AboutMethadone

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

Table of Contents

AboutMethadone

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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

Acknowledgments

This handbook is modeled on an excellent book written for methadone patients in the UnitedKingdom, The Methadone Handbook by AndrewPreston. We wanted methadone patients in theUnited States as well to have ready access to basicinformation about their medication.

Many thanks to my collaborators, Corinne Carey,Travis Jordan, Michael McAllister, Sharon Stancliff,Ellen Tuchman, and Peter Vanderkloot for theirinvaluable 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 andworked with. You are the inspiration for this.

Holly Catania, JDThe Lindesmith Center-Drug Policy Foundation

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You may be reading this book because you are taking methadone or because you are thinkingabout taking methadone—or because you careabout somebody who is.

People usually enter methadone treatment becausethey feel overwhelmed by their dependence onheroin or other opioids. But not everyone whocomes into methadone maintenance has the samegoals. Some people want to stop taking streetopioids for good. Some want to temporarilystop taking street opioids. And some wantto reduce or re-regulate their use of street opioids.

Some people begin methadone with thebelief that they will need medicationindefinitely. Others feel that they will only need it for a short time.Regardless of what you hope to getfrom methadone maintenance,however, all the evidence agrees on these 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 timein jail and in the hospital, are less often infectedwith HIV, and commit fewer crimes.

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

� Methadone maintenance is treatment for peoplewho are dependent on opioid drugs. It is not atreatment 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 drugsthat have similar effects. Morphine, heroin,codeine, methadone, dilaudid, LAAM, 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, andit has long been known that many people who havebecome dependent on opioids have extreme difficul-ty permanently ending their use of them.

Suffering through the withdrawal sickness is onlypart of the problem. The real difficulty has alwaysbeen staying off 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 hardnot to return to the use of opioids. Reasons includelong-term depression, lack of energy, drug cravings,and sudden attacks of physical withdrawal sickness. Some people find that these problemsdiminish over time and eventually disappear altogether—but others continue to suffer thesesymptoms indefinitely, and many of them eventual-ly relapse to their regular use of opioids.

The reason that people relapse often has nothing todo with lack of will power or other personality prob-lems. Instead, it appears that people with a long his-

Dependency

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tory of opioid problems have experienced changesto the part of their brains that allows a person tofeel and function normally. This part of the brainmakes and uses its own natural opioids.

The best known of these natural opioids are thechemicals 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 manyother functions.

It is possible that people who develop a dependencyon opioids were born with an endorphin systemthat makes them particularly vulnerable. For example, we know that addiction appears to run insome families.

Addiction might also be related to changes in thebrain 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.

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We do not yet know exactly how this malfunction-ing occurs, or even whether all people who feelunable to stop using opioids have this damage.There is, however, an increasing amount of evidencethat many people who find it difficult to end theiruse of opioids have experienced these physicalchanges—which are likely to be permanent.

There is not yet any test that can determine howmuch damage a person may have to his or her natu-ral opioid system, or how hard it may be for thatperson to stay away from opioids. All that we knowfor sure right now is that relapse is a major featureof opioid dependency.

Methadone is not a cure for the problem of opioiddependency. It is a treatment—and one that is effec-tive for only as long as a person continues to take itappropriately.

The reason that people relapse often

has nothing to do with lack of will power or

other personality problems.

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Methadone is a long-acting, synthetic, narcotic drugthat was first used in the maintenance treatment ofdrug addiction in the United States in the 1960s. It isan opiate “agonist,” which means that it acts in away that is similar to morphine and other narcoticmedications.

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 weightand opiate tolerance. The proper maintenance doseis the one at which the cravings stop, withoutcreating the effects of euphoria or sedation.

Although methadone is not a single product from a single manufacturer, the active ingredient isalways the same: methadone hydrochloride.All manufacturers add a small number of additionalinactive ingredients, such as magnesium steurateand cellulose. Some of the U.S. companies thatmanufacture methadone include cherry or orangeflavoring. Methadone is dispensed orally in different forms, which include:

What Is Methadone?

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� 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 iscolloidal silicone dioxide.

� Powder is also dissolved in water.

� Liquid methadone can be dispensed with an auto-mated measuring pump. Dosages can be adjusted toas small as a single milligram.

