About
Methadone
Table of Contents
Acknowledgments 3
Introduction 5
Dependency 7
What Is Methadone? 10
What Is LAAM? 13
Maintenance 14
After Methadone 16
Myths & Facts 17
Drug Interactions 21
Your Other Doctors 24
Methadone & Women 26
Storing Methadone 30
Concerns about Overdose 31
In Case of Overdose 36
Detoxification 38
Detox: How It Works 40
Driving 42
Traveling with Methadone 44
About
Methadone
Illustrations: Liz Pagano
Design and Production: Criscola Design
Printer: Herlin Press, Inc.
Copyright ©2000 The Lindesmith Center-Drug Policy Foundation
All rights reserved
Printed in the United States of America
ISBN: 1-930517-27-0
2 |
Acknowledgments
This handbook is modeled on an excellent book
written for methadone patients in the United
Kingdom, The Methadone Handbook by Andrew
Preston. We wanted methadone patients in the
United States as well to have ready access to basic
information about their medication.
Many thanks to my collaborators, Corinne Carey,
Travis Jordan, Michael McAllister, Sharon Stancliff,
Ellen Tuchman, and Peter Vanderkloot for their
invaluable contributions to the research and
writing of this booklet.
Thanks also to Matt Briggs, Paul Cherashore,
Amanda Davila, Ethan Nadelmann, Robert Newman,
J. Thomas Payte and Shayna Samuels for their
suggestions for improvements.
And special thanks to all the methadone patients,
advocates, and their loved ones that I have met and
worked with. You are the inspiration for this.
Holly Catania, JD
The Lindesmith Center-Drug Policy Foundation
| 3
Introduction
You may be reading this book because you are
taking methadone or because you are thinking
about taking methadone-or because you care
about somebody who is.
People usually enter methadone treatment because
they feel overwhelmed by their dependence on
heroin or other opioids. But not everyone who
comes into methadone maintenance has the same
goals. Some people want to stop taking street
opioids for good. Some want to temporarily
stop taking street opioids. And some want
to 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 a short time.
Regardless of what you hope to get
from methadone maintenance,
however, all the evidence agrees
on these several points:
| 5
People dependent on street opioids who receive
methadone treatment are healthier and safer than
those who do not. They live longer, spend less time
in jail and in the hospital, are less often infected
with HIV, and commit fewer crimes.
Longer periods of methadone maintenance are
better than shorter periods. The longer you stay on
methadone maintenance, the better the overall out-
come. Indefinite treatment often means life-long
extension of good health, HIV seronegativity, and
freedom from incarceration.
Methadone maintenance is treatment for people
who are dependent on opioid drugs. It is not a
treatment for people whose major problems
are with other drugs-such as cocaine, alcohol,
benzodiazepines, or cigarettes.
Opioid drugs include all the drugs that come
fully or partially from opium and synthetic drugs
that have similar effects. Morphine, heroin,
codeine, methadone, dilaudid, LAAM, and fentanyl
are opioids.
People dependent on street opioids who
receive methadone treatment are healthier
and safer than those who do not.
6 |
Dependency
Opioids have been used for thousands of years, and
it has long been known that many people who have
become dependent on opioids have extreme difficul-
ty permanently ending their use of them.
Suffering through the withdrawal sickness is only
part of the problem. The real difficulty has always
been staying off the drugs once the period of
withdrawal is over.
Just as in the case of those who are unable to stop
smoking, it is difficult to explain why it is so hard
not to return to the use of opioids. Reasons include
long-term depression, lack of energy, drug cravings,
and sudden attacks of physical withdrawal
sickness. Some people find that these problems
diminish over time and eventually disappear
altogether-but others continue to suffer these
symptoms indefinitely, and many of them eventual-
ly relapse to their regular use of opioids.
The reason that people relapse often has nothing to
do with lack of will power or other personality prob-
lems. Instead, it appears that people with a long his-
| 7
tory of opioid problems have experienced changes
to the part of their brains that allows a person to
feel and function normally. This part of the brain
makes and uses its own natural opioids.
The best known of these natural opioids are the
chemicals known as endorphins. The word endor-
phin literally means "the morphine within." Indeed,
these chemicals are functionally identical to mor-
phine or heroin.
