sign in sign up
<<
Home , Methadone, Methadone clinic, Methadone maintenance

About and

Revised Second Edition

www.drugpolicy.org We are the Policy Alliance and we envision a just society in which the use and regulation of are grounded in science, compassion, health and human rights, in which people are no longer punished for what they put into their own bodies but only for crimes committed against others, and in which the fears, prejudices and punitive prohibitions of today are no more.

Please join us.

About Methadone and Buprenorphine About Methadone and Buprenorphine

Revised Second Edition

Copyright ©2006 Alliance. All rights reserved. “Drug Policy Alliance” and the “A Drug Policy Alliance Release” logo are registered trademarks of the Drug Policy Alliance.

Printed in the of America

ISBN: 1-930517-27-0

No dedicated funds were or will be received from any individual, foundation or corporation in the writing or publishing of this booklet. Table of Contents

3 Acknowledgments 4 Introduction 6 Dependency 8 What is Methadone? 10 Buprenorphine 11 Maintenance 13 After Methadone 14 Myths & Facts 16 Drug Interactions 18 Your Other Doctors 19 Methadone & Women 21 Storing Methadone 22 Concerns about Overdose 25 In Case of Overdose 26 Detoxification 28 Methadone & Pain 29 Driving 30 Traveling with Methadone 32 State Agencies 33 Other Resources

2 About Methadone and Buprenorphine Acknowledgments

This is the third printing of this Many thanks to my collaborators, booklet. The first 300,000 copies Corinne Carey, JD, Travis Jordan, were distributed, across the U.S. Michael McAllister, Sharon Stancliff, and internationally, primarily by MD, Ellen Tuchman, PhD, and Peter advocates. We are deeply grateful Vanderkloot for their invaluable to all who helped get the booklet contributions to the research and out to patients, families, treatment writing of this booklet. providers and program staff, policymakers and other interested Thanks also to Matthew Briggs, members of the community. About Paul Cherashore, Amanda Davila, Methadone and Buprenorphine has Chris Ford, MD, Ethan Nadelmann, also been translated into Italian, JD, PhD, Robert Newman, MD, Russian and Spanish. J.Thomas Payte, MD, Shayna Samuels, and Isaac Skelton for their This second edition has been suggestions for improvements. revised to include information about buprenorphine, an important treat- And special thanks to all the metha- ment option that has emerged as an done patients, advocates, and their additional treatment loved ones that I have met and to methadone. Future editions of worked with. You are the inspiration About Methadone and Buprenorphine for this. will provide readers with more comprehensive information about Holly Catania, JD opioid addiction treatment using Baron Edmond de Rothschild buprenorphine. Chemical Dependency Institute

www.drugpolicy.org 3 Introduction

You may be reading this book • People dependent on street because you are taking methadone who receive methadone treatment are or because you are thinking about healthier and safer than those who do taking methadone – or because you not. They live longer, spend less time care about somebody who is. in jail and in the hospital, are less often infected with HIV, and commit People usually enter methadone fewer crimes. treatment because they feel over- whelmed by their dependence on • Longer periods of methadone or other opioids. But not maintenance are better than shorter everyone who comes into metha- periods. The longer you stay on done maintenance has the same , the better goals. Some people want to stop the overall outcome. Indefinite treat- taking street opioids for good. Some ment often means life-long extension want to temporarily stop taking street of good health, HIV seronegativity, opioids. And some want to reduce or and freedom from incarceration. re-regulate their use of street opioids. • Methadone maintenance is treatment Some people begin methadone for people who are dependent on with the belief that they will need opioid drugs. It is not a treatment indefinitely. Others feel for people whose major problems that they will only need it for a short are with other drugs – such as time. Regardless of what you hope , , , to get from methadone maintenance, or cigarettes. however, all the evidence agrees on these several points: Opioid drugs include all the drugs that come fully or partially from and synthetic drugs that have similar effects. , heroin, , methadone, dilaudid, buprenorphine, LAAM, OxyContin, and are opioids.

4 About Methadone and Buprenorphine People dependent on street opioids who receive methadone treatment are healthier and safer than those who do not.

www.drugpolicy.org 7 Dependency

Opioids have been used for thousands people with a long history of opioid of years, and it has long been known problems have experienced changes that many people who have become to the part of their that allows a dependent on opioids have extreme person to feel and function normally. difficulty permanently ending their This part of the makes and uses use of them. its own natural opioids.

