METHADONE
Brief History of Methadone Maintenance Treatment Methadone maintenance treatment was on the cusp of the social revolution in the sixties. Doctors and public health workers had concluded what objective observers and users alike had known for decades: that there was no treatment known which could cure more than a small fraction of long term opiate (heroin, morphine, etc) dependencies. In every case the result was the same: between 70 and 90 percent of these chronic opioid users would return to opiates within a short time. In light of such statistics a number of prestigious panels examined the problem and by 1963 had come to the same conclusion: it was time to re-examine nearly fifty years of prohibition and consider allowing doctors to prescribe persons with dependencies the opiates they needed.
Methadone Today doctors have the ability to prescribe methadone maintenance treatment to patients struggling with opioid dependencies. At BSMC patients are required to meet with the medical team for a brief History & Physical to diagnose their dependency, and create a personalized treatment plan. Methadone is a synthetic analgesic drug that is similar to morphine in its effects but longer acting. Methadone has been used for decades to treat people who have developed dependencies to heroin and narcotic pain medicines. When taken as prescribed, it is safe and effective. It allows people to recover from their dependencies and to reclaim active and meaningful lives. The purpose of Methadone is to decrease and eliminate craving and withdrawal symptoms, helping patients feel stable.
How does it work? Methadone works by changing how the brain and nervous system respond to pain. It lessens the painful symptoms of opiate withdrawal and blocks the euphoric effects of opiate drugs such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. At BSMC Methadone is offered in a pink liquid form, which should be taken once per day. Pain relief from a dose of methadone lasts about four to eight hours. SAMHSA's TIP 43: Medication-Assisted Treatment shows that methadone is effective in higher doses, particularly for heroin users, helping them stay in treatment programs longer. As with all medications used in medication-assisted treatment (MAT), methadone is to be prescribed as part of a comprehensive treatment plan that includes counseling and participation in social support programs. At BSMC patients are required to come in everyday between 6-11 AM to receive their dose. Treatment is most effective when patients have a steady and stable schedule, taking their medication on the same days and times.
Maintenance Maintenance therapy is long term. The recommended taper plan by the FDA is approximately two years in length. Although this is flexible and changes from one patients circumstances to the next, it is important to keep in mind that maintenance treatment is rewiring the brain of an opioid dependent person which takes time. By seeking treatment long term a patient is increasing their chances of being successful throughout their recovery. According to the National Institute on Drug Abuse publication Principles of Drug Addiction Treatment: A Research-Based Guide 2012, the length of methadone treatment should be a minimum of 12 months. Some patients may require treatment for years. Even if a patient feels that they are ready to stop methadone treatment, it must be stopped gradually to prevent withdrawal. Such a decision should be supervised by a doctor.
The aim of long term treatment is to substitute methadone, a legal opiate with a long half-life, for illicit drugs such as heroin, which is associated with a high risk of morbidity and mortality. This will aid individuals in reintegrating themselves as a functional member of society. Methadone has shown to reduce illicit heroin use, decrease the incidence of infectious disease (such as HIV and hepatitis) commonly contracted through needle sharing, reduce criminal activity, improve social outcome, and reduce mortality. After a period of stability (based on progress and proven, consistent compliance with the medication dosage), patients may be allowed to take methadone home between program visits. By law, methadone can only be dispensed through an opioid treatment program (OTP) certified by SAMHSA.
USE IN PREGNANCY Methadone is not Birth Control. Pregnancy can still happen when using Methadone even if client is not currently having regular periods. It is the responsibility of the patients to use birth control and inform BSMC if they are pregnant. Pregnant women who are dependent on opiates and their fetuses do better on a regimen of Methadone rather than being untreated. Methadone does cross the placenta and can cause fetal dependence, so the administration of methadone during pregnancy should be limited to patients with an established opiate dependence. Detoxification during pregnancy is not recommended because fetal distress has been documented during maternal withdrawal from opiates. The advantages of methadone maintenance treatment during pregnancy include longer gestational periods and higher birth weights than mothers who are heroin users and are not being treated, as well as a lower risk of fetal exposure to infectious diseases contracted through needle sharing. Dosage should be tailored to the individual during pregnancy to minimize the chance to relapse to heroin use and prevent withdrawal symptoms. Neonates born to women who are dependent on methadone are at risk of developing an opiate abstinence syndrome, but the syndrome tends to develop more slowly, is more moderate in severity, and lasts longer than in infants born to heroin-dependent women.
Pregnant or Breastfeeding Women and Methadone Women who are pregnant or breastfeeding can safely take methadone. When withdrawal from an abused drug happens to a pregnant woman, it causes the uterus to contract and may bring on miscarriage or premature birth. Methadone's ability to prevent withdrawal symptoms help pregnant women better manage their dependencies while avoiding health risks to both the mother and the baby. Undergoing methadone maintenance treatment while pregnant will not cause birth defects, but some babies may go through withdrawal after birth. This does not mean that the baby is addicted. Infant withdrawal usually begins a few days after birth but may begin two to four weeks after birth. Mothers taking methadone can still breastfeed. Research has shown that the benefits of breastfeeding outweigh the effect of the small amount of methadone that enters the breast milk. A woman who is thinking of stopping methadone treatment due to breastfeeding or pregnancy concerns should speak with her doctor first. Learn more from the SAMHSA publication Methadone Treatment for Pregnant Women 2009.