We don't yet understand everything that these
natural opioids do in the body, but evidence sug-
gests that they are involved with pain control,
learning, regulating body temperature, and many
other functions.
It is possible that people who develop a dependency
on opioids were born with an endorphin system
that makes them particularly vulnerable. For
example, we know that addiction appears to run in
some families.
Addiction might also be related to changes in the
brain caused by the overuse of heroin or other opi-
oids. Or it may be the result of a complex relation-
ship between genetics and the environment.
8 |
We do not yet know exactly how this malfunction-
ing occurs, or even whether all people who feel
unable to stop using opioids have this damage.
There is, however, an increasing amount of evidence
that many people who find it difficult to end their
use of opioids have experienced these physical
changes-which are likely to be permanent.
There is not yet any test that can determine how
much damage a person may have to his or her natu-
ral opioid system, or how hard it may be for that
person to stay away from opioids. All that we know
for sure right now is that relapse is a major feature
of opioid dependency.
Methadone is not a cure for the problem of opioid
dependency. It is a treatment-and one that is effec-
tive for only as long as a person continues to take it
appropriately.
The reason that people relapse often
has nothing to do with lack of will power or
other personality problems.
| 9
What Is Methadone?
Methadone is a long-acting, synthetic, narcotic drug
that was first used in the maintenance treatment of
drug addiction in the United States in the 1960s. It is
an opiate "agonist," which means that it acts in a
way that is similar to morphine and other narcotic
medications.
When used in proper doses in maintenance treat-
ment, methadone does not create euphoria, seda-
tion, or an analgesic effect. Doses must be individu-
ally determined based on a person's body weight
and opiate tolerance. The proper maintenance dose
is the one at which the cravings stop, without
creating the effects of euphoria or sedation.
Although methadone is not a single product from
a single manufacturer, the active ingredient is
always the same: methadone hydrochloride.
All manufacturers add a small number of additional
inactive ingredients, such as magnesium steurate
and cellulose. Some of the U.S. companies that
manufacture methadone include cherry or orange
flavoring. Methadone is dispensed orally in
different forms, which include:
10 |
Tablets, also called diskettes. Each one contains
40 milligrams of methadone, is dissolved in
water, and then is administered in an oral dose.
The primary inactive ingredient in the tablet form is
colloidal silicone dioxide.
Powder is also dissolved in water.
Liquid methadone can be dispensed with an auto-
mated measuring pump. Dosages can be adjusted to
as small as a single milligram.
Patients have different opinions about the various
types of methadone. Some prefer the dissolving
white tablet, some the orange, and some the liquid
form. Each methadone provider usually offers a sin-
gle type of the drug and obtains its supply from one
source, which means that patients generally do not
get to choose which form of methadone they get.
For most people, a single dose of methadone lasts
24 to 36 hours.
| 11
How is methadone different from heroin and other
opioids (for example, morphine or dilaudid)?
Methadone lasts longer. The body metabolizes
methadone differently than it does heroin or mor-
phine. 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
find that once they're stabilized on a dose of
methadone that's right for them, a single oral dose
will "hold" them for at least a full 24-hour day. For
some, the effect lasts longer; for others it lasts a
shorter time.
Stability is easier on oral methadone. Most
people who are on a stable, appropriate dose of
methadone for several weeks will not feel any
significant sense of being "high" or "dopesick."
Some patients may feel a "transition"-or tempo-
rary, mild glow-for a short time several hours
after being medicated, however. Others may feel
slightly "dopesick" prior to taking the day's med-
ication, but most will feel very little or no effect
from the proper dose of methadone once they
have stabilized.
12 |
What Is LAAM?
LAAM (Levo-Alpha Acetyl Methadol), also known as
ORLAAM, is a synthetic opiate. Like methadone,
LAAM blocks cravings and withdrawal effects
for opioids.
LAAM metabolizes slowly, which means that
patients need to take it only every 48 to 72 hours,
while patients must take methadone every day.
LAAM also has a slow onset, which means that,
at first, some people may feel the symptoms
of withdrawal. To offset this effect, doctors may
prescribe LAAM and methadone together until
the patient's levels of LAAM are sufficient to
eliminate the methadone entirely.