Suffering through the withdrawal The best known of these natural sickness is only part of the problem. opioids are the chemicals known The real difficulty has always been as endorphins. The word endorphin staying off the drugs once the period literally means “the morphine within.” of withdrawal is over. Indeed, these chemicals are function- ally identical to morphine or heroin. Just as in the case of those who are unable to stop smoking, it is difficult We don’t yet understand everything to explain why it is so hard not to that these natural opioids do in the return to the use of opioids. Reasons body, but evidence suggests that include long-term , lack of they are involved with pain control, energy, drug cravings, and sudden learning, regulating body tempera- attacks of physical withdrawal sick- ture, and many other functions. ness. Some people find that these problems diminish over time and It is possible that people who develop eventually disappear altogether – a dependency on opioids were but others continue to suffer these born with an endorphin system that symptoms indefinitely, and many makes them particularly vulnerable. of them eventually relapse to their For example, we know that addiction regular use of opioids. appears to run in some families.

Relapse often has nothing to do with lack of will power or other personality problems. Instead, it appears that

6 About Methadone and Buprenorphine Addiction might also be related to Relapse often changes in the brain caused by the overuse of heroin or other opioids. has nothing to Or it may be the result of a complex relationship between genetics and do with lack of the environment. We do not yet know will power or exactly how this malfunctioning occurs, or even whether all people other personality who feel unable to stop using opioids have this damage. There is, however, problems. an increasing amount of evidence that many people who find it diffi- cult to end their use of opioids have experienced these physical changes – which are likely to be permanent.

There is not yet any test that can determine how much damage a person may have to his or her natural opioid system, or how hard it may be for that person to stay away from opioids. All that we know for sure right now is that relapse is a major feature of opioid dependency.

Methadone is not a cure for the problem of opioid dependency. It is a treatment – and one that is effective for only as long as a person continues to take it appropriately.

www.drugpolicy.org 7 What is Methadone?

Methadone is a long-acting, synthetic drug that was first used in the maintenance treatment of drug addiction in the United States in the 1960s. It is an opioid “,” which means that it acts in a way that is similar to morphine and other .

When used in proper doses in maintenance treatment, methadone does not create , sedation, or an effect. Doses must be individually determined. The proper is the one at which the cravings stop, without creating the effects of euphoria or sedation.

Although methadone is not a single product from a single manufacturer, the active ingredient is always the same: methadone hydrochloride.

8 About Methadone and Buprenorphine All manufacturers add inactive How is methadone different from ingredients, such as fillers, preserva- heroin and other opioids (for tives and flavorings. Methadone is example, morphine or dilaudid)? dispensed orally in different forms, which include: Methadone lasts longer. The body metabolizes methadone differently • Tablets, also called diskettes. than it does heroin or morphine. Each one contains 40 milligrams of When a person takes methadone methadone, is dissolved in water, and regularly, it builds up and is stored in then is administered in an oral dose. the body, so it lasts even longer when • Powder is also dissolved in water. used for maintenance. Most people • Liquid methadone can be dispensed find that once they’re stabilized on with an automated measuring pump. a dose of methadone that’s right for Dosages can be adjusted to as small them, a single oral dose will “hold” as a single milligram. them for at least a full 24-hour day. For some, the effect lasts longer; for Patients have different opinions about others it lasts a shorter time. the various types of methadone. Each methadone provider usually Stability is easier on oral offers a single type of the drug and methadone. Most people who are obtains its supply from one source, on a stable, appropriate dose of which means that patients generally methadone for several weeks will not do not get to choose which form of feel any significant sense of being methadone they get. “high” or “dopesick.” Some patients may feel a “transition” – or temporary, For most people, a single dose of mild glow – for a short time several methadone lasts 24 to 36 hours. hours after being medicated, however. Others may feel slightly “dopesick” prior to taking the day’s dose but most will feel very little or no effect from the proper dose of methadone once they have stabilized.

www.drugpolicy.org 9 Buprenorphine

By Sharon Stancliff, MD Prescribed in the U.S. as Suboxone or Subutex, buprenorphine is usually Buprenorphine, when appropriately taken daily as tablets to be dissolved prescribed and taken, is an effective, under the tongue. There is little safe medication approved by the effect from the drug if it is swallowed. FDA for use in the treatment of opioid Suboxone contains not just buprenor- addiction. Buprenorphine relieves phine but also , an , reduces craving and antagonist that may precipitate blocks the effects of heroin in ways withdrawal symptoms if injected. similar to methadone. Maintenance For people dependent on any opioid, doses are generally between 12 and taking the first dose of buprenorphine 32 milligrams but (like methadone) when not in withdrawal can result in should be individualized. acute withdrawal symptoms.

