By Melanie Haiken|
CONSUMER HEALTH INTERACTIVEBelow:
• What are the pros of methadone treatment?
• What are the cons of methadone treatment?
• What other treatments are available?
Heroin use is on the rise, which means there will also be an increasing number of addicts needing treatment. From 1995 to 2005, the number of admissions to treatment programs for heroin abuse increased from 227,989 to 254,345, according to the White House Office of National Drug Control Policy.
One thing hasn't changed over the decades: When a heroin addict gets professional help, there's an excellent chance treatment will include methadone, a synthetic opiate that blocks the effects of heroin. Thousands of recovering addicts get a prescription for methadone each year. Patients typically take the drug for at least a year, although some continue treatment for several years.
Methadone use may be as controversial as it is widespread. Critics charge that treating recovering addicts with methadone is simply substituting one addictive drug for another. On the other hand, many patients say they never could have kicked their heroin habit without help from methadone.
What are the pros of methadone treatment?
|•Methadone has been used for 30 years and is legally dispensed from regulated clinics. It's a well-known and regulated treatment.|
|•At the correct dosage, methadone relieves cravings for heroin.|
|•You only need to take one dose a day.|
|•As long as you're receiving the correct dosage, you won't get high. |
|•Methadone is sometimes covered by insurance. As a result, many users no longer have to take drastic measures to pay for their treatment. |
|•If you do relapse and take heroin while on methadone, the heroin won't have much, if any, effect. This will reduce the temptation to relapse again.|
|•Methadone treatment can be flexible. Some patients stay on a maintenance dose of methadone for several years, while others may be able to taper off after 12 months. |
|•Methadone treatment can be a successful route to becoming drug-free, and dramatically improves a user's quality of life right away.|
What are the cons of methadone treatment?
|•Methadone is deadly at high doses. According to the National Center for Health Statistics, 3,700 Americans died of unintentional methadone poisoning in 2005. The total number of fatal methadone overdoses --including suicides and accidental overdoses -- jumped 66 percent between 1999 and 2005. (The government's report did not distinguish between people using methadone as treatment for heroin addiction and those who were using the drug for pain control or as an illicit drug.) |
|•Methadone has side effects. Among the most common are sweating, constipation, loss of sex drive, skin rash, and water retention. Less common, but still important, side effects include vomiting and mood problems. Although methadone generally does not interfere with the ability to drive, it does make some people feel sleepy.|
|•Being on methadone is restrictive. Because you must obtain your daily dose from a licensed dispensing facility, you are effectively 'chained' to your clinic. It can be difficult to travel, and often you must obtain permission to be away even for just a day or two. Clients in rural areas may have to drive a long distance to a methadone clinic, which can interfere with work and other activities. However, after a few months of daily supervised treatments, some providers may allow patients to take home methadone doses.|
What other treatments are available?
In 2002, the FDA approved buprenorphine (brand name Subutex), a drug for treating opioid addiction. Buprenorphine can be prescribed in a doctor's office, eliminating the need to be registered at a methadone clinic.
At low doses, the drug helps addicts to stop using opioids without experiencing withdrawal symptoms. Because it has the potential for abuse, it's usually used in combination with naloxone, a drug that causes a systemic reaction to opioids. Suboxone is the brand name of the drug that combines buprenorphine with naloxone. Subutex is given during the first few days of treatment, while Suboxone is used during the maintenance phase of treatment.
Some reports have given the impression that Suboxone works as well or even better than methadone, but others believe this is not the case. Patients who seem to benefit the most from the buprenorphine/naloxone combination are those with shorter histories of addiction. According to the National Alliance of Methadone Advocates (NAMA), many methadone patients have attempted to switch to Suboxone from methadone because they want to leave the clinic system, only to find that it doesn't work for them. NAMA recommends that if you start therapy with buprenorphine/naloxone and continue to experience drug cravings, then you are probably a candidate for methadone treatment instead.
Most heroin treatment programs involve the use of medications, but patients who would like to try the 'cold turkey' approach can look into a residential or outpatient detoxification program. Detoxification helps to reduce the severity of withdrawal symptoms while patients adjust to being in a drug-free state. Although this isn't a stand-alone treatment for heroin addiction, it is a helpful first step that can lead to a longer-term, drug-free residential or outpatient program, or a program that uses medications as part of the treatment. According to the National Institute on Drug Abuse, the best documented drug-free treatments for heroin are therapeutic residential programs that last three to six months.
-- Melanie Haiken, MA, is A former health editor of Parenting magazine and specializes in health, business, and parenting issues. She has served as managing editor of San Francisco magazine and has written for Time Inc. Health, The Washington Post, and many other publications.
National Institute on Drug Abuse http://www.drugabuse.gov/NIDAHome.html
National Association of Methadone Advocates (NAMA) http://www.methadone.org/
White House Office of Drug Policy Fact Sheets http://www.whitehousedrugpolicy.gov/drugfact/index.html
Office of National Drug Abuse Policy, Drug facts: heroin. http://www.whitehousedrugpolicy.gov/drugfact/heroin/index.html
National Institute on Drug Abuse (NIDA). National Institutes of Health (NIH). Research report series – heroin abuse and addiction. http://www.nida.nih.gov/ResearchReports/Heroin/heroin2.html#what
Office of National Drug Control Policy. Methadone fact sheet. http://www.whitehousedrugpolicy.gov/publications/factsht/methadone/index.html
Centers for Disease Control and Prevention (CDC). Methadone maintenance treatment. February 2002. http://www.cdc.gov/IDU/facts/MethadoneFin.pdf
NIDA. NIDA media advisory: Panel urges broadened access, insurance coverage for methadone treatment nationwide. December 8, 1998.
CDC. National Center for Health Statistics. Increases in poisoning and methadone-related deaths: United States, 1999-2005. http://www.cdc.gov/nchs/products/pubs/pubd/hestats/poisoning/poisoning.htm
American Cancer Society. Methadone. http://www.relayforlife.com/docroot/CDG/content/CDG_methadone.asp
Substance Abuse and Mental Health Services (SAMHSA). Center for Substance Abuse Treatment. Introduction to methadone. http://csat.samhsa.gov/publications/brochure.aspx
SAMHSA. About buprenorphine therapy. http://buprenorphine.samhsa.gov/about.html
United States Food and Drug Administration (FDA). Center for Drug Evaluation and Research. Subutex and Suboxone questions and answers. http://www.fda.gov/CDER/drug/infopage/subutex_suboxone/subutex-qa.htm
United States Food and Drug Administration. Patient information leaflet: Suboxone, Subutex. http://www.fda.gov/cder/foi/label/2002/20732lppi.pdf
National Alliance of Methadone Advocates. Basic information for patients about buprenorphine. http://www.methadone.org/library/buprenorphine_patient_info.html
Mayo Clinic. Drug addiction treatment. http://www.mayoclinic.com/health/drug-addiction/DS00183/DSECTION=8
Reviewed by Michael Potter, MD, an attending physician and associate clinical professor at the University of California, San Francisco, who is board-certified in family practice.
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