Currently, LAAM is less available in the
United States than methadone-so most
patients cannot choose between the two
treatments. In addition, many programs provide only
one therapy or the other.
| 13
Maintenance
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 recommend-
ed, is 30 to 40 milligrams a day. After several days,
providers adjust a patient's dose as needed.
2. Keep the patient comfortable and free from
craving street opioids. Having a craving means
more than just having a desire to get high. It means
feeling such a strong need for opioids that people
may have regular dreams about using drugs, think
about doing drugs to the exclusion of anything else,
and/or do things that they wouldn't normally do
to get drugs.
Methadone won't control a person's emotional
desire to get high, but an adequate dose of
methadone should prevent the overwhelming
physical need to use street opioids.
14 |
3. "Block"the effects of street opioids. If the dose
is high enough, methadone keeps the patient from
getting much, if any, effect from the usual doses
of street opioids. This result is often called the
"blockade" effect.
If a person's opioid tolerance is elevated high
enough with methadone treatment, a great deal
of heroin would be required to overcome it and
produce a significant high.
Methadone won't control a person's
desire to get high, but an adequate
dose of methadone should prevent the
overwhelming physical need to use street opioids.
| 15
After Methadone
Some patients become tired of the maintenance
regime, which requires the indefinite use of
medication. This is especially true of patients on
methadone maintenance because, in the United
States, methadone patients are also required to
make frequent visits to a clinic (with few exceptions)
to receive their medication.
However, after reaching a comfortable level of
stability-with a good support system-patients
can choose to gradually lower their methadone dose
and end their treatment. Plans
can be made to allow for a
very slow, gentle tapering off
of the medication, and
may include after-care
counseling
for some
period of
time.
16 |
Myths & Facts
Myth Methadone gets into your bones and
weakens them.
Fact Methadone does not"get into the bones"
or in any other way cause harm to the skeletal
system. Although some methadone patients report
having aches in their arms and legs, the discomfort
is probably a mild withdrawal symptom and may
be eased by adjusting the dose of methadone.
Also, some substances can cause more rapid
metabolism of methadone (see pages 2123 for a
list of medications that interact with methadone).
If you are taking another substance that is affecting
the metabolism of your methadone, your doctor
may need to adjust your methadone dose.
Other substances can cause
more rapid metabolism
of methadone.
| 17
Myth It's harder to kick methadone than it is
to kick a dope habit.
Fact Stopping methadone use is different
from kicking a heroin habit. Some people find it
harder because the 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 more than 30 years, and there has been no
evidence that long-term use causes any physical
damage. Some people do suffer some side effects
from methadone-such as constipation, increased
sweating, and dry mouth-but these usually go
away over time or with dose adjustments. Other
effects, such as menstrual abnormalities and
decreased sexual desire, have been reported by
some patients but have not been clearly linked to
methadone use.
Myth Methadone is worse for your body
than heroin.
18 |
Fact Methadone is not worse for your body
than heroin. Both heroin and methadone are non-
toxic, yet both can be dangerous if taken in excess-
but this is true of everything, from aspirin to food.
Methadone is safer than street heroin because it is a
legally prescribed medication and it is taken orally.
Unregulated street drugs often contain many harm-
ful additives that are used to "cut" the drug.
Myth Methadone harms your liver.
Fact The liver metabolizes (breaks down and
processes) methadone, but methadone does not
"harm" the liver. Methadone is actually much
easier for the liver to metabolize than many other
types of medications. People with hepatitis or with
severe liver disease can take methadone safely.
Myth Methadone is harmful to your immune
system.
Fact Methadone does not damage the
immune system. In fact, several studies sug-
gest that HIV-positive patients who are tak-
ing methadone are healthier and live longer than
those drug users who are not on methadone.
| 19
Myth Methadone causes
people to use cocaine.
Fact Methadone does not cause people to
use cocaine. Many people who use cocaine started
taking it before they started methadone mainte-
nance treatment-and many stop using cocaine
while they are on maintenance.
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 heroin and-most important-to cut
the craving for heroin. Most patients will need
between 60 and 120 milligrams of 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 feel
comfortable. Ideally, patients should decide on their
dose with the help of their physician, and without
outside interference 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 feel any more drowsy or sedated than
is normal.
