Wednesday December 7th 2016

Trusted Helpline
Help Available 24/7
1-888-882-1456
PRIVACY
GUARANTEED

Methadone treatment guideline in opiate addiction-is longer better?

 

 

 

 

 

Methadone treatment for opiate addiction

 

Trusted Helpline
Help Available 24/7
1-888-882-1456
PRIVACY GUARANTEED

The longer patients are retained in methadone treatment, the less illicit opioids they use. Studies show that at six months or more of treatment, heroin use in patients drops from ninety-seven percent to twenty-three percent. When patients stay on long term methadone maintenance for more than four and a half years, the number dropped to eight percent. Of the patients that left methadone maintenance treatment, eighty-two percent injected heroin within 1 year. Therefore, we know that longer treatment is better than shorter treatment.

More on methadone pills 60 mg

More on side effects methadone

Methadone maintenance discussion

Longer methadone treatment for opiate addiction works better than short term treatment using methadone.  But stigma surrounds the practice of methadone maintenance treatment.  What do you think is the source of the misunderstanding of opiate addiction treatment using methadone?   Why are people such critics of the practice of methadone treatment?  Why do people urge opiate addicts to start getting off methadone?  We invite your comments, feedback and even disagreement here.

Leave a Reply

19 Responses to “Methadone treatment guideline in opiate addiction-is longer better?
Tammy
7:35 pm January 8th, 2011

Greetings!
First, I would like to say “thank you” for being a CARING doctor who educates her herself on this real life issue. I am a 45 year old female, wife, mother…who is desperately seeking help. 10 years ago I had an acident/injury which caused me great pain and was put on hydrocodone. I wasn’t warned about the danger or possibilty of addiction with this type med so I used it as often as needed..time goes on..I become addicted. After several years of misery, doctor shopping, buying off the streets…my needed amount became very dangerous. I couldnt find enough, so to avoid withdrawel and the still paining body I tried heroin out of desperation, morphine, anything that would relieve me. Finally, a doctor (a regular MD) put me on methedone as he suspected I was addicted, and it worked well for me for several years, I even went down on my dosage over the years.I maintained the last 4 years on just 30mg a day and it relieves my pain and I feel “normal”. NOW, we have moved out of state and I CANNOT find any doctor to prescribe the methadone! I dont know where to turn, I can see the writing on the wall, my life is going to go back to what hell it used to be if I cant get help soon! I have found methadone clinics info but I cant drive downtown EVERYDAY to get dosed! I am a wife, a mother, I have obligations, rather than spend half a day in some clinic. WHERE and HOW can a person locate a docor who will prescribe low dose of this medication, monitor your case, and truly care about your well being? People treat people like me as if I were just some scum of the earth who doesnt deserve help. How do I find a docor like you? Who is educated and NOT AFRAID to treat patients like myself? I am in the Dallas area, PLEASE let me know what I can do to find real help. Thank you for caring and dedicating your time on these issues. God Bless!

jamescook1380
1:49 pm January 30th, 2011

Hi Tammy! I am a doc. with many years experience in addiction medicine. Have ever considered the possibility to leave opioids once and for good?( Methadone is a semi-synthetic opiate with addiction potential higher than heroine) Probably this idea looks scary , but it is real and it is worth. It takes about 10 days in-hospital treatment to detox you from methadone smoothly with following Naltrexone therapy ( long-term implant or daily intake in oral form) combined with adequate counseling and mild sedative therapy to help you to erase mental dependency . Promise, you will see the positive changes immediately. Our clinic (Dr.Vorobiev Drug Clinic. Belgrade) provides this kind of treatment to hundreds of heroin and methadone addicted people every year with excellent results . We are not against medically supervised Methadone treatment ( for many people it works well) but we dont support this program for pure medical reasons ( it is substitution therapy – switching from one opioid to another).

Dr. Jana Burson
6:15 pm February 2nd, 2011

Dear Tammy,

After a person takes opioids regularly, even for as little as 2 weeks, a physical dependency can develop. That is not the same thing as addiction. With addiction, there’s the physical part, but there’s also an intense psychological component: much time is spent thinking about drugs, making plans to stay supplied with drugs, using drugs in ways they aren’t meant to be used, like snorting, injecting, or removing time-release coating. Real addicts use drugs to feel high, or to dull emotions, or to treat emotional symptoms such as anxiety or depression. They neglect family obligations in order to use drugs or stay supplied with drugs. They may visit multiple doctors for prescriptions, which is what you referred to as doctor shopping.

If you were only physically dependent, you could be prescribed methadone for pain, if you could find a willing doctor. But because methadone is long-acting, it’s dangerous for patients who like to abuse their medication. An overdose can happen before the addict feels the “high.” Obviously, you’ve had an unusually good experience with it. Any doctor can prescribe methadone to treat chronic pain with physical dependency. But it’s illegal (in this country) for doctors to prescribe methadone for the purposes of treating addiction.

Since 2003, there’s another option for people (in the U.S.) with chronic pain and addiction: Suboxone, the brand name for the drug buprenorphine. Because it can be prescribed in doctors’ offices, it doesn’t have the strict federal and state regulations surrounding it. Suboxone is a partial opioid, but still helps many patients with mild to moderate chronic pain. You can find a doctor who prescribes in your area by going to one of the following websites: buprenorphine.samhsa [dot] gov or suboxone [dot[ com . And please read other blog entries on this site to learn more about it.

Certainly there are drug-free options to treat opioid addiction. Inpatients treatment works, as long as the period of detoxification is followed by at least 30 days of drug rehab. This second part is necessary because it takes time to learn about addiction, what you’ll need to do to stay in recovery from this potentially fatal disease, and learn about relapse prevention strategies. This takes time.