Unlike methadone, buprenorphine Buprenorphine, like methadone, may be prescribed for treatment of can be used as a short- or long-term opioid addiction by any doctor who detoxification medication or indefi- has received training (available via nitely as a maintenance medication. the Internet or as a one-day course) The risks of relapse following and a waiver from the DEA. This is its detoxification appear to be similar principal advantage over methadone whether methadone or buprenor- for most doctors and patients. Misuse phine (or any drug-free treatment of buprenorphine is less likely than modality) is used. methadone to result in death. A directory of physicians approved to prescribe buprenorphine can be found at http://buprenorphine. samhsa.gov/bwns_locator/.

10 About Methadone and Buprenorphine Maintenance

Methadone maintenance is Methadone won’t control a person’s intended to do three things for emotional desire to get high, but an patients who participate: adequate dose of methadone should prevent the overwhelming physical 1. Keep the patient from going into need to use street opioids. withdrawal. The standard initial dose, as currently recommended, 3. “Block” the effects of street is 30 to 40 milligrams a day. After opioids. If the dose is high enough, several days, providers adjust a methadone keeps the patient from patient’s dose as needed. getting much, if any, effect from the usual doses of street opioids. 2. Keep the patient comfortable and This result is often called the free from craving street opioids. “blockade” effect. Having a craving means more than just having a desire to get high. If a person’s opioid tolerance is It means feeling such a strong need elevated high enough with for opioids that people may have methadone treatment, a great regular dreams about using drugs, deal of heroin would be required think about doing drugs to the to overcome it and produce a exclusion of anything else, and/or significant high. do things that they wouldn’t normally do to get drugs.

www.drugpolicy.org 11 Methadone won’t control a person’s desire to get high, but an adequate dose of methadone should prevent the overwhelming physical need to use street opioids.

About Methadone and Buprenorphine After Methadone

Many people who must take staying opioid free over the long medications every day get tired of term is the harder challenge. Studies doing so. This is especially true of find that people who have long patients on methadone maintenance histories of trying and failing to live because, in the United States, almost without opioids will probably not be all methadone patients are also able to stay abstinent for long. required to make frequent visits to a clinic to receive their medication. It isn’t yet possible to predict who For many reasons, most methadone will be able to live life without opioids, maintenance patients decide at but it doesn’t seem to depend on how some point that they want to stop “together” you are. If you are detoxing taking methadone. and find that you are craving opioids, or you have finished detoxing and If you do choose to leave mainte- you are always thinking of opioids, nance, your provider should reduce then perhaps maintenance should your dose at the speed you feel be part of your life. comfortable with. If it is slow enough you should not experience major physical withdrawal symptoms.

But if you have tried withdrawing from opioids many times and have relapsed, then you may have found that detoxing is the easier part and

www.drugpolicy.org 13 Myths & Facts

Myth: Methadone gets into your Myth: Taking methadone damages bones and weakens them. your body.

Fact: Methadone does not “get into Fact: People have been taking the bones” or in any other way cause methadone for more than 30 years, harm to the skeletal system. Although and there has been no evidence that some methadone patients report long-term use causes any physical having aches in their arms and legs, damage. Some people do suffer the discomfort is probably a mild some side effects from methadone withdrawal symptom and may be – such as , increased eased by adjusting the dose sweating, and dry mouth – but these of methadone. usually go away over time or with dose adjustments. Other effects, Also, some substances can cause such as menstrual abnormalities more rapid of methadone and decreased sexual desire, have (see pages 16-17 for a list of medica- been reported by some patients tions that interact with methadone). but have not been clearly linked to If you are taking another substance methadone use. that is affecting the metabolism of your methadone, your doctor may Myth: Methadone is worse for your need to adjust your methadone dose. body than heroin.