20 |
Drug Interactions
Like any medication, methadone can interact with
other types of medicines and with street drugs. The
body is a complex system, and it's possible that
foods, hormones, weight changes, and stress may
each also affect the way in which methadone works
in your body.
We know about some of the substances that may
interact with methadone-and some of them are
listed here. Others may yet be discovered.
These medicines cause the liver to metabolize
methadone more quickly and may cause a need
for an increased methadone dose:
Carbamazepin (Tegretol)
Phenytoin (Dilantin)
Neverapine (Virammune)
Rifampin
Ritonavir (Norvir)-less of an effect
Some medicines slow the metabolism of
methadone. Sometimes people will feel the effect of
methadone more strongly when they take these
medications, and sometimes they experience
| 21
withdrawal symptoms when they stop taking these
medications:
Amitriptyline (Elavil)
Cimetidine (Tagamet)
Fluvoxamine (Luvox)
Ketoconazole (Nizoral)
Some medications are opioid blockers and may
cause withdrawal. These block the effect of
methadone and SHOULD NOT BE TAKEN if you are
taking methadone:
Pentazocine (Talwin)
Naltrexone (Revia)
Tramadol (Ultram), in most cases
Some medications initially interact with
methadone to cause sedation, but then the opposite
occurs, and they can cause withdrawal symptoms.
These medications include:
Benzodiazepines such as Xanax and valium
Alcohol
Barbiturates
22 |
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 regarding
methadone interactions:
Methadone is not responsible for every new feeling
you have, and it won't be affected by most medica-
tions or changes in your life conditions.
If your methadone dosage doesn't feel right, it
probably isn't right. You are the expert when it comes
to how much methadone is enough. Talk to your
doctor about how you're feeling.
If your methadone dosage doesn't feel right,
it probably isn't right.
| 23
Your Other Doctors
Methadone patients are some-
times reluctant to tell their
other doctors that they are
taking methadone. They
are afraid that these
doctors-or other
health-care
providers-will
discriminate
against them.
Unfortunately,
they are often
right.
Find a primary-care
provider whom you
can trust. The ideal
situation is to make
sure all your doctors know
that you are taking methadone. If you choose not
to tell them, however, keep these important things
in mind:
24 |
If you are having surgery for which you may be
put to sleep, the anesthesiologist might use a
type of medication that will cause abrupt
methadone withdrawal. Be sure you know
which medications interact 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 or
anyone else without your written permission.
(Title 42 of the Code of Federal Regulations
Part 2 [42CFR part 2] protects against disclosure
of drug treatment records.)
Ideally, though, open communication among all
the doctors who are treating you may assist you
in getting the best-possible health care.
| 25
Methadone & Women
Is it true that women sometimes stop getting their
periods when they begin taking
methadone?
Yes, but there are also many other reasons why
women's 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
don't get your period.
You can conceive and have normal pregnancies
and normal deliveries while you are receiving
methadone.
26 |
You may have heard that you should not take
methadone when pregnant. This is not true.
Methadone is not harmful to the developing
fetus-but detoxing is.
Methadone is the treatment of choice for heroin
and opiate dependency during pregnancy.
The effects of methadone on pregnancy have been
widely studied.
Methadone has been used successfully
during pregnancy.
When properly prescribed for pregnant women,
methadone provides a non-stressful environment in
which the fetus can develop.
Taking methadone during pregnancy may
prevent miscarriage, fetal distress, and
premature labor.
| 27
If you are pregnant, be sure to
talk to your doctor.
Decreasing the dose of methadone during the first
trimester increases the risk of miscarriage.
During pregnancy, your dose should be sufficient
to avoid cravings, avoid street drugs, and prevent
withdrawal.
If you are pregnant, be sure to talk with your doctor,
because:
When you're pregnant, your body metabolism
changes, 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
addicted to methadone or will suffer other side
effects, but here are the facts:
Methadone does not cause fetal abnormalities. No
harmful effects to a fetus have been found in the
study of methadone's effect on pregnancy.
28 |
Premature birth and low birth weight can be asso-
ciated with cigarette smoking and/or poor nutrition
and are not attributed to methadone.
Babies born to mothers dependent on methadone
will have methadone in their systems, but studies
show that the children can be weaned successfully
and safely with no adverse effects.
