Methadone Addiction

Methadone Addiction

Methadone Addiction

Methadone AddictionIn December 2011, two reporters from the Seattle Times noticed a sharp increase in deaths in their home state due to accidental poisoning by prescription drugs. There was nothing extraordinary in that finding — more Americans were dying in every state from similar overdoses. In fact, the number of these kind of fatalities was already more than the number of deaths by illicit drugs or car accidents.
Reporters Michael Berens and Ken Armstrong, however, looked up the addresses of all 3,260 Washingtonians who died of prescription painkiller overdoses between 2003 and 2011. They found that 64% were living in poverty areas and had died from taking methadone. Apparently, officials in Washington needed to cut costs in the state’s healthcare program for the poor, and directed doctors to prescribe the cheaper drug -methadone- over more expensive painkillers like OxyContin, saving the state $45 million a year. The reporters went on to win the Pulitzer Prize in journalism, and Washington state officials revamped their rules for Medicaid.

What happened in Washington is part of a national trend in the increased use of methadone. About 15 years ago, doctors changed the way they prescribed painkillers. Narcotic drugs that had once been used only for terminally ill patients and cancer victims because of their potential for addiction were now routinely prescribed for all kinds of pain. Between 1998 and 2006 the number of prescriptions written for methadone increased by 700%, even though it is a dangerous and unpredictable drug. Today methadone causes more deaths than OxyContin and Vicodin, and twice as many as heroin.

Just as troubling is the fact that methadone abuse is increasing because it is more widely prescribed and therefore more available. Another reason for the increase is that people addicted to OxyContin are turning to methadone and other narcotics because their drug of choice recently became tamper-proof. What happened in Washington is now true of the nation.

What Is Methadone?

The Germans invented methadone, a synthetic opiate painkiller, in the late 1930s, but Eli Lilly Company developed and manufactured it in the 1960s. Today the cheap and long-lasting drug is made by Lilly, Mallinckrodt Pharmaceuticals, Cebert Pharmaceuticals and Roxane Laboratories. Its chemical name is 6-dimethylamino-4,4-diphenyl-3-heptan-one.

Methadone comes as tablets, dissolvable tablets, liquids, injectables, or in a concentrated form that must be diluted with liquids. Mallinckrodt makes Methadose, small round pills that say Methadose and either 5 or 10 on one side to indicate the dosage amount, and the other side is scored. The 40mg pills are orange, rounded pills divided into four parts. Methadose Oral is a sweet green syrup that comes in a bottle with a white label. Roxanne Labs makes methadone as white pills available in strengths of 5mg or 10mg. Dolophine is made by Eli Lilly as white pills that say “Lilly J72.” The 40mg Dolophines are pink square pills that say “Lilly USA.” Diskets are dissolvable tablets made by Cebert Pharmaceuticals.

The United States government classifies methadone as a Schedule II Controlled Substance, which means it has medical uses but a high potential for addiction, carrying with it the most severe penalties for illegal trafficking.

What Are The Medical Uses Of Methadone?

Over 250,000 former heroin addicts take methadone once a day through government clinics. Methadone alleviates their withdrawal symptoms without providing the euphoric effect that addicts typically seek. Since the drug does not cause drowsiness, it does not affect mental capability and allows them to hold down jobs and drive automobiles. Analysts believe the government gets back $4 for every one dollar spent on methadone, because of a reduction in crime and infections like HIV/AIDS and hepatis transmitted through needle sharing. Russia has been criticized by international committees because both intravenous drug use and AIDS is rapidly increasing in that country and yet its government refuses to allow methadone replacement therapy. Officials there believe it is just substituting one addiction for another. Some American former addicts may agree. Some have been on methadone replacement therapy for more than 30 years, which is why they call it “liquid handcuffs.”

Up until the late 1990s, methadone was rarely prescribed as a painkiller because it has a long half-life in the body, is addictive, and is very difficult to prescribe. It was only used in hospitals for postoperative pain or for terminally ill patients.Today it is being routinely prescribed for moderate to severe round-the-clock pain that lasts for extended periods of time. It is not prescribed for acute pain or on an “as needed” basis.