Myth: It’s harder to kick Fact: Methadone is not worse for methadone than it is to kick your body than heroin. Both heroin a dope habit. and methadone are nontoxic, yet both can be dangerous if taken in excess Fact: Stopping methadone use is – but this is true of everything, from different from kicking a heroin habit. to food. Methadone is safer Some people find it harder because than street heroin because it is a the withdrawal lasts longer. Others legally prescribed medication and say that although it lasts longer, it is it is taken orally. Unregulated street milder than heroin withdrawal. drugs often contain many harmful additives that are used to “cut” the drug.

14 About Methadone and Buprenorphine Myth: Methadone harms your . Myth: The lower the dose of methadone, the better. Fact: The liver metabolizes (breaks down and processes) methadone, Fact: Low doses will reduce but methadone does not “harm” withdrawal symptoms, but higher the liver. Methadone is actually much doses are needed to block the easier for the liver to metabolize effect of heroin and – most than many other types of medica- important – to cut the craving for tions. People with hepatitis or heroin. Most patients will need with severe liver disease can take between 60 and 120 milligrams methadone safely. of methadone a day to stop using heroin. A few patients, however, Myth: Methadone is harmful will feel well with 5 to 10 milligrams; to your immune system. others will need hundreds of milligrams a day in order to feel Fact: Methadone does not damage comfortable. Ideally, patients should the immune system. In fact, several decide on their dose with the help studies suggest that HIV-positive of their physician, and without patients who are taking methadone outside interference or limits. are healthier and live longer than those drug users who are not Myth: Methadone causes on methadone. drowsiness and sedation.

Myth: Methadone causes people Fact: All people sometimes feel to use cocaine. drowsy or tired. Patients on a stabilized dose of methadone will Fact: Methadone does not cause not feel any more drowsy or sedated people to use cocaine. Many people than is normal. who use cocaine started taking it before they started methadone maintenance treatment – and many stop using cocaine while they are on maintenance.

www.drugpolicy.org 15 Drug Interactions

Like any medication, methadone Some medicines slow the metabolism can interact with other types of of methadone. Sometimes people medicines and with street drugs. will feel the effect of methadone The body is a complex system, and more strongly when they take it’s possible that foods, hormones, these medications, and sometimes weight changes, and stress may they experience withdrawal symp- each also affect the way in which toms when they stop taking these methadone works in your body. medications: • (Elavil) We know about some of the • (Tagamet) substances that may interact with • (Luvox) methadone – and some of them • (Nizoral) are listed here. Others may yet be discovered. Some medications are opioid blockers and may cause withdrawal. These medicines cause the liver These block the effect of methadone to metabolize methadone more and should not be taken if you are quickly and may cause a need for taking methadone: an increased methadone dose: • (Talwin) • Carbamazepin (Tegretol) • (Revia) • Phenytoin (Dilantin) • (Ultram), in most cases • Neverapine (Virammune) • Rifampin • (Sustiva) • Amprenavir (Agenerase) – methadone also significantly reduces the level of amprenavir. • Ritonavir (Norvir) – less of an effect

16 About Methadone and Buprenorphine Some medications initially Two things should always be interact with methadone to cause kept in mind regarding sedation, but then the opposite methadone interactions: occurs, and they can cause withdrawal symptoms. These • Methadone is not responsible medications include: for every new feeling you have, • Benzodiazepines such as and it won’t be affected by most Xanax and valium medications or changes in your • Alcohol life conditions. • • If your methadone dosage doesn’t Other medications with interactive feel right, it probably isn’t right. You effects: are the expert when it comes to how • Cocaine can increase the dose of much methadone is enough. Talk to methadone required. your doctor about how you’re feeling. • Methadone increases the level of AZT and in For more information about drug the blood. interactions, go to: www.hivguidelines.org. Search under “methadone.”

If your methadone dosage doesn’t feel right, it probably isn’t right.

www.drugpolicy.org 17 Your Other Doctors

Methadone patients are sometimes reluctant to tell their other doctors that they are taking methadone. They are afraid that these doctors – or other health- care providers – will discriminate against them. Unfortunately, they are often right.