You may have heard that you shouldn't breast-feed
your baby if you are taking methadone, but here are
the facts:
Breast-feeding is now considered safe for
the babies of women who are taking
methadone, but not safe for women
who are HIV+.
Small amounts of methadone in
breast milk can pass to the baby.
Methadone levels in breast
milk are very low.
| 29
Storing Methadone
While at home, always keep your methadone in a
safe place-preferably in a locked box or cabinet-
out of the reach of children and clearly marked to
prevent anyone else from taking it accidentally.
Remember: Methadone is a very strong narcotic
drug. A small amount can kill a child or an
adult who does not have a tolerance to
it. If anyone in your home accidentally
drinks your methadone, call 911 or an
ambulance immediately.
Store your methadone away from extreme
heat or cold. The methadone that you
take home is often mixed with water-and
sometimes mixed with other additives,
depending on where you get your methadone.
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 methadone provider
to prevent any trouble with the law. Like any
prescription drug, it is illegal to possess methadone
without a prescription.
30 |
Concerns about Overdose
Methadone treatment reduces the chance of
overdose for those 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 overdose remain, however,
especially if you continue to use street drugs or
if you resume regular heroin use after stopping
your methadone treatment.
If you stop taking methadone and start using street
drugs again, your chance of overdose increases
because you now have a lower tolerance for the
If anyone in your home accidentally
drinks methadone,call 911 or an ambulance
immediately.
| 31
drugs. Tolerance increases when your body has
gotten used to having the drug in its system-in
other words, your body "tolerates" the presence
of the drug.
If you stop using regularly-or if you have
detoxed-it takes a smaller amount of the heroin,
methadone, or other opiate to cause an overdose.
Also, mixing pills such as benzodiazepines, barbitu-
ates and/or alcohol with methadone or heroin
increases the risk of overdose.
Frequently Asked Questions
Can I overdose on methadone?
It is possible to overdose on methadone, but
providers work to adjust dosages so that they are
safe for each individual patient. It is important to be
honest with the clinic staff about how much heroin
or other opiates you are using so that they prescribe
a dosage that is right for you-too little won't be
effective; too much could cause you to overdose.
Methadone is a strong medication, so you need to
build up the dosage slowly to be sure that your body
is handling the medicine well.
32 |
Can I overdose on LAAM?
You can overdose if you are given too large a dose
of LAAM before your body can tolerate it. This is
very unlikely, however-especially if you are honest
with the clinic staff about how much heroin you
are using.
Before the LAAM is entirely absorbed, you may feel
like the dose is too small. You may also feel like you
need some heroin or another opiate to ease the
withdrawal. Because LAAM takes a long time to
build up in your body, it's best not to take any opi-
ates while you are beginning treatment. It's possible
that the opiate combined with the LAAM could
cause an overdose.
What if I use other drugs while I am taking
methadone or LAAM?
The correct dosage of methadone blocks the effects
of heroin. If you take opiates while also taking
methadone, you may not feel the effects of the opi-
ates. You may then decide to take even more of the
opiate, which could cause an overdose. Some drugs
also interact with methadone and can change how
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 be
dangerous because each substance makes the other
more powerful, increasing your risk of overdose. Be
extremely careful if you mix these drugs.
| 33
Can I overdose on heroin while I am taking
methadone?
Yes. Even while taking methadone, if you take too
much heroin-especially if the heroin is unusually
strong-you could overdose. You increase the odds
of overdosing on heroin while you're taking
methadone if you mix it with sedatives, alcohol, or
other drugs.
What if I stop going to my methadone program?
If you stop taking your methadone and return to
using street drugs, you can overdose more easily
than when you last used. When you stop taking
methadone, your body will rapidly develop a lower
tolerance for the heroin. As soon as your metha-
done completely wears off (a couple of days), your
tolerance for heroin wil be lower than it was when
you began taking methadone or LAAM. So, if you
decide to use again, you need to be very careful. Take
some precautions-always be sure there are other
people with you when you're using, in case you need
medical attention, and test the effect of the drug on
you before you take an entire dose.
The correct dosage of methadone
blocks the effects of heroin.
34 |
What happens if I start taking methadone again
after I have stopped?