Methadone Safety Methadone can be addictive, so it must be used exactly as prescribed. This is particularly important for patients who are allowed to take methadone at home and aren t required to take medication under supervision at an OTP. Methadone medication is specifically tailored for the individual patient and is never to be shared with or given to others. Patients should share their complete health history with health providers to ensure the safe use of the medication. Other medications may interact with methadone and cause heart conditions. Even after the effects of methadone wear off, the medication s active ingredients remain in the body for much longer. Taking more methadone can cause unintentional overdose. Call 911 if too much methadone is taken or if an overdose is suspected. Never use more than the amount prescribed, and always take at the times prescribed. If a dose is missed, or if it feels like it s not working, do not take an extra dose of methadone. Do not consume alcohol while taking methadone. Be careful driving or operating machinery on methadone. Take steps to prevent children from accidentally taking methadone.
DRUG INTERACTIONS The interaction of other drugs with methadone may be classified as either pharmacodynamic (having effects on the mechanism of action) or pharmacokinetic (having effects on absorption, distribution, and elimination). 25 These interactions may vary in their magnitude and do not necessarily prohibit the concomitant administration of other drugs. Ensure that all medical team is aware of other prescriptions or medications you are taking while on methadone maintenance treatment programs. Physicians will need to overview these medications to ensure there will be no adverse side effects or interactions that could cause physical danger. Talk with your physician about taper plans if you have medications that may interact with each other and may cause problems for you.
Side Effects of Methadone Side effects should be taken seriously, as some of them may indicate an emergency. Patients should stop taking methadone and contact a doctor or emergency services right away if they: Experience difficulty breathing or shallow breathing Feel lightheaded or faint Experience hives or a rash; swelling of the face, lips, tongue, or throat Feel chest pain Experience a fast or pounding heartbeat Experience hallucinations or confusion
Legal Confrontation Methadone is a FDA approved program that has been available since the 1970s. Rapid expansion of methadone treatment was permitted by our Minister of Health at the Consensus Conference. At the conference every doctor in the country received the following points: Methadone is an effective medication for the treatment of heroin users. Methadone reduces heroin consumption and injection, reduces mortality related to heroin, reduces the risk of infection with HIV as well as hepatitis B and C, improves therapeutic compliance of HIV-positive persons, facilitates detection of illness and health education strategies and is associated with an improvement in socio- professional aptitude and a reduction in delinquency. Prolonged treatment with proper doses of methadone is medically safe. At present, methadone has not been shown to be toxic for any organ. There is no scientific reason to limit the overall number of persons admitted for methadone treatment. Availability of methadone treatment should be increased to respond to the need for such treatment, including by private practitioners. Psycho-social support is not compulsory and should be adapted to the individual needs of patients. BSMC is able to provide verification of patients treatment in the program with compliance standards. Patients may not be discriminated against by employers, parole officers, etc. for seeking treatment and complying with treatment regulations. Seeking treatment helps patients regain a fully functioning life, rebuild relationships, hold a full time job and participate in the community.
Counseling For optimal results, patients should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support. BSMC offers the following counseling options included in treatment fee: 1 on 1 counseling with the head counselor on Tuesdays by appointment 1 on 1 peer to peer support on Fridays between 6-11 AM W.R.A.P. Wellness Recovery Action Plan 1 on 1 Monday-Thursday between 6-11 AM Peer to Peer Support Group Thursdays 7 PM Family Support Group Thursdays 7 PM Treatment Education Group Tuesdays 7 PM Medication 101 Group meeting led by Medical team, first Thursday of each month, 7 PM Education & Life skills 1 on 1 Monday-Thursday 6-11 AM This includes classes such as: Budgeting Interviewing Resume Methadone 101 Buprenorphine 101 Treatment Education Vision Boards and Goal Setting
CONCLUSIONS Methadone is a long-acting opiate used in the treatment of opiate dependence and detoxification and for patients having chronic, severe pain. There is increasing evidence that long-term methadone use in patients who are dependent on opiates has substantial societal benefits, including: Diminishing illicit opiate use Reducing transmission of HIV and hepatitis Decreasing criminal activity Reducing healthcare costs in the population Stability for patient in relationships, work, family and other life activities. Reduction and elimination of opiate withdrawals for patient Aid in restoring physical and mental health
Patient Education To receive credit for online Patient Education, please take the following quiz regarding Methadone 101 by clicking on the link located next to this PowerPoint Presentation.
References SAMHSA NHTSA Methadone.org NCBI