Find a primary-care provider whom you can trust. The ideal situation is to make sure all your doctors know that you are taking metha- done. If you choose not to tell them, however, keep these important things in mind:

• If you are having surgery for which • It is illegal for your methadone you may be put to sleep, the provider to communicate with your anesthesiologist might use a type primary-care doctor or anyone else of medication that will cause abrupt without your written permission. methadone withdrawal. Be sure you (Title 42 of the Code of Federal know which medications interact Regulations Part 2 [42CFR part 2] with methadone (see pages 16-17) protects against disclosure of drug – even if your doctors know that you treatment records.) are taking methadone. Ideally, though, open communica- tion among all the doctors who are treating you may assist you in getting the best possible health care.

18 About Methadone and Buprenorphine Methadone & Women

Is it true that women sometimes You may have heard that you should stop getting their periods when not take methadone when pregnant. they begin taking methadone? This is not true.

Yes, but there are also many other • Methadone is not harmful to the reasons why women’s periods developing fetus – but detoxing is. become irregular or stop: • Methadone is the treatment of choice • Pregnancy for heroin and opioid dependency • Stress during pregnancy. • Poor diet • The effects of methadone on • Weight gain and loss pregnancy have been widely studied. • Menopause • Methadone has been used • Other medical problems successfully during pregnancy. • Other medications • When properly prescribed for pregnant women, methadone Remember: provides a non-stressful environment • You can still get pregnant even if you in which the fetus can develop. don’t get your period. • Taking methadone during pregnancy • You can conceive and have normal may prevent miscarriage, fetal pregnancies and normal deliveries distress, and premature labor. while you are receiving methadone. • Decreasing the dose of methadone during the first trimester increases the risk of miscarriage. • During pregnancy, your dose should be sufficient to avoid cravings, avoid street drugs, and prevent withdrawal.

www.drugpolicy.org 19 Methadone & Women (cont.)

If you are pregnant, be sure to • Babies born to mothers dependent talk with your doctor, because: on methadone will have methadone in their systems, but studies show • When you’re pregnant, your body that the children can be weaned metabolism changes, so you may successfully and safely with no need to adjust your dosage. You adverse effects. may need to increase your dose of methadone, or split your dose and You may have heard that you take smaller amounts two or three shouldn’t breast-feed your baby if times a day. you are taking methadone, but here are the facts: You may have heard that your baby will be born addicted to methadone • Breast-feeding is now considered or will suffer other side effects, but safe for the babies of women who are here are the facts: taking methadone, but not safe for women who are HIV positive. • Methadone does not cause fetal • Small amounts of methadone in abnormalities. No harmful effects breast milk can pass to the baby. to a fetus have been found in the • Methadone levels in breast milk are study of methadone’s effect on very low. pregnancy. • Premature birth and low birth weight can be associated with cigarette smoking and/or poor nutrition and are not attributed to methadone.

20 About Methadone and Buprenorphine Storing Methadone

While at home, always keep your If anyone in methadone in a safe place – preferably in a locked box or cabinet – out of your home the reach of children and clearly marked to prevent anyone else from accidentally taking it accidentally. drinks methadone, Remember: Methadone is a very call 911 or an strong drug. A small amount can kill a child or an adult who does not ambulance have a tolerance to it. If anyone in immediately. your home accidentally drinks your methadone, call 911 or an ambulance immediately.

Store your methadone away from extreme heat or cold. The methadone that you take home is often mixed with water – and sometimes 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 bottles that were given to you by your methadone provider to prevent any trouble with the law. As with any prescription drug, it is illegal to possess methadone without a prescription.

www.drugpolicy.org 21 Concerns About Overdose

Methadone treatment reduces the If you stop taking methadone and chance of overdose for those who are start using street drugs again, your using or are addicted to heroin. chance of overdose increases because you now have a lower Methadone is a pure drug and is tolerance for the drugs. Tolerance individually prescribed. It does not increases when your body has contain the harmful “cuts” that are gotten used to having the drug in its mixed into drugs bought on the system – in other words, your body street. Concerns about overdose “tolerates” the presence of the drug. remain, however, especially if you If you stop using regularly – or if you continue to use street drugs or if have detoxed – it takes a smaller you resume regular heroin use after amount of the heroin, methadone, or stopping your methadone treatment. other opioid to cause an overdose. Also, mixing pills such as benzodiaz- epines, barbiturates and/or alcohol with methadone or heroin increases the risk of overdose.