If you stop taking methadone even for a few days,
you need to be careful when you start taking it
again. Your body may have lost some of its tolerance
for the methadone, so you could overdose. You need
to restart at a lower dose and work back up to the
level you were at when you stopped. The doctor at
the clinic can help you determine the right dosages.
| 35
In Case of Overdose
If you suspect that someone has overdosed on
methadone, lie the person on his or her side in the
recovery position and call 911 immediately.
If medical professionals arrive quickly, they can treat
the individual with an antagonist, such as naloxone,
that will help them come out of the overdose. It is
important to tell the medical professionals what
drug the overdose victim took so they know which
drug to use to counteract the overdose.
The person who overdosed will need to be
watched for a few hours. Methadone is a long-
acting drug. The medications 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 a state of
overdose and require medical attention again.
36 |
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.
What are the signs of a methadone overdose?
Nausea and vomiting
Constricted (small, pin-point) pupils
Drowsiness
Cold, clammy, bluish skin
Reduced heart rate
Reduced body temperature
Slow or no breathing
What might happen if an overdose is not treated?
Breathlessness
Respiratory distress
Pulmonary edema (fluid in the lungs)
Convulsions (due to a lack of oxygen)
Death
| 37
Detoxification
Doctors do not advise that people quickly taper off
of their dose of methadone-but there are,
unfortunately, many situations where this occurs.
For example, a methadone patient may be in jail or
in a hospital where methadone is not prescribed.
Or the person may be complying with a demand
from family court in order to be reunited with
children who are in foster care. Public policy is slowly
changing, but some methadone patients are still
being forced to detox from their medication.
If you are being "administratively detoxed" by
your methadone provider, you should find another
provider quickly. If your provider is not helping
you find another, contact a harm-reduction program,
needle exchange, or your state's health department
for assistance. A directory of state alcohol
and drug-abuse agencies can be found at
http://www.treatment.org_states/.
Some people also use gradually tapering doses
of methadone for a short period of time (three to
seven days) to relieve the initial discomfort of
heroin withdrawal. This method may be successful
for people who haven't been dependent on heroin
or other opioids for a long time.
38 |
It's important that even those people who use
detox as a primary method of treatment feel
motivated to quit drugs. You should also establish a
support system for staying drug-free. If you do not,
the detox may only provide a few weeks of absti-
nence or decreased use-and it's very likely that you
will resume daily use of heroin, and end up right
back where you started.
But remember, if you do start using drugs again
after your detox, you are not a "failure." Each period
of time that you spent away from street drugs was a
period of reduced risk-risk of arrest, exposure to
disease, and overdose. These periods of success pro-
vide a period of stability during which you can begin
to focus on other aspects of life and consider your
long-term plans.
| 39
Detox: How It Works
Methadone patients have two options: inpatient
and outpatient treatment.
With inpatient treatment, the
Methadone & Pain patient is admitted for overnight
Severe pain has long been undertreated care to a clinic or hospital. The
in the United States. This is partly
because of ignorance and prejudice, but patient usually must spend sev-
also because of the laws hat made eral days and take medication to
drugs like heroin illegal. The relieve the withdrawal symp-
government has actively pursued toms. In outpatient detox, med-
and prosecuted physicians for
prescribing opioids. ication also provides relief from
withdrawal symptoms. The med-
If you are on methadone maintenance, ication is administered during
your regular maintenance dose of daily clinic visits over a period of
methadone will provide little or no pain
relief. You will still feel pain, just like several weeks or longer. Often,
everyone else. In fact, you may need methadone is used, in doses that
more pain-relief medication than peo- are gradually reduced.
ple who are not taking methadone.
Greater public awareness of how many Any "cross-tolerant" opiate-
people have needlessly suffered such as morphine, dilaudid,
because of this undertreatment of pain methadone, heroin, or LAAM-
is beginning to force changes. To man- can suppress withdrawal.
age pain, doctors are beginning to more
freely prescribe opioids-including Methadone is preferred because
methadone, which has been recognized it is long-acting, gentle, elimi-
as an effective pain medication.
40 |
nates craving, and does not produce a "high" when it
is used properly.
Other medications, including drugs such as
buprenorphine and clonidine, which are not opiates,
are also used-and may be used more widely in the
future. The potential side effects-such as lower
blood pressure, loss of energy, and dry mouth-are
considered before a drug is chosen.