Patients have different opinions about the varioustypes of methadone. Some prefer the dissolvingwhite tablet, some the orange, and some the liquidform. Each methadone provider usually offers a sin-gle type of the drug and obtains its supply from onesource, which means that patients generally do notget to choose which form of methadone they get.

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

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

� Methadone lasts longer. The body metabolizesmethadone 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 evenlonger when used for maintenance. Most peoplefind that once they’re stabilized on a dose ofmethadone that’s right for them, a single oral dosewill “hold” them for at least a full 24-hour day. Forsome, the effect lasts longer; for others it lasts ashorter time.

� Stability is easier on oral methadone. Mostpeople who are on a stable, appropriate dose ofmethadone 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 hoursafter being medicated, however. Others may feelslightly “dopesick“ prior to taking the day’s med-

ication, but most will feel very little or no effectfrom the proper dose of methadone once they

have stabilized.

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LAAM (Levo-Alpha Acetyl Methadol), also known asORLAAM, is a synthetic opiate. Like methadone,LAAM blocks cravings and withdrawal effects for opioids.

LAAM metabolizes slowly, which means thatpatients 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 mostpatients cannot choose between the two treatments. In addition, many programs provide onlyone therapy or the other.

What Is LAAM?

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Methadone maintenance is intended to do threethings 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 fromcraving street opioids. Having a craving meansmore than just having a desire to get high. It meansfeeling such a strong need for opioids that peoplemay have regular dreams about using drugs, thinkabout 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 emotionaldesire to get high, but an adequate dose ofmethadone should prevent the overwhelming physical need to use street opioids.

Maintenance

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3. “Block” the effects of street opioids. If the doseis high enough, methadone keeps the patient fromgetting 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 highenough 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 adequatedose of methadone should prevent the

overwhelming physical need to use street opioids.

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Some patients become tired of the maintenanceregime, which requires the indefinite use of medication. This is especially true of patients onmethadone maintenance because, in the UnitedStates, methadone patients are also required tomake 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—patientscan choose to gradually lower their methadone doseand end their treatment. Planscan be made to allow for avery slow, gentle tapering offof the medication, andmay include after-carecounselingfor someperiod oftime.

After Methadone

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� Myth Methadone gets into your bones andweakens them.

� Fact Methadone does not “get into the bones”or in any other way cause harm to the skeletal system. Although some methadone patients reporthaving aches in their arms and legs, the discomfortis 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 21–23 for a list of medications that interact with methadone).If you are taking another substance that is affectingthe metabolism of your methadone, your doctormay need to adjust your methadone dose.

Myths & Facts

Other substances can cause

more rapid metabolismof methadone.

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� Myth It’s harder to kick methadone than it isto kick a dope habit.

� Fact Stopping methadone use is differentfrom kicking a heroin habit. Some people find itharder because the withdrawal lasts longer. Otherssay that although it lasts longer, it is milder thanheroin 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 physicaldamage. Some people do suffer some side effectsfrom methadone—such as constipation, increasedsweating, and dry mouth—but these usually goaway over time or with dose adjustments. Othereffects, such as menstrual abnormalities anddecreased sexual desire, have been reported bysome patients but have not been clearly linked tomethadone use.

� Myth Methadone is worse for your body than heroin.

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� Fact Methadone is not worse for your bodythan 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 alegally 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 andprocesses) methadone, but methadone does not“harm” the liver. Methadone is actually much easier for the liver to metabolize than many othertypes of medications. People with hepatitis or withsevere liver disease can take methadone safely.

� Myth Methadone is harmful to your immunesystem.

� Fact Methadone does not damage theimmune system. In fact, several studies sug-gest that HIV-positive patients who are tak-ing methadone are healthier and live longer thanthose drug users who are not on methadone.

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� Myth Methadone causes people to use cocaine.

� Fact Methadone does not cause people to use cocaine. Many people who use cocaine startedtaking it before they started methadone mainte-nance treatment—and many stop using cocainewhile 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 cutthe craving for heroin. Most patients will needbetween 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 willneed hundreds of milligrams a day in order to feelcomfortable. Ideally, patients should decide on theirdose with the help of their physician, and withoutoutside interference or limits.