22 About Methadone and Buprenorphine Frequently Asked Questions What if I use other drugs while I am taking methadone? Can I overdose on methadone? The correct dosage of methadone It is possible to overdose on metha- blocks the effects of heroin. If you done, but providers work to adjust take opioids while also taking metha- dosages so that they are safe for done, you may not feel the effects of each individual patient. It is important the opioids. You may then decide to to be honest with the clinic staff about take even more of the opioid, which how much heroin or other opioids could cause an overdose. Some you are using so that they prescribe a drugs also interact with methadone dosage that is right for you – too little and can change how your medica- won’t be effective; too much could tions affect you (see pages 16-17). cause you to overdose. Methadone Taking too much of a or is a strong medication, so you need drinking a lot of alcohol while you to build up the dosage slowly to be are taking methadone can also be sure that your body is handling the dangerous because each substance medicine well. makes the other more powerful, increasing your risk of overdose. Can I overdose on buprenorphine? Be extremely careful if you mix Misuse of buprenorphine is less likely these drugs. than methadone to result in death (see page 10). The correct dosage of methadone blocks the effects of heroin.

www.drugpolicy.org 23 Concerns About Overdose (cont.)

Can I overdose on heroin while very careful. Take some precautions I am taking methadone? – always be sure there are other Yes. Even while taking methadone, people with you when you’re using, if you take too much heroin – in case you need medical attention, especially if the heroin is unusually and test the effect of the drug on strong – you could overdose. You you before you take an entire dose. increase the odds of overdosing on heroin while you’re taking What happens if I start taking methadone if you mix it with methadone again after I have , alcohol, or other drugs. stopped? If you stop taking methadone What if I stop going to my even for a few days, you need to methadone program? be careful when you start taking If you stop taking your methadone it again. Your body may have lost and return to using street drugs, some of its tolerance for the you can overdose more easily than methadone, so you could overdose. when you last used. When you stop You need to restart at a lower dose taking methadone, your body will and work back up to the level rapidly develop a lower tolerance for you were at when you stopped. the heroin. As soon as your metha- The doctor at the clinic can help done completely wears off (a couple you determine the right dosages. of days), your tolerance for heroin will be lower than it was when you began taking methadone. So, if you decide to use again, you need to be

24 About Methadone and Buprenorphine In Case of Overdose

If you suspect that someone What should I do if someone has overdosed on methadone, overdoses? lay the person on his or her side • Immediately call 911 and remain with in the recovery position and call the person. 911 immediately. • Do not force the person to vomit. • Do not make them take a cold If medical professionals arrive shower. quickly, they can treat the • Do not inject salt water into individual with an antagonist, such their veins. as naloxone, that will help them come out of the overdose. It is What are the signs of an opioid important to tell the medical profes- overdose? sionals what drug the overdose • Unresponsiveness victim took so they know which drug • Drowsiness to use to counteract the overdose. • Cold, clammy, bluish skin • Reduced heart rate The person who overdosed will • Reduced body temperature need to be watched for a few hours. • Slow or no breathing Methadone is a long-acting drug. The medications that are used to What might happen if an overdose treat the overdose are short-acting. is not treated? If the antagonist wears off before • Brain damage the methadone level decreases • Paralysis (temporary or permanent) enough, the patient may go back • Death into a state of overdose and require medical attention again.

www.drugpolicy.org 25 Detoxification

Doctors do not advise that people of heroin withdrawal. This method quickly taper off of their dose of may be successful for people who methadone – but there are, unfor- haven’t been dependent on heroin tunately, many situations where this or other opioids for a long time. occurs. For example, a methadone patient may be in jail or in a hospital If you do start using drugs again after where methadone is not prescribed. your detox, you are not a “failure.” Or the person may be complying with Time that you spent away from street a demand from family court in order drugs was a period of reduced risk to be reunited with children who are – risk of arrest, exposure to disease, in foster care. Public policy is slowly and overdose. But remember, if you changing, but some methadone relapse, the first weeks of use (again) patients are still being forced to are a time of higher risk of overdose. detox from their medication. How it Works If you are being “administratively Methadone patients have two options: detoxed” by your methadone inpatient and outpatient treatment. provider, you should find another provider quickly. If your provider With inpatient treatment, the patient is not helping you find another, is admitted for overnight care to a contact a program, clinic or hospital. The patient usually needle exchange, or your state’s must spend several days and take health department for assistance. medication to relieve the withdrawal A directory of state alcohol and symptoms. In outpatient detox, drug abuse agencies can be found medication also provides relief from at www.treatment.org/states/ withdrawal symptoms. The medica- index.html tion is administered during daily clinic visits over a period of several weeks Some people also use gradually or longer. Often methadone is used in tapering doses of methadone for a doses that are gradually reduced. short period of time (three to seven days) to relieve the initial discomfort

