maintenance treatment of narcotic addiction . Both heroin and methadone are opioids; as such, methadone and heroin bind to the same places in the brain . Methadone, however, is the opioid of choice for the treatment of narcotic addiction since it is longer lasting and patients don't experience the "high" associated with the drug of abuse. In opioid maintenance therapy, a person addicted to heroin receives methadone instead of heroin. Essentially, the person is switched from an opioid that gives a "high" to an opioid that does not. The dose of methadone may then be decreased over time so that the person can overcome his or her opioid addiction without experiencing withdrawal symptoms, or, after a person has received methadone for a period of time, he or she may choose to go through detoxification with clonidine . In the United States, methadone treatment is associated with a significant reduction in predatory crime, improvement in socially acceptable behavior, and psychological well-being.

Methadone may also be prescribed for pain relief, but in these cases, the physician must note this use on the prescription.

Description

Methadone has been used successfully to treat narcotic addiction for over twenty years in the United States. Methadone is the only FDA-approved agent in its class for the maintenance treatment of narcotic addiction.

Methadone for maintenance treatment is dispensed in methadone clinics. The program needs to be registered with the Drug Enforcement Agency. For admission to methadone treatment in clinical programs, federal standards mandate a minimum of one year of opiate addiction as well as current evidence of addiction. Pregnant, opiate-addicted females can be admitted with less than a one-year history and AIDS patients are routinely accepted. New patients must report daily, take medication under observation, and participate in recommended psychosocial treatments.

Some studies have shown that over 50% of patients in methadone clinics do not abuse drugs in the first month of treatment. After ten months, however, the success rate drops to approximately 20%. Moreover, major depression is a powerful predictor of relapse in methadone treatment. If the patient has dual addictions (alcoholism along with the heroin addiction, for example), management of the other addiction increases the success rate of the methadone therapy. Proper psychiatric and psychological treatment can considerably improve methadone treatment outcome.

In the cases of pregnant women who are addicted to heroin, detoxification (discontinuing the opioid altogether) is associated with a high rate of spontaneous abortions in the first trimester and premature delivery in the third trimester. Therefore, pregnant women can be in methadone maintenance programs if they are at risk of returning to drug dependence. These women should receive the lowest effective dose, receive appropriate prenatal care, and be warned about risks of returning to drug abuse, as well as the dangers associated with withdrawal effects of methadone. Methadone is associated with lower birth weights and smaller head circumference, but it has never been shown that this has any impact on the infants' further development.

Methadone is available in 5-, 10-, and 40-mg tablets and a solution.

Recommended dosage

The initial dose of methadone is 40 mg daily administered in single or divided doses. After achieving initial dosing of about 40 mg daily, the dose should be increased since there is evidence that the relapse rate is significantly lower in patients on 80-100 mg daily rather than 40-50 mg daily. The stabilization to maintenance dosing requires one to three months.

The minimum effective dose is 60 mg daily taken at once or in divided doses. Patients on lower maintenance doses have recently been studied and have shown shorter treatment retention and have continued heroin use. If patients are stable on methadone for six months or longer, their methadone dose should not be increased by 33% or over, as this sudden increase in dose is associated with an increase in craving for the drugs that were previously abused. Some heroin patients need to be on doses up to 180 mg daily to provide adequate maintenance and to prevent relapse.

Precautions

Methadone should not be used in patients who have had hypersensitivity to methadone. Patients who experience an allergic reaction to other opioids, which may include a generalized rash or shortness of breath, such as morphine, hydromorphone, oxymorphone, or codeine may try methadone. They are less likely to develop the same reaction since methadone has a different chemical structure. Methadone should be administered carefully in patients with pre-existing respiratory problems, history of bowel obstruction, glaucoma, renal problems, and hyperthyroidism.

As stated, pregnant women can be in methadone maintenance programs if they are at risk of returning to drug dependence. Methadone is associated with smaller birth weights and smaller head circumference.

Side effects

Most adverse effects of methadone are mild and seen only in the beginning of therapy. Initially, patients may develop sedation and analgesia. It takes about four to six weeks for tolerance to these effects to develop. Tolerance to constipation and sweating may take longer to develop.

A few patients who are on larger doses of methadone may experience respiratory problems. These patients also may experience unwanted cardiac effects.