As for the option mentioned above: detox alone does not work. This has been proven time and time again. If detox alone worked, every addict who has been put in jail for more than 10 days would be clean today. Relapse rates with detox alone have consistently, in study after study, been about 96%, with most of these occurring in the first month.

Adding naltrexone may help. In this country, trials with oral naltrexone have failed miserably, because the addict “forgets” to take the medication. The only exceptions have been with professionals like doctors, nurses, dentists, and pharmacists. They do well with oral naltrexone, because their licensing boards tell them they can’t work unless they take the medication, and periodically monitor to make sure they take it. With their profession and livelihood at stake, they have strong motivation to do whatever it takes to stay in recovery. And these folks do have excellent recovery rates. Studies show 80 – 92% of these professionals are abstinent at one year. But the average addict doesn’t have these resources available to them.

We just have had depot naltrexone approved in this country, where a once-per-month intramuscular injection is given. Trials are ongoing to see if there will be better success rates with this method than with the oral tablet.

Still, drug addiction counseling is needed to treat the psychological part of addiction. It’s possible to do this as an outpatient, and takes time and energy. The naltrexone, either as depot injection or as implants, blocks the effects of any opioid if the addict does have a relapse, thus discouraging return to drug use. This works great as a temporary measure, but you’ll need to learn new ways of dealing with stress and physical pain in the long run. It’s not easy, but it’s way worth it!

Also, many people with chronic pain have “hyperalgesia” from opioids. This is a term that means the chronic pain patient’s body adapts to the consumption of pain pills, and changes. The person actually becomes more sensitive to pain, ironically. These patients often feel better when off all opioids.

It’s a complex issue, and I advise you to see a doctor who’s familiar with all of the options, who can do an individual evaluation and talk with you about all the options.

Best wishes,
Jana Burson M.D.

Lynda Damelio
7:06 am March 12th, 2011

I have been on methadone for two weeks, is it possible that I feel so much better, than when I was on oxicodone. I have been on darvon for fourteen years, and oxicodone for three months. the meth has helped me in two weeks, is this possible?

brian lovely
1:50 am June 1st, 2011

I was over prescribed oxycodone for years and when I attempted to stop taking them because my physical dependancy was becoming rediculous I was horrified by the withdrawl. None of my doctors would recommend anything accept “get in a program”. I had to research it myself and found out aboout methadone. All I knew of methadone was that it was something from 70s movies for heroine addicts. I had to go to a clinic, a horrible experience in its self. But with a daily intake of 360mg of Oxycodone, 30mg of methadone daily stopped the withdrawl. Gradually lowering my dose I was off of everything in 3 1/2 months. I have returned to my doctors to seek some type of releaf for my pain issues but none of them will help me in any way. Two have even refused to treat me at all. I don’t understand their reactions, the fact that I willingly stopped taking opiates and was able to stop methadone should prove that I was never addicted only physically dependant. Does anyone have any recommendations. Also as a side note is tramadol an opiate.

L Garcia
12:12 pm September 30th, 2011

I would realy like to find a doctor that would prescribe methadone to me for pain and addiction but everytime you talk or try to talk to a doctor about methadone and pain they treat you like you dont even have the right to walk on the same side of the street as them. Yes Im a addict but Im trying everything I can to have a normal good life, and I know even though all the mistakes I have made I deserve at least that much. Not asking anyone to give me anything but a fair shake at life.And I have tried suboxone but it does NOTHING for pain.Please email me with any recommendations!!!

Opiate Addict
10:33 pm December 21st, 2011

Being an opiate addict in recovery, I fully understand the quandary of being in pain and not being able to reach for those little helpers, but I am here to say that my time in detoxing myself, cold turkey for two weeks at home, prior to coming into rehab, was worth every minute of it, as today, I am clean, happy and rebuilding a life lost from a 43 year run. I have found other ways to deal with my severe back pain, including acupuncture, stretching, non-opiate pain relievers and hot showers. For me, this is working, but there are many different remedies out there other than pain medications. Addiction was, and still is, a nasty, life sucking proposition, whether it is opiate pain medications or methadone. Narcotics Anonymous and rehabs are there to help the suffering addict to find their way back to a life of joy and happiness, without the need for addictive, mind altering substances. Consider the alternative……..It Is A Wonderful Life !!!

Big D
1:43 am January 1st, 2012

Im just now finished with a methadone program. It took me two years to finally come off of it. Having a good support system helps a lot . The counselor at the clinic sucked . If it wasn’t for my own will power I believe I wouldn’t have made it this far. It was a real longp process . I believe that ifsomeone is serious about getting recovered and use methadone the right way it can do wonders. It all depends on the person. I thank god all the time for helping me through this recovery as well

Big D
1:44 am January 1st, 2012

The way I did the program was found a good dose to start at and stuck at that mg. For quite sometime to get myself out of the mental addiction to the heroin and pain killers. I Probly stayed at this number for a year or so. Then eventually after time I would make small drops in my dose maybe 2 mg. At the most. Then I would go about a month or so and drop a little more. 2-3 mg now. Work that for another two weeks see how I feel then judging by how I’m sleeping ill make the decision to maybe drop a little more … And once I came down to about 16-19 mg. I would cut 3 mgs. Every two to three weeks. I took my last dose of three mg.Ten days ago and I feel just fine. Didnt really feel much withdraw after 6 mg. Methadone really turned my life around . I would also have to say saved my marrage. I would recommend methadone to someone who is serious about getting help battling an opiate addiction . Just need to build a strong plan in your own mind . And really want to be a drug free person. I guess what im saying is really be sