MYTHS ABOUT METHADONE AND OTHER INTERESTING FACTS:

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1 II. MYTHS ABOUT METHADONE AND OTHER INTERESTING FACTS: How much do you know about methadone? Test yourself. How many could you have answered correctly? If you are thinking about possibly working as an Advocate for Advocates For Recovery Through Medicine and joining us, then you need to be able to answer of all these questions. Even if you are not, but you are a patient, you still need to know for yourself, therefore when you hear these myths you can dispute them. Knowledge is power!!! Then we all grow. 1. IS METHADONE MAINTENANCE TRADING ONE ADDICTION FOR ANOTHER? TRUE OR FALSE Methadone is prescribed as in maintenance therapy, acts as a normalizer rather than a narcotic. The patient is able to function in every physical, emotional, and intellectual capacity without impairment. It is orally effective and does not produce mood swings, tranquilization or narcotic effects. Methadone patients can obtain college educations, perform all types of intellectual and physical skills, marry and raise families. Methadone does not produce dependency as so other medications prescribed. For many addicts the alternative to methadone maintenance is: continued illicit use of heroin, criminal behavior, jail and premature deaths. 2. PREGNANT WOMEN SHOULD WITHDRAW OR AT LEAST LOWER THEIR DOSE OF METHADONE SO THAT THE BABY IS NOT BORN DEPENDENT. TRUE OR FALSE A pregnant woman who abuses opioid drugs may seriously damage both herself and her unborn child. While methadone itself does not eliminate all potential problems, participation in methadone maintenance treatment greatly reduces the risks of illness or even the death in mother or child. Methadone is the only approved medication for treating opioid addiction during pregnancy. When properly used as part of an methadone maintenance treatment program, there has been no reported evidence of harmful effects of methadone to the mother or unborn child. A respected group of experts, gathered by The Institute of Medicine in 1995, concluded that methadone maintenance, when combined with appropriate medical care can reduce the incidence of complications in the mother or fetus, the slowing of fetal growth during pregnancy, and illness or Page 1

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3 death in the newborn infant. Withdrawal from methadone treatment is rarely appropriate during pregnancy, as relapse to illicit drug use is likely to occur. Methadone maintenance is considered so vital for the health of pregnant opioid -addicted women that new Federal Regulations governing methadone maintenance treatment programs require that these women are given a preference for admission and that arrangements are made for proper medical care during pregnancy. Years of experience have shown there is no lasting harm to the child from exposure to methadone during pregnancy. 3. METHADONE GETS INTO THE BONE MARROW, ROTS THE TEETH, AND DEPLETES CALCIUM. TRUE OR FALSE That is absolutely false. Methadone has been used for the of treatment of opioid-dependency for more than thirty-five years and millions of patients. The effects of methadone on the health of those persons has probably been studied more thoroughly than for any other medication in all of medicine. Dr. Mary Jeanne Kreek, MD, one of the best known and leading researchers in the field of methadone maintenance has summed up the findings: "The most important medical consequence of ongoing methadone treatment, in fact, is the marked improvement in general health and nutritional status observed in patients as compared with the status at time of admission to treatment. Most medical complications observed in methadone maintenance patients are either related to ongoing preexisting chronic disease, especially chronic liver disease, the onset of which occurred prior to entry into methadone treatment, or to coexisting new diseases or illnesses or to ongoing polydrug or alcohol use. In short, people actually grow healthier in methadone maintenance treatment. Just how healthy depends on their condition before treatment and how they take care of themselves during treatment. Persons with certain medical conditions may feel body or bone aches and pains. Sometimes this is due to just getting older. However, such afflictions often go unnoticed during a stressful life of opioid addiction. Once the person starts generally feeling better in recovery, those aches and pains may be more noticeable, but they are not due to methadone. Many drug-dependent persons neglect dental care before, and even after, entering addiction treatment. Any damage to their teeth has nothing to do with methadone and can be corrected with proper dental treatment. [Source: Kreek, MJ Health consequences associated with the use of methadone, In: Cooper JR Altman F. Brown; BS, Czechowicz D (eds.) Research on the Treatment of Narcotic addiction: State of the Art (NIDA Research Monograp ). Rockville, MD: National Institute on Drug Abuse: 1983} Page 2

4 4. METHADONE SUPPRESSES THE IMMUNE SYSTEM SO THAT THE HIV +METHADONE OR AIDS PATIENT SHOULD BE ENCOURAGED TO WITHDRAW. TRUE OR FALSE Research in methadone maintenance treatment patients has demonstrated that methadone does not make HIV or AIDS worse, nor does methadone interfere with treatment for this viral infection. Laboratory experiments reported in 2002 from the University of Pennsylvania found that the HIV virus was able more easily to infect certain cells when methadone was added to the mix in a test tube. Also, when methadone was added to cells in which the HIV infection was inactive, the virus began to grow again. These cells, however, were not from methadone maintenance patients so nothing can be said here about HIV in such patients. Other research had found that steady doses of methadone actually inhibit viral activity. Of interest, the methadone doses used in Pennsylvania experiments were extremely low. Similarly, other experiments had shown that very low, inadequate doses of methadone can hinder the immune system, possibly allowing infections like HIV to become worse. Studies in human subjects-methadone maintenance patients-have shown that methadone is not harmful and, in fact, may boost recovery from HIV-infected former injection drug users (IDUs) not in methadone maintenance treatment and individuals still injecting illicit drugs. In the methadone-maintained patients, the progression of HIV disease was three times less than in the IDUs and less than the in opioid- free former IDUs not in methadone maintenance treatment. Importantly, over-time, ten persistent IDUs died of heroin overdoses and 2 drug-free former IDUs relapsed and died--there was no such deaths in methadone maintenance. 5. IF IT IS NECESSARY FOR A METHADONE PATIENT TO TAKE PAIN MEDICA-TION THEY DO NOT NEED STRONG NARCOTICS BECAUSE THE METHADONE WILL BLOCK THE PAIN. TRUE OR FALSE Methadone was originally invented as an opioid medication to treat pain. So it is sometimes believed that persons taking the drug daily as part of a methadone maintenance treatment program for addiction do not feel physical pain like everybody else. This is untrue--patients stabilized on methadone feel pain just like anybody else would. And, when it comes to treating pain, you will have the same needs as other people for adequate pain medication. For average pain that doesn't last very long--such as, a headache or muscle strain--over-thecounter painkillers (analgesic) should do the job. If pain is more severe and/or long-lasting, opioid painkillers with actions similar to morphine may be prescribed. Page 3

5 Be aware that certain painkillers---such as, Buprenex, Nubain, Stadol, Talacen, Talwin - -block the effects of methadone and could bring on uncomfortable withdrawal symptoms. Also, Darvon and Demerol are not recommended because harmfully high doses may be needed for effective pain relief in a methadone-maintain person. You should definitely inform the healthcare professionals treating your pain that you are on methadone maintenance. If they are unsure of how best to treat your pain, or seem reluctant to prescribe stronger medication refer them to the medical staff at your methadone clinic. Never take unprescribed medications or street drugs (including alcohol) along with pain medication or you could seriously harm yourself. {Spring 1998 edition of Addiction Treatment Forum} 6. METHADONE CAUSES PATIENTS TO BECOME ALCOHOLICS AND/OR COCAINE ABUSERS. TRUE OR FALSE The idea in this myth is that there is a special tendency for methadone patients to turn to alcohol because they are on methadone. The DARP studies indicate that the amounts of alcohol consumed by methadone maintenance patients and the therapeutic community and out-patient drug -free clients at the beginning of treatment were almost identical. At earlier follow-ups after treatment, the amounts of alcohol reported consumed has increased considerably. These increases were almost identical for each of the three treatment modalities. Therefore, it can be concluded that methadone treatment has no special relationship to people's propensity to increase their alcohol intake. At twelve-year follow-up, it was concluded that the increases in alcohol consumption reported above had leveled off within a few years of completion of treatment. It has been found in the DARP follow-ups, including the twelve-year follow-up, that as time passes a larger and larger percentage of the original subject group remained free of illicit drug use. Therefore, it appears that there is no progressive tendency to substitute alcohol for heroin. Some, but only some, patients may so substitute, or at any rate increase alcohol consumption. 7. METHADONE IS MORE ADDICTING THAN HEROIN. TRUE OR FALSE This is a persistent myth that was long ago disproved. A blind comparison study years ago at a federal facility for addiction treatment in Lexington, Kentucky, found that withdrawal symptoms actually were less severe in patients maintained on methadone than in those taking equivalent doses of short-acting opioids like heroin. Because methadone is very long-acting, withdrawal from methadone does last much longer than withdrawal from short-acting opioids. Therefore, a person who has experienced "cold turkey" withdrawal separately from heroin and methadone might say that "kicking" methadone was worse-because it lasted longer. Page 4

6 However, gradual withdrawal from methadone, when properly done under medical supervision, can be virtually free of discomfort. On the other hand, patients who try to withdraw from methadone by themselves, on their own time and dose schedule, almost always experience undue discomfort and fail. Also, some patients forget that the reason they came into methadone maintenance treatment was because they could not stay away from opioid drugs on their own. When they decide to leave methadone maintenance treatment and find they cannot just stop taking methadone, they blame the methadone rather than the heroin or other opioids that deranged their brain chemistry in the first place. For many former opioid -addicted persons, methadone is a lifelong medication necessary for stabilizing brain functions, much like a person with diabetes needs insulin every day to live a normal life. Methadone Treatment For Opioid Dependence; Chapter 5 pages: Eric Strain, MD and Maxine Stitzer Ph.D. 8. METHADONE PATIENTS SHOULD NOT BE ALLOWED TO OPERATE HEAVY MACHINERY OR TO DRIVE A CAR? TRUE OR FALSE The public has been greatly concerned about persons using alcohol or any drugs that might impair mental functioning while driving motor vehicles. However, it is clear that methadone itself does not in any way hinder persons stabilized on imethadone maintenance treatment from driving safely. Various research studies involving methadone patients in methadone maintenance treatment have examined important skills required for safe driving, such as the ability to pay close attention, reaction time, eye-hand coordination, and accurate responses in emergency situations. In some cases, driving simulators were used to test skills. In all studies, persons maintained on adequate methadone doses had normal functioning. In some cases, their reaction times were better than comparison to group members not taking methadone. To examine "real world" driving performance, some researchers looked at reported traffic violations and accidents among methadone-maintained patients compared with others having no history of drug addiction. Methadone maintenance treatment patients did not differ in any way from other drivers of the same age. Therefore, the research consistently shows that methadone itself is not a concern when it comes to driving motor vehicles. However, it should be noted, that the patients tested were well-established in methadone maintenance treatment and receiving adequate methadone doses. Patients going through opioid withdrawal due to insufficient methadone doses, or experiencing methadone overmedication effects, such as sleepiness or fatigue, might not perform as well. Page 5

7 For the discussion and listing of the research, see "The Functional Potential of The Methadone Maintained Person" Norman B. Gordon, in a compendium for methadone maintenance treatment by The Chemical Dependency Research Working Group of New York State OASAS (Monograph 2, 1994). This is available online at: 9. METHADONE WAS NAMED FOR ADOLPH HITLER. TRUE OR FALSE Dolophine is the name under which Eli Lilly Company markets methadone. When methadone was first used for maintenance treatment of heroin addiction, Dolophine was the common brand name of methadone. It was dispensed as a wafer. Certain problems became apparent in the use of wafers. It is quite difficult to dispense small increases or decreases in milligrams of methadone. For this and other reasons, when methadone became available in a stable liquid suspension (Methadose), most clinics dropped Dolophine and went to it. Dolophine is practically history now. Some younger methadone patients and staff may have never heard of it, much less the myth about its having been named for Adolph Hitler. The connection, by the way, is that the "Dolph" of Dolophine is supposed to be the "dolf" of Adolf. A minor myth about methadone is that Methadose is not real methadone. All methadone is the same chemical. Methadose is just a brand name. The Germans invested in methadone during the second world war when their supplies of opium were cut off. During the war the Germans needed more painkillers than usual, so they got to work synthesizing opioids. Meperidine, its brand time is Demerol, was another analgesic they invented, along with several hundred others that didn't become famous. You will notice that there are no myths about Demerol having been named for Nazis.The reason methadone "unlucked-out" has to do with the fact that methadone did emerge as a maintenance treatment for heroin addicts. In short, the myth is that since Adolp was a bad person who wanted to control to people and was against freedom of choice, "They " gave his name to a bad drug used to control people. The myth is colorful and just happens to tie in the prejudice against methadone, but what is the truth about Dolophine? In Latin, dolor means pain, suffering. In English (look it up in an unabridged dictionary) the dol means "a unit in pain measurement" and there are such words as dolorimetry. The dol in Dolophine was from dol, dolor (Goldstein, 1992). The Germans also invented heroin, which English word came from the German trademark, Heroisch, from their word meaning heroic. The German pharmaceutical company that manufactured heroin was named " Bayer" of aspirin fame. Page 6

8 Heroin's chemical name is diacetylmorphine, sometimes shortened to diamorphine. After morphine and heroin, and before methadone and meperidine (Demerol), the Germans also invested the all-time painkiller, which we still know by the German trademark name, Aspirin. 10. THE METHADONE PATIENT IS ADDICTED TO THEIR MEDICATION. TRUE OR FALSE The methadone patient is DEPENDENT on their medication, not "ADDICTED"! The term "addiction" is currently used as a psychological term referring to the loss of control over drug use or other behaviors such as eating or gambling. By these criteria as laid out in The Diagnostic and Statistical Manual of Mental Disorders IV, the methadone patient is not addicted to his/her medication. In fact, the experts in this field have taken to comparing an individual on methadone maintenance therapy to a diabetic who is dependent on their daily dose of insulin. We would never label a diabetic an "insulin addict"! Even the Drug Czar, General McCafferey uses this comparison.. In terms of physical dependence, double blind studies done at Lexington have demonstrated that when comparing the withdrawal symptoms of patients maintained on equivalent doses of methadone and short-acting opioids like heroin, those of the former group were less severe than those of the latter group. Withdrawal from methadone does last significantly longer than that from short-acting opioids, however, and this clearly contributes to the patient who withdraws "cold" perceiving methadone as the more uncomfortable. Most patients coming into methadone maintenance treatment today have relatively heavy habits due to the high quality and low cost of street opioids in the United States since the early nineties. After having been built up to a blockading dose of methadone, if they are subjected to sudden withdrawal (ie. in jail) they would not likely experience the withdrawal syndrome any more intensely than they had on the street. Also, gradual withdrawal from methadone, when properly done, is virtually free of discomfort... Sources: J. Woods, M. Beresky NAMA Isbell, H. and Vogel, V.H..: The addiction liability of methadone (Amidon, Dolophine, "10820") and its use in the treatment of the morphine abstinence syndrome. American Journal Of Psychiatry, 105:12 (June) Editor: Deborah Shrira Updated: April 2009 Page 7