26 About Methadone and Buprenorphine Any “cross-tolerant” opioid – such The usual detox program for as morphine, dilaudid, methadone, methadone requires that the patient heroin, or LAAM – can suppress use it as a tapering dose for 21 to withdrawal. Methadone is used 30 days. During induction, the doctor because it is long-acting, gentle, determines the right dose to over- eliminates craving, and does come withdrawal. Afterward, the not produce a “high” when it is dose you take gradually becomes used properly. smaller, until you no longer need the methadone. The medical and Other medications, including counseling staff in your program drugs such as buprenorphine and can help you develop a plan for , are also used – and may further treatment if you need it, and be used more widely in the future. will guide you through the physical changes you experience during the detox period.

www.drugpolicy.org 27 Methadone & Pain

Severe pain has long been under treated in the United States. This is partly because of ignorance and prejudice, but also because of the laws that made drugs like heroin illegal. The government has actively pursued and prosecuted physicians for prescribing opioids.

If you are on methadone maintenance, your regular maintenance dose of methadone will provide little or no pain relief. You will still feel pain, just like everyone else. In fact, you may need more pain-relief medication than people who are not taking methadone.

Greater public awareness of how many people have needlessly suffered because of this undertreatment of pain is beginning to force changes. To manage pain, doctors are beginning to more freely prescribe opioids – including methadone, which has been recognized as an effective pain medication.

About Methadone and Buprenorphine Driving

Study after study has shown that Discrimination persists, despite people who are maintained on a the fact that people maintained on correct dose of methadone can do methadone are no different from the anything that people who are not general population in their motor using any medication can do. skills, reaction times, ability to learn, focus, and make complex judgments. Researchers have conducted laboratory and field studies since Of course, your ability to think and 1964. They have consistently found function normally depends on that methadone – when used in the your having the correct dosage of treatment of heroin addiction – has methadone. If you feel groggy, tired, no adverse effects on a person’s or unable to focus, you should not ability to think and function normally. drive. Be sure to consult your clinician about whether you are receiving a Methadone patients still experience correct amount of methadone. a great deal of discrimination by employers, however, especially when they seek to get or keep jobs that involve driving.

www.drugpolicy.org 29 Traveling with Methadone

Traveling in the United States A comprehensive “Methadone It can be very stressful for methadone Maintenance Treatment Directory” patients to plan a trip. Rules vary from listing contact information for place to place throughout the United outpatient methadone maintenance States, and many of them are unclear. facilities in the United States can be found on the Internet at: If you are traveling within the United www.findtreatment.samhsa.gov. States, decide whether you want to If you do not have access to the travel with your medication or obtain it Internet, see the directory of state when you arrive at your destination. substance abuse agencies on page 32. To be sure that your methadone treatment is not interrupted, you will Traveling Abroad either need to get enough methadone Methadone is a prescribed medi- from your provider to cover you for cation, and most countries allow the entire time you’re away – or your visitors to bring whatever prescription provider/clinic will need to arrange medications they need with them. In for you to be “guest medicated” at a some places, however, methadone located in the area may be considered an exception to where you will be staying. this policy.

In either case, it is wise to make your In many countries, methadone is arrangements as early as possible not available, and some countries before you leave. prohibit bringing it in. Some countries also have laws prohibiting former Keep in mind that federal, state, and addicts or people with criminal clinic regulations limit the amount of records from entering. It may be methadone that you can take with difficult to find out which laws are in you. These rules differ from place to effect in which countries – and which place, so check with your provider to laws are actually enforced. find out about the rules in the areas you plan to visit.

30 About Methadone and Buprenorphine There are some resources that Whichever option you choose, you patients can check to determine the will need to bring your prescription for laws that apply to methadone at their methadone, and, if you are guest- destinations. Ultimately, however, medicating, a letter from your home patients are responsible for deter- provider, explaining your prescription/ mining whether it is legal and/or safe dosage. Make these arrangements as to bring methadone with them when early as possible before your trip. they travel. What should you do if methadone • An excellent place to start is the importation is prohibited at your INDRO Web site at: destination? www.indro-online.de/travel.htm Knowing that their medication is • For more information about European legal, most simply do not declare it at methadone providers, go to: customs unless they are specifically www.q4q.nl/methwork2/home.htm asked to do so. There are, however, • You can also check with the severe penalties for importation of consulate of the country that you even small, prescribed amounts are traveling to – although not all of medications in some countries consulates will be well informed (for example, the death penalty in about methadone. Singapore!).