Dangers Of Methadone

Each individual metabolizes and responds to methadone differently. Doctors are supposed to start with a very small dosage and gradually work upwards, depending on the patient’s tolerance. It has a narrow therapeutic index, which means just a little too much can be deadly. It can cause life-threatening breathing problems up to eight hours after taking it, and should never be prescribed to people with asthma, chronic obstructive pulmonary disease, and other breathing problems.

Patients who have never taken narcotics before can be deathly allergic to methadone, and develop dizziness, hives, swelling of their faces, tongues and throat, and then have trouble breathing, collapse and die.

Two of the greatest dangers of this drug is that it slows down respiration for longer than it relieves pain and then builds up in the body. Most narcotic painkillers leave the body within hours. Methadone lingers for 60 to 128 hours and accumulates in fatty tissues, even though it provides pain relief for only four to five hours. What happens is people take a second pill for pain relief or to get another “buzz” and then die from overdoses. This has been described as a silent death in that breathing simply stops.

Unlike most narcotic painkillers, methadone, reacts with benzodiapezines, drugs used to relieve anxiety. Many people in pain take such drugs, and addicts like to mix methadone with Xanax to get a better “buzz.” This combination produces many accidental deaths and “cross-addictions.”

If taken over a long period of time, methadone can cause serious heart problems.

Some who are addicted to methadone die of pneumonia. Because their drug suppresses coughing and pain, they do not realize how sick they are until it is too late.

What Are The Side Effects Of Methadone?

One of the main symptoms of methadone is sweaty and itchy skin, sometimes even rashes. People develop back and stomach pain from constipation due to this drug. These are the most common side effects, but others can be anxiety, nervousness, restlessness, insomnia, drowsiness, dry mouth, vomiting, water retention, loss of appetite, and impotence. Other side effects can be headache, weight gain, vision problems, mood changes, swelling of extremities, missed menstrual periods, and difficulty in urination.

Long-term use of methadone or its abuse leads to addiction and heart problems.

What Drugs Interact With Methadone?

Methadone interacts with alcohol, other narcotics, antidepressants, antihistamines, diuretics, heart medications, anti-seizure medicines, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase (MAO) inhibitors, sleeping pills, steroids, antifungals, buprenorphine, naloxone, calcium channel blockers, HIV medications, medicines for anxiety and mental illness, benzodiapezines, sedatives, tranquilizers,and any drug that slows down the central nervous system.

Methadone Overdoses

Methadone accounts for only 2% of narcotic painkiller prescriptions but 30% of deaths by painkillers. In 1999, 800 people died this way, but by 2007, the number of methadone deaths rose to 5500, dropping to to 4700 in 2009, the latest year for statistics. Government analysts believe the number is leveling off but not reversing. Typical victims have combined methadone with alcohol or Xanax, or else they have taken too much either for pain relief or because they are abusing it.

Symptoms of a methadone overdose are extreme drowsiness, pinpoint pupils, confusion, cold and clammy skin, bluish lips and skin, irregular heartbeat, weak pulse, low blood pressure, fainting, and shallow breathing. The person can develop a death rattle, go into cardiac arrest, and stop breathing.

If the person gets to an emergency medical facility in time, doctors will administer an opioid antagonist such as naloxone, and perhaps oxygen, vasopressors, and intravenous fluids. They usually monitor the patient for 36 to 48 hours.

Why Do People Use Methadone?

Methadone abuse is increasing, partly as a replacement for OxyContin and partly because it is more widely available. Nevertheless, the increase in abuse puzzles some experts because this drug does not provide a strong “rush” and its effect is like a sedative. Methadone can also take hours to kick in, and then provides relaxation, freedom from pain, and suppresses withdrawal symptoms from heroin or other narcotics. Some addicts grind the pills into powders to inject the drug. Methadone is cheaper than heroin, and some suburban youth come into cities to buy it from methadone addicts.

Street names for methadone are doll, Dolly, red rocks, tootsie rolls, paper and script.

Signs You Are Addicted To Methadone

If you can answer yes to one or more of these questions, it may be time to consult a medical professional about your methadone abuse.