A small number of patients report a decrease in libido, impotence, and premature, delayed, or failed ejaculation. There are a few reports of occasional menstrual irregularities in female patients on methadone.

Interactions

Life-threatening interactions with other drugs have not been identified. One of the initial side effects of methadone could include dizziness and sedation, and these effects are worsened if the patient is also taking other narcotics, benzodiazepines, or is consuming alcohol.

Monoamine oxidase inhibitors (MAOIs), such as Parnate ( tranylcypromine ) and Nardil ( phenelzine ), should be avoided by people taking methadone. Medications such as naltrexone and naloxone should never be used concurrently with methadone. People must stop taking methadone for seven to 10 days before starting naltrexone or naloxone.

See also Alcohol and related disorders ; Disease concept of chemical dependency ; Opioids and related disorders

Resources

BOOKS

Albers, Lawrence J., M.D., Rhoda K. Hahn, M.D., and Christopher Reist, M.D. Handbook of Psychiatric Drugs. 2001–2002. Laguna Hills, CA: Current Clinical Strategies Publishing, 2001.

Kay, Jerald. Psychiatry: Behavioral Science and Clinical Essentials. Philadelphia: W. B. Saunders Company, 2000.

PERIODICALS

Curran, Valarie H. "Additional Methadone Increases Craving for Heroin: A Double-Blind, Placebo-Controlled Study of Chronic Opiate Users Receiving Methadone Substitution Treatment." Addiction 94 (1999):665-74.

Strain, Eric. "Moderate-vs High-Dose Methadone in the Treatment of Opioid Dependence." Journal of the American Medical Association 281 (1999):1000-5.

Ajna Hamidovic, Pharm.D.



User Contributions:

Kristina
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Apr 19, 2007 @ 10:22 pm
This page was helpfull. I have been on Methadone for 5 months and I finally fell freedom. Also my moods are so much better I feel like a person and not a junkie.
Christina
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Aug 6, 2009 @ 4:16 pm
To whom it may concern...

I know someone currently attending the methadone clinic daily for treatment. just within the past week, the patient has been experiencing some cardiac/respiratory symptoms...There has also been a weight gain within the past two weeks. The patient just recently went to the Dr. for blood work up and a stress test is scheduled. Is the methadone treatment causing these symptoms?