Whichever country you travel to, Each patient will have to weigh you will need to decide whether this decision very carefully. Many you will carry your own methadone methadone patients have traveled (where permitted) or find a metha- to various parts of the world without done provider there who will treat you experiencing any problems. (if one is available).

www.drugpolicy.org 31 State Substance Abuse Agencies

Alabama 334.242.3961 Nebraska 402.471.7818 Alaska 907.465.2071 Nevada 775.684.4190 Arizona 602.542.1000 New Hampshire 603.271.6110 Arkansas 501.686.9866 609.292.5760 800.879.2772 New Mexico 505.827.2601 Colorado 303.866.7480 New York 518.473.3460 Connecticut 860.418.7000 North Carolina 919.733.4670 Delaware 302.255.9399 North Dakota 701.328.8920 District of Ohio 614.466.3445 Columbia 202.727.8857 Oklahoma 405.522.3619 Florida 850.487.2920 Oregon 503.945.5763 Georgia 404.657.2331 Pennsylvania 717.783.8200 Hawaii 808.692.7506 Puerto Rico 787.764.3795 Idaho 208.334.5935 Rhode Island 401.462.4680 Illinois 800.843.6154 South Carolina 803.896.5555 Indiana 317.232.780 0 South Dakota 605.773.3123 Iowa 515.281.4417 Tennessee 615.741.1921 Kansas 785.296.6807 Texas 512.206.5000 Kentucky 502.564.2880 Utah 801.538.3939 Louisiana 225.342.6717 Vermont 802.651.1550 Maine 800.499.0027 Virginia 804.786.3906 410.402.8600 Washington 877.301.4557 Massachusetts 617.624.5111 West Virginia 304.558.2276 Michigan 517.335.0278 Wisconsin 608.266.2717 Minnesota 651.582.1832 Wyoming 307.777.6494 Mississippi 877.210.8513 Missouri 573.751.4942 Montana 406.444.3964

32 About Methadone and Buprenorphine Other Resources

For more information about For information about methadone, please visit: buprenorphine, please visit:

Addiction Treatment Forum Substance Abuse and Mental www.atforum.com Health Services Administration http://buprenorphine.samhsa.gov The Baron Edmond de Rothschild Chemical Dependency Institute The National Alliance of www.opiateaddictionrx.info Advocates for Buprenorphine Treatment Centers for Disease Control www.naabt.org www.cdc.gov/idu/facts/ Methadone.htm

Drug Policy Alliance www.drugpolicy.org/library/research/ methadone.cfm

The National Alliance of Methadone Advocates www.methadone.org

Substance Abuse and Mental Health Services Administration http://csat.samhsa.gov/publications/ PDFs/brochure.pdf

www.drugpolicy.org 33 The Drug Policy Alliance Please join our fight for the rights published About Methadone and and dignity of methadone patients Buprenorphine to help patients make and the millions of others who healthy and informed treatment suffer the consequences of the decisions with their doctors. As part failed . Join the of our broader mission, we also seek Drug Policy Alliance today. to end the prejudices and policies that cause discrimination against all To become a member and help end people in maintenance therapies. the war on drugs, please contact:

By educating hundreds of thou- Membership sands of readers, About Methadone Drug Policy Alliance and Buprenorphine has helped 70 West 36th Street advance both of these goals, so we’re 16th floor pleased to offer it for just the cost of New York, NY 10018 production. As a private, nonprofit 212.613.8020 voice organization, however, the Drug 212.613.8021 fax Policy Alliance relies solely on our [email protected] members and contributors for finan- www.drugpolicy.org/join cial support – both to advance drug policies based on science, health, For additional copies of About compassion and human rights, and Methadone and Buprenorphine, to aid in the distribution of About please contact the above address, Methadone and Buprenorphine and email us at: publications like it. [email protected] or call: 212.613.8020

DPA AM 0710 About Methadone and Buprenorphine