� Myth Methadone causes drowsiness and sedation.

� Fact All people sometimes feel drowsy ortired. Patients on a stabilized dose of methadonewill not feel any more drowsy or sedated than is normal.

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Like any medication, methadone can interact withother types of medicines and with street drugs. Thebody is a complex system, and it’s possible thatfoods, hormones, weight changes, and stress mayeach also affect the way in which methadone worksin your body.

We know about some of the substances that mayinteract with methadone—and some of them arelisted here. Others may yet be discovered.

� These medicines cause the liver to metabolizemethadone 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 ofmethadone. Sometimes people will feel the effect ofmethadone more strongly when they take thesemedications, and sometimes they experience

Drug Interactions

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withdrawal symptoms when they stop taking thesemedications:

� Amitriptyline (Elavil)� Cimetidine (Tagamet)� Fluvoxamine (Luvox)� Ketoconazole (Nizoral)

� Some medications are opioid blockers and maycause withdrawal. These block the effect ofmethadone and SHOULD NOT BE TAKEN if you aretaking methadone:

� Pentazocine (Talwin)� Naltrexone (Revia)� Tramadol (Ultram), in most cases

� Some medications initially interact withmethadone to cause sedation, but then the oppositeoccurs, 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 methadonerequired.� Methadone increases the level of AZT anddesipramine in the blood.

Two things should always be kept in mind regardingmethadone interactions:

� Methadone is not responsible for every new feelingyou 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, itprobably isn’t right. You are the expert when it comesto 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.

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Methadone patients are some-times reluctant to tell theirother doctors that they aretaking methadone. Theyare afraid that thesedoctors—or otherhealth-careproviders—willdiscriminateagainst them.Unfortunately,they are oftenright.

Find a primary-careprovider whom youcan trust. The idealsituation is to makesure all your doctors knowthat you are taking methadone. If you choose notto tell them, however, keep these important thingsin mind:

Your Other Doctors

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� If you are having surgery for which you may be put to sleep, the anesthesiologist might use a type of medication that will cause abruptmethadone withdrawal. Be sure you know which medications interact with methadone (see pages 21–23)—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.

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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 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 pregnanciesand normal deliveries while you are receivingmethadone.

Methadone & Women

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

� Methadone is not harmful to the developingfetus—but detoxing is.

� Methadone is the treatment of choice for heroinand opiate dependency during pregnancy.

� The effects of methadone on pregnancy have beenwidely studied.

� Methadone has been used successfully during pregnancy.

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

� Taking methadone during pregnancy may prevent miscarriage, fetal distress, and premature labor.

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

� During pregnancy, your dose should be sufficientto avoid cravings, avoid street drugs, and preventwithdrawal.

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

� When you’re 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 orthree times a day.

You may have heard that your baby will be bornaddicted to methadone or will suffer other sideeffects, but here are the facts:

� Methadone does not cause fetal abnormalities. Noharmful effects to a fetus have been found in thestudy of methadone’s effect on pregnancy.

If you are pregnant, be sure to

talk to your doctor.

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� Premature birth and low birth weight can be asso-ciated with cigarette smoking and/or poor nutritionand 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.

You may have heard that you shouldn’t breast-feedyour baby if you are taking methadone, but here arethe facts:

� Breast-feeding is now considered safe forthe babies of women who are takingmethadone, but not safe for women who are HIV+.

� Small amounts of methadone inbreast milk can pass to the baby.

� Methadone levels in breastmilk are very low.

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While at home, always keep your methadone in asafe place—preferably in a locked box or cabinet—out of the reach of children and clearly marked toprevent anyone else from taking it accidentally.

Remember: Methadone is a very strong narcoticdrug. A small amount can kill a child or an

adult who does not have a tolerance to it. If anyone in your home accidentallydrinks your methadone, call 911 or an ambulance immediately.

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

take home is often mixed with water—andsometimes 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 bottlesthat were given to you by your methadone providerto prevent any trouble with the law. Like any prescription drug, it is illegal to possess methadonewithout a prescription.

Storing Methadone

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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 streetdrugs again, your chance of overdose increasesbecause you now have a lower tolerance for the

Concerns about Overdose

If anyone in your home accidentallydrinks methadone, call 911 or an ambulance

immediately.