The usual detox program for methadone requires
that the patient use it as a tapering dose for 21 to 30
days. During induction, the doctor determines the
right dose to overcome withdrawal. Afterward, the
dose you take gradually becomes smaller, until you
no longer need the methadone. The medical and
counseling staff in your program can help you devel-
op a plan for further treatment if you need it, and
will guide you through the physical changes you
experience during the detox period.
| 41
Driving
Study after study has shown that people who are
maintained on a correct dose of methadone can do
anything that people who are not using any medica-
tion can do.
Researchers have conducted laboratory and field
studies since 1964. They have consistently found
that methadone-when used in the treatment of
heroin addiction-had no adverse effects on a
person's ability to think and function normally.
Methadone patients still experience a great
deal of discrimination by employers, however,
especially when they seek to get or keep jobs that
involve driving.
Discrimination persists, despite the fact that
people maintained on methadone are no different
from the general population in their motor skills,
reaction times, ability to learn, focus, and make com-
plex judgments.
Of course, your ability to think and function normal-
ly depends on your having the correct dosage of
42 |
methadone. If you feel groggy, tired, or unable to
focus, you should not drive. Be sure to consult your
clinician about whether you are receiving a correct
amount of methadone.
| 43
Traveling with
Methadone
Traveling in the United States
It can be very stressful for methadone patients
to plan a trip. Rules vary from place to place
throughout the United States, and many of
them are unclear.
If you are traveling within the United States, decide
whether you want to travel with your medication or
obtain it when you arrive at your destination.
To be sure that your methadone treatment is not
interrupted, you will either need to get enough
methadone from your provider to cover you for the
entire time you're away-or your provider/clinic will
need to arrange for you to be "guest medicated" at a
methadone clinic located in the area where you will
be staying.
In either case, it is wise to make your arrangements
as early as possible before you leave.
44 |
Keep in mind that federal, state, and clinic regula-
tions limit the amount of methadone that you
can take with you. These rules differ from place
to place, so check with your provider to find out
about the rules in the areas you plan to visit.
A comprehensive "Methadone Maintenance
Treatment Directory" listing contact information for
outpatient methadone maintenance facilities in the
United States can be found on the Internet at:
http://methinfex.home.mindspring.com/directory.
If you do not have access to the Internet, call
the National Alliance for Methadone Advocates
at (212) 595-6262 or the local chapter of NAMA in
your area.
| 45
Traveling Abroad
Methadone is a prescribed
medication, and most countries
allow visitors to bring whatever
prescription medications they
need with them. In some places,
however, methadone may be con-
sidered an exception to this policy.
In many countries, methadone is
not available, and some countries
prohibit bringing it in. Some
countries also have laws prohibiting
former addicts or people with
criminal records from entering. It may
be difficult to find out which laws are
in effect in which countries-and which
laws are actually enforced.
There are some resources that patients can check to
determine the laws that apply to methadone at
their destinations. Ultimately, however, patients are
responsible for determining whether it is legal
and/or safe to bring methadone with them when
they travel.
An excellent place to start is the INDRO website at
http://home.muenster.net/~indro/travreg.htm or
at www.methadone.org.
46 |
You can also check with the consulate of the
country that you are traveling to-although not
all consulates will be well informed about
methadone.
Whichever country you travel to, you will need
to decide whether you will carry your own
methadone (where permitted) or find a methadone
provider there who will treat you (if one is available).
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 as early as possible before your trip.
What should you do if methadone importation is
prohibited at your destination?
Knowing that their medication is legal, most
simply do not declare it at customs unless they
are specifically asked to do so. There are, however,
severe penalties for importation of even small, pre-
scribed amounts of medications in some countries
(for example, the death penalty in Singapore!).
Each patient will have to weigh this decision very
carefully. Many methadone patients have traveled
to various parts of the world without experiencing
any problems.
| 47
For more information about methadone or to
order additional copies of this booklet, contact:
The Lindesmith Center-Drug Policy Foundation
925 Ninth Avenue
New York, NY 10019
Tel: (212) 548-0695
Fax: (212) 548-4670
E-mail: methadone@drugpolicy.org
Web site: www.drugpolicy.org