Tuesday, March 4, 2008

Opioid Addiction
Methadone Treatment Basics
by j.l.jahrig







Preface~
Methadone is a drug utilized in Canada as both a pain management medication as well as an opioid addiction harm reduction tool.

Harmreduction consists of doing what is required to elevate the quality of both physical and mental health of an individual. In this case the primary health concern is of course injection drug abuse; a tertiary health concern being psycho-social disintegration.

Methadone works as a harmreduction tool by blocking the craving and withdrawal symptoms associated with opioid abuse. This decreases the likelyhood of injection drug abuse or the perceived need for other opioids substantially. The benefit of being able to focus on life skills as opposed to drug seeking behavior allows for significant progress against social disintegration.

Please refer to the links on the right with regards to specific questions you may have regarding Methadone Maintenance Treatment (MMT).












Methadone Maintenance Treatment

Your ultimate goal may be abstinence... this is good. However, you need a guide to get there. Trust me, here's the rough breakdown:




  • 30% MMT clients achieve long clean time (no drugs or alcohol).
  • 40% MMT clients struggle with relapse however maintain a relatively normal lifestyle.
  • 30% MMT clients are chronic users and need constant support from a clinic.
  • You are choosing the hard road... if you go to a detox center and follow up with counselling and treatment you will be off of opioids and on your way to a new life inside three months!
  • However, MMT is a year + commitment (stabilization and withdrawal inclusive). One client I know has been on and stable for over 30+ years!



First: You need to be following all the rules above in section #01.

Second: Know the rules and expectations of the Doctor or clinic prescribing for you.

Third:Integrate those rules into your lifestyle, because much like diabetes, you now have a daily responsibility to your personal self-care.

Fourth: Know that people do not die from detoxing from opioids. (unless, in rare cases extenuating health problems exist. ie: heart condition)

Fifth:Cocaine and Speed both change how effective Methadone is when absorbed in your body... so if you stop using cocaine you will most likely be over sedated and will need to request a decrease in Methadone.

Sixth: Successfully tapering off Methadone is not the same for everyone. Take these popular reduction regimes as an example:




  • Those on 40mg daily dose: decrease 2mg a week (slowed down to 01mg week @ the 10mg daily point) should minimize withdrawal. Please propose this to your physician rather than making any hasty decisions.
  • Those on 150mg daily dose: decrease 5mg a week for four weeks and then hold at that dose (130mg daily) for two weeks, then repeat this cycle, tapering all the way down to 20mg daily and slow down the taper as desired. Please propose this to your physician rather than making any hasty decisions.
Withdrawal: Both tapers are relatively tame. Please do your own research online regarding opioid withdrawal or just watch The Basketball Diaries (for an example of the worst case scenario) however it looks something like this:




  • 48hrs or less minimal withdrawal
  • 2 - 4 days moderate to severe withdrawal (like a whopper flu! yee-ha!)
  • 5 days - 3 months gradual subsiding of variable aches and upset digestion as everything begins to settle and normalize.

External influences on dose absorption include:



  • Physical activity: (work or play)
  • Perception: (withdrawal will be worse if you are too focused on it!)
  • Height/Weight
  • Metabolism




Hats off to those who have the courage to meet the challenges head on!













More to come...



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Good articles: Metha-Science

Pure R-Methadone, Used In Germany, Could Reduce United States Methadone Overdose Deaths
September 05, 2007

TARPON SPRINGS, FL -- September 5, 2007 -- The National Center for Health Statistics reports 3,849 poisoning deaths, involving methadone, in 2,004. Eliminating S-Methadone, from the mixture of R and S methadone, used in the United States, could reduce deadly cardiac arrhythmias and decrease the dangerous, unpredictable variations, in methadone therapeutic dose, between individuals. The therapeutic methadone dose is dangerously close to the fatal dose, partially due to the huge methadone half life variation, between patients. Replacing the racemic methadone mixture, used in United States, with pure R methadone, used in Germany, could reduce the United States methadone death epidemic," explains Rick Sponaugle, MD, Medical Director of Florida Detox.

Racemic methadone prescribed in the United States , is a 50 percent mixture of the active R methadone.with 50 percent S methadone, which are mirror images, of each other. R methadone is 50 times more active for pain control and binds 10 times more strongly to opiate receptors, than S methadone. According to a Swiss study of 179 patients, S-methadone causes cardiac arrhythmias or an irregular heartbeat, but provides little pain relief or opiate craving decrease. Swiss researchers determined S methadone was 3.5 times more likely to cause prolonged QT interval arrhythmias, than R methadone. Approximately 6 percent of patients metabolize or detoxify S methadone more slowly, due to decreased levels of the CYP2B6 enzyme. The Lausanne researchers determined these individuals were 4.5 times more likely to suffer dangerous prolonged QT interval arrythymias.

Inactive S methadone contaminates racemic R/S methadone mixtures, and increases the methadone dose needed to provide pain relief or prevent opiate craving. A Swiss study of 180 methadone maintainence patients, in 2000, found R methadone serum levels of 250 ng/ml prevented unprescribed opiate use as effectively as serum levels of 400 ng/ml of racemic R/S methadone. The same study found racemic R/S methadone doses varying from 55 mg/ day to 921 mg/day were required to produce a 250 ng/ml R methadone serum level, in a 70 kg patient. These huge variations in individual patient response to methadone dose demonstrate the unpredictability of the safe, effective methadone dose for a particular patient.

For many methadone patients, the fatal and therapeutic methadone doses are almost the same. Methadone patients are 7 times more likely to die from a methadone overdose, during the first two weeks of methadone treatment, while their individual response to methadone is determined. Eliminating cardiotoxic S methadone, from R methadone would decrease the methadone dose needed to control pain and opiate craving and reduce the total methadone dose required.

"The cost factor is not very important. Methadone is a very cheap drug. It only costs around SFr0.80 [$0.65] a day per patient and would rise to around SFr2.5 if we just use R-methadone," explained Hugues Abriel, MD, PhD, Department of Pharmacology and Toxicology, University of Lausanne, Switzerland. Most methadone clinics could easily absorb the increased cost of pure R methadone, since they report profits, from 16 to 50 percent of revenue, after taxes. CRC, treating over 20,000 United States methadone patients daily, reports daily profits per Methadone patient of $10.91 to $11.07.

"Since replacing R/S methadone with safer R methadone would reduce methadone cardiotoxicity and dangerous methadone half life variations, the FDA should expedite any approvals required for R methadone to be prescribed, in the United States. United States methadone patients deserve treatment with the safer R methadone, used in Germany. Physicians should also be required to obtain additional training and certification, before they are allowed to prescribe methadone, which is killing more Americans, than heroin," said Dr. Sponaugle, who is Board Certified in Addiction Medicine and Anesthesiology.