Thank you
cricket
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Aug 21, 2009 @ 6:06 am
I've been in a Methadone Treatment Program for 11 yrs. now. When I started this program,I had no intentions on being there this long. But when I started it, I was very determined to stop using. I have not touched any drugs or alcohol now in 11 yrs. It has definetly changed my whole life. It's just really bad about all the people that starts the program for the wrong reasons. All they do is harm themselves and other people, and they definetly make it harder for the one's that really need these programs.Good luck to all those who need and use these programs correctly. THANKS AND GOD BLESS!!!
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Aug 15, 2010 @ 9:09 am
How long does methadone stay in your system? I was just wondering, because my friend took some and then found out she too take a drug test in couple of day!! Thanks
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Aug 15, 2010 @ 1:13 pm
Answer to number 4, kim. Your friend doen't have to worry about the metadone showing up, cause it does'nt, the only way it shows is if thats what there looking for, I'm on methadone, and i'm only on 49mils, I'm there for pain, but I tried to wean off of it, and I got down to 25 and all hell broke loose, and the pain all came bcak, now i feel like Ill be on it for life, does anyone know what I can do ?
jennie
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Sep 4, 2010 @ 8:20 pm
Answer to #5, Kitty... I was on 45-50mgs of meth a day for a year for chronic pain. Everytime i seemed to wean down the pain would get really bad. THIS IS GARBAGE! METHADONE makes you hypersensitive to pain when you start to withdrawal. So if you have pain, meth makes it feel ten times worse when your detoxing. It takes exactly 17 days of extreme hell to get off of methadone (dont bother weaning down from 25mg to 0mgs, the withdrawals are just as bad). My story...I did 4 days cold turkey off meth (i weaned down to nothing) as soon as I was off of the meth for 24 hours...WOW PAIN! By day 4 my face was bright red and my heart was pounding too hard so I got nervious and checked into an expensive detox. BIG MISTAKE! They put me on suboxone for 7 days and while I was on it I felt like a million dollars BUT all hell broke out when I came home. There is no avoiding methadone withdrawls they last atleast 17 days - a month. Parafon Forte 500mgs every 6hrs for muscle cramps, xanax 2mgs every 8hrs for shaking, immodium once a day for diahrea, zofran 8mgs (every 8 hrs for neaseua), visteral 50mgs twice a day for sneezing, running nose, and CLONODINE 0.1mg every 6 hrs as needed for goosebumps and chills. Good luck finding a doctor who will understand and treat you with these approprite things while you detox. I was lucky to find a caring doc and im on day 21 and still feel crappy.
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Sep 3, 2011 @ 9:09 am
hello.my name is mike iam on 100 mg a day of methadone.i missed yesterdays dose making it 48hr.now.last nite i smoked meth.should i go in and take my dose today or try to go 72hr.i have only gone 48 before with no withdrays.I plan on sleeping tonite and never doing meth again!! anyone?
bill
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Nov 4, 2011 @ 12:12 pm
Response to #3 and #6 A slow detox over a period of many months is a more appropriate way to get off Methadone. If "dropping off cold turkey" leads to such horrible conditions- as expected- it is recommended to detox by as little as 1mg a week once you get to about 20mg. Dropping by more than 4mg a week at doses around 100mg are not suggested. As one drops in dose, eventually the "per week drop" should shift to 3mg, for example, then 2mg, and so on, once minor withdrawal symptoms start to set in. I recommend holding the detox until one feels better, and then proceeding to the next step down. Any chronic pain issues need to be addressed while stable on the dose, as pain issues will always return once the patient drops their dose from the "addiction" level to that of the "pain level." Fix first what was broke, then proceed with detox. If #3 is solid in her recovery and environment, and has no chronic pain issues, detox can work if you go slow like stated above. You'll have to deal with the anxiety of a future with no program to help out with, but without pain issues it can be done and comfortably
lee
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Jan 19, 2012 @ 1:01 am
i have a 16 yr old daughter who is on methadone for heroin use.she has been on it for 8 months now. she started at 20ml and went up 5ml about every 3 weeks.she is currantly at 70ml. i've noticed she has really bad mood swings like a jeckle and hyde thing. she goes from happy and loving to mean and abusive. other things she has is bad depression,excessive weight gain (50lbs). no desire for life. she has no friends anymore and says that she was happier and life was much better when she was using. i guess i am just wondering if there are any parents who are going through the same things or if this is an isolated thing..she says she would never go back to using and i believe her.
jeff
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Jun 3, 2012 @ 9:09 am
This articale is all a good but I feel there is no evidence of people who stay on this drug long term socially and physically. T is all his artical only tells the reader all the good so they feel as if it is ok to substitute on drug from another. The bottom line is you are still using drugs no matter what so people say. This artical does not say anything about how irresponsible it is to make an innocecnt child exposed to a drug before it is even born, that is cruel. The baby has to go through a terrible detox after birth and may not survive. My feeling for this drug is all bullshit and it is for the weak who can not do what they should do to stay sober.
nikkie
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Aug 16, 2012 @ 11:11 am
My boyfriend does liquid doses every morning how much I don't know but he been doing it for years now I only been with him for one anyways my questions is what ate the side effects if he miss a dose, is it easy to get off, I know nothing about this and it seems like he don't want me to know nothing also van you get sick if you miss doses...
Nicki
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Oct 17, 2013 @ 9:09 am
I believe that people love to tell others what to do. I have meet numerous people that have become addicted because of a doctor. The doctor then sends these people to the methadone clinic. The clinic's do NOT advice the patient how hard and long the withdraw is. They lead you to believe that stopping pain medicine may kill you and that methadone may save your life. People need to think of this. If you just stop taking methadone you are sick. Not flu sick, MUCH worse. and you stay bedridden sick for around 30 days. During those 30 days who will pay your bills? take care of your children? They don't need to see you pooping on yourself, throwing up, crying, legs that NEVER stop moving, muscle twitching. And If you fall asleep for an hour you are blessed. You DO NOT Sleep coming off methadone. After 4 days of no sleep you can lose your mind!!! People thinking about methadone need to think about that or just coming off whatever you are addicted to which usually only has withdraw for 4 to 7 days. Please educate yourself before starting!!!

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