  • Do you have withdrawal symptoms whenever you stop using methadone?
  • Are you unable to get through one or two days without using methadone?
  • Do you exaggerate pain symptoms or go from one doctor to another to obtain prescriptions for methadone?
  • Are you buying methadone from a street dealer?
  • Do you feel guilty, ashamed or depressed about your drug use?
  • Do you know that methadone is causing physical problems such as constipation, and yet you continue to use it?
  • Do your friends and/or family members criticize you because you use methadone?
  • Do you find yourself increasing the amounts of methadone you are using?
  • Are you using methadone in combination with alcohol and other drugs, whether legal or illegal?
  • Do you worry that you will get in trouble with the law because of your methadone abuse?
  • Is your methadone abuse interfering with your performance at work or school?

Withdrawal Syndrome For Methadone

Methadone is considered one of the most difficult drugs in terms of withdrawal, and addicts say it is difficult or worse than giving up heroin. Methadone takes longer to pass through the body than most narcotics, so withdrawal can last longer.

When people in pain become physically dependent on methadone, doctors usually reduce their dosage on a very gradual basis. Physical dependency, however, is not the same as addiction. Addicts are also psychologically dependent on theor drug, and this complicates their withdrawal. They usually have taken the drug for longer periods of time and in greater amounts, and this in turn produces more exaggerated withdrawal symptoms. Some people in withdrawal from methadone addictions have had strokes or stopped breathing; others have developed auditory and visual hallucinations, delusions, and suicidal ideation, which is why chemical detoxication from methadone should be done under medical supervision. Doctors can also provide drugs to relieve anxiety and other symptoms during acute withdrawal.

A person detoxing from methadone develops flu symptoms, such as a high fever along with chills and feelings of being cold. He or she may have a sore throat, runny nose, sneezing, restlessness, agitation, tearing eyes, diarrhea, insomnia, nausea, vomiting, itching, tremors, aches and pains, and increased sensitivity to pain. Once these end, psychological problems such as drug cravings, depression, suicidal ideation, insomnia, hallucinations, anxiety, and paranoia can last for weeks. As one expert put it, “Residential treatment is usually the ideal situation, because agitated and frightened patients can be monitored around the clock.”

Methadone Addiction Treatment

The founder of Alcoholics Anonymous once said that the solution to alcoholism or drug addiction is not stopping drinking or using drugs, but acquiring the power never to start using them again. Addiction is a complex problem that a requires long-range solution.

Methadone addiction is treatable through a holistic approach that employs counseling, relaxation techniques, being in touch with your emotions, examining and changing relationships, setting new goals for yourself, getting into top shape physically, and finding long-term support to prevent future substance abuse. The highest success rates for methadone addiction treatment are among those who enroll in residential treatment centers and remain there at least a month. This is the most expensive alternative, but it can prove cheaper in the long run because you are more likely to succeed this way and save yourself years of continued pain.

When you enter a residential treatment center for methadone addiction, the first step is chemical withdrawal. Medical professionals will help you get through it, and when the inevitable depression occurs later, psychologists can help you with deal with it. You will be living away from your old drug environment, where certain people, places and situations would normally trigger drug abuse, and you will be with others who are facing similar problems. Your group may attend classes and learn about the biochemical basis of methadone abuse. You will have individual and group counseling sessions, sometimes with your family or other loved one. Your counselor may help you set new career or educational goals. You will learn relaxation techniques such as yoga and meditation that will help you handle stress and anxiety and remain drug-free once you go home. If you have any undiagnosed psychiatric problems such as chronic depression or anxiety disorders, the medical professionals at your treatment center can address them as issues separate from your addiction to methadone. Once you return home, you usually will remain in individual counseling and attend support meetings in your community.

Sources:

The National Center for Health Statistics, the U.S. Centers for Disease Control, see http://www.cdc.gov/nchs/

“Overdose Deaths Involving Prescription Opioids Among Medicaid Enrollees — Washington, 2004–2007,” The U.S. Center for Disease Control, Morbidity and Mortality Weekly Report, see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5842a1.htm and a

Berens, Michael and Ken Armstrong. “State pushes prescription painkiller methadone, saving millions but costing lives,” The Seattle Times, December 10, 2011.