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drugs. Tolerance increases when your body has gotten used to having the drug in its system—inother words, your body “tolerates” the presence of the drug.

If you stop using regularly—or if you havedetoxed—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 heroinincreases the risk of overdose.

Frequently Asked Questions

� Can I overdose on methadone?It is possible to overdose on methadone, butproviders work to adjust dosages so that they aresafe for each individual patient. It is important to behonest with the clinic staff about how much heroinor other opiates you are using so that they prescribea dosage that is right for you—too little won’t beeffective; too much could cause you to overdose.Methadone is a strong medication, so you need tobuild up the dosage slowly to be sure that your bodyis handling the medicine well.

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� 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 honestwith the clinic staff about how much heroin you are using.

Before the LAAM is entirely absorbed, you may feellike the dose is too small. You may also feel like youneed some heroin or another opiate to ease thewithdrawal. Because LAAM takes a long time tobuild up in your body, it’s best not to take any opi-ates while you are beginning treatment. It’s possiblethat the opiate combined with the LAAM couldcause an overdose.

� What if I use other drugs while I am takingmethadone or LAAM?The correct dosage of methadone blocks the effectsof heroin. If you take opiates while also takingmethadone, you may not feel the effects of the opi-ates. You may then decide to take even more of theopiate, which could cause an overdose. Some drugsalso interact with methadone and can change howyour medications affect you (see pages 21–23).Taking too much of a sedative or drinking a lot ofalcohol 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.

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� Can I overdose on heroin while I am takingmethadone?Yes. Even while taking methadone, if you take toomuch heroin—especially if the heroin is unusuallystrong—you could overdose. You increase the oddsof overdosing on heroin while you’re 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 tousing street drugs, you can overdose more easilythan when you last used. When you stop takingmethadone, your body will rapidly develop a lowertolerance for the heroin. As soon as your metha-done completely wears off (a couple of days), yourtolerance for heroin wil be lower than it was whenyou began taking methadone or LAAM. So, if youdecide to use again, you need to be very careful. Takesome precautions—always be sure there are otherpeople with you when you’re using, in case you needmedical attention, and test the effect of the drug onyou before you take an entire dose.

The correct dosage of methadoneblocks the effects of heroin.

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� What happens if I start taking methadone againafter I have stopped?If you stop taking methadone even for a few days,you need to be careful when you start taking itagain. Your body may have lost some of its tolerancefor the methadone, so you could overdose. You needto restart at a lower dose and work back up to thelevel you were at when you stopped. The doctor atthe clinic can help you determine the right dosages.

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If you suspect that someone has overdosed onmethadone, lie the person on his or her side in therecovery position and call 911 immediately.

If medical professionals arrive quickly, they can treatthe individual with an antagonist, such as naloxone,that will help them come out of the overdose. It isimportant to tell the medical professionals whatdrug the overdose victim took so they know whichdrug 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 treatthe overdose are short-acting. If the antagonistwears off before the methadone level decreasesenough, the patient may go back into a state ofoverdose and require medical attention again.

In Case of Overdose

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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

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Doctors do not advise that people quickly taper offof their dose of methadone—but there are,unfortunately, many situations where this occurs.For example, a methadone patient may be in jail orin a hospital where methadone is not prescribed.Or the person may be complying with a demandfrom family court in order to be reunited with children who are in foster care. Public policy is slowlychanging, but some methadone patients are stillbeing forced to detox from their medication.

If you are being “administratively detoxed” by your methadone provider, you should find anotherprovider quickly. If your provider is not helping you find another, contact a harm-reduction program,needle exchange, or your state’s health departmentfor 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 toseven days) to relieve the initial discomfort of heroin withdrawal. This method may be successfulfor people who haven’t been dependent on heroinor other opioids for a long time.

Detoxification

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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 asupport 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 youwill resume daily use of heroin, and end up rightback where you started.

But remember, if you do start using drugs againafter your detox, you are not a “failure.” Each periodof time that you spent away from street drugs was aperiod of reduced risk—risk of arrest, exposure todisease, and overdose. These periods of success pro-vide a period of stability during which you can beginto focus on other aspects of life and consider yourlong-term plans.

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Methadone patients have two options: inpatientand outpatient treatment.

With inpatient treatment, thepatient is admitted for overnightcare to a clinic or hospital. Thepatient usually must spend sev-eral days and take medication torelieve the withdrawal symp-toms. In outpatient detox, med-ication also provides relief fromwithdrawal symptoms. The med-ication is administered duringdaily clinic visits over a period ofseveral weeks or longer. Often,methadone is used, in doses thatare gradually reduced.

Any “cross-tolerant” opiate—such as morphine, dilaudid,methadone, heroin, or LAAM—can suppress withdrawal.Methadone is preferred becauseit is long-acting, gentle, elimi-

Methadone & PainSevere pain has long been undertreatedin the United States. This is partlybecause of ignorance and prejudice, butalso because of the laws hat madedrugs like heroin illegal. The government has actively pursued and prosecuted physicians for prescribing opioids.

If you are on methadone maintenance,your regular maintenance dose ofmethadone will provide little or no painrelief. You will still feel pain, just likeeveryone else. In fact, you may needmore pain-relief medication than peo-ple who are not taking methadone.

Greater public awareness of how manypeople have needlessly sufferedbecause of this undertreatment of painis beginning to force changes. To man-age pain, doctors are beginning to morefreely prescribe opioids—includingmethadone, which has been recognizedas an effective pain medication.

Detox: How It Works

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nates craving, and does not produce a “high” when itis used properly.

Other medications, including drugs such asbuprenorphine and clonidine, which are not opiates,are also used—and may be used more widely in thefuture. The potential side effects—such as lowerblood pressure, loss of energy, and dry mouth—areconsidered before a drug is chosen.

The usual detox program for methadone requiresthat the patient use it as a tapering dose for 21 to 30days. During induction, the doctor determines theright dose to overcome withdrawal. Afterward, thedose you take gradually becomes smaller, until youno longer need the methadone. The medical andcounseling staff in your program can help you devel-op a plan for further treatment if you need it, andwill guide you through the physical changes youexperience during the detox period.

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Study after study has shown that people who aremaintained on a correct dose of methadone can doanything that people who are not using any medica-tion can do.

Researchers have conducted laboratory and fieldstudies since 1964. They have consistently foundthat methadone—when used in the treatment ofheroin addiction—had no adverse effects on a person’s ability to think and function normally.

Methadone patients still experience a greatdeal of discrimination by employers, however,especially when they seek to get or keep jobs thatinvolve driving.

Discrimination persists, despite the fact thatpeople maintained on methadone are no differentfrom 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

Driving

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methadone. If you feel groggy, tired, or unable tofocus, you should not drive. Be sure to consult yourclinician about whether you are receiving a correctamount of methadone.

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� Traveling in the United States

It can be very stressful for methadone patients to plan a trip. Rules vary from place to placethroughout the United 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 theentire time you’re away—or your provider/clinic willneed to arrange for you to be “guest medicated” at amethadone clinic located in the area where you willbe staying.

In either case, it is wise to make your arrangementsas early as possible before you leave.

Traveling withMethadone

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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 outabout 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://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 inyour area.

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� Traveling Abroad

Methadone is a prescribed medication, and most countriesallow visitors to bring whateverprescription medications theyneed with them. In some places,however, methadone may be con-sidered an exception to this policy.

In many countries, methadone isnot 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 todetermine the laws that apply to methadone attheir destinations. Ultimately, however, patients areresponsible for determining whether it is legaland/or safe to bring methadone with them whenthey travel.

� An excellent place to start is the INDRO website athttp://home.muenster.net/~indro/travreg.htm orat www.methadone.org.

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� You can also check with the consulate of the country that you are traveling to—although notall consulates will be well informed aboutmethadone.

Whichever country you travel to, you will need to decide whether you will carry your ownmethadone (where permitted) or find a methadoneprovider there who will treat you (if one is available).

Whichever option you choose, you will need to bringyour prescription for methadone, and, if you areguest-medicating, a letter from your home provider,explaining your prescription/dosage. Make thesearrangements as early as possible before your trip.

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

Knowing that their medication is legal, mostsimply 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 verycarefully. Many methadone patients have traveled to various parts of the world without experiencingany problems.

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