Eckholm, Erik and Olga Pierce. “Methadone Rises As A Painkiller with Big Risks,” The New York Times, August 18, 2008.

Ibid.

Emery, Gene. “OxyContin abuse down with time-release formula,” Reuters, July 11, 2012.

Emmett, David and Graeme Nice.  Understanding Street Drugs.  London: Jessica Kingsley Publishers, 2006, page 160.

“Methadone,” PubMed Health. A service of the National Library of Medicine, National Institutes of Health, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000591/

“Methadone Fact Sheet,” Office of White House Drug Policy,  see www.whitehousedrugpolicy.gov/publications/factsht/methadone/

Ibid.

McDonald, Victoria.”Russia Condemned for its futile fight against AIDS,” Channel 4 News, July 19, 2012, see http://www.channel4.com/news/russia-condemned-for-its-futile-fight-against-aids.  See also Schwirtz, Michael. “Russia Scorns Methadone for Heroin Addiction,” New York Times, July 22, 2008.

Meier, Barry. “Tightening the Lid on Pain Prescriptions,” New York Times, April 8, 2012.

“Dolophine,” RxList, the Internet Drug List, see articles for professionals and consumers at www.rxlist.com/cgi/generic/methadone.htm

“Methadone,” The National Institute of Health, Medline Plus, posted at www.nlm.nik.gov/medlineplus/druginfo/medmaster/a682134.html

“Methadone” at Drugs.com, Drug Information for Health Professionals, June 2008, see www.drugs.com/methadone.html

“Dolophine,” RxList, the Internet Drug List, see articles for professionals and consumers at www.rxlist.com/cgi/generic/methadone.htm

Berens, Michael and Ken Armstrong. “State pushes prescription painkiller methadone, saving millions but costing lives,” The Seattle Times, December 10, 2011.

Emmett, David and Graeme Nice.  Understanding Street Drugs.  London: Jessica Kingsley Publishers, 2006, page 164.

Berens, Michael and Ken Armstrong. “State pushes prescription painkiller methadone, saving millions but costing lives,” The Seattle Times, December 10, 2011.

Kilgannon, Corey. “Casting Methadone as An Ingredient for Cross Addiction,” The New York Times, October 6, 2005.

“Methadone” at Drugs.com, Drug Information for Health Professionals, June 2008, see www.drugs.com/methadone.html

Emmett, David and Graeme Nice.  Understanding Street Drugs.  London: Jessica Kingsley Publishers, 2006.

“Dolophine,” RxList, the Internet Drug List, see articles for professionals and consumers at www.rxlist.com/cgi/generic/methadone.htm

“Methadone,” PubMed Health. A service of the National Library of Medicine, National Institutes of Health, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000591/

“Dolophine,” RxList, the Internet Drug List, see articles for professionals and consumers at www.rxlist.com/cgi/generic/methadone.htm. See also “Methadone,” PubMed Health. A service of the National Library of Medicine, National Institutes of Health, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000591/

Stobbe, Mike. “Methadone deaths still high but may have peaked,” Foster’s Daily Democrat, July 9, 2012.

Belluck, Pam. “Methadone Grows as a Killer Drug,” The New York Times, February 9, 2003.

“Methadone” at Drugs.com, Drug Information for Health Professionals, June 2008, see www.drugs.com/methadone.html; see also  “Dolophine,” RxList, the Internet Drug List, see articles for professionals and consumers at www.rxlist.com/cgi/generic/methadone.htm

Ibid.

Belluck, Pam. “Methadone Grows as a Killer Drug,” The New York Times, February 9, 2003

Emmett, David and Graeme Nice.  Understanding Street Drugs.  London: Jessica Kingsley Publishers, 2006, page 159.

Belluck, Pam. “Methadone Grows as a Killer Drug,” The New York Times, February 9, 2003

Ibid.

Emmett, David and Graeme Nice.  Understanding Street Drugs.  London: Jessica Kingsley Publishers, 2006, page 155.

Ibid, pg. 164-165.

Drug Abuse Treatment Outcome Studies (DATOS) see http://www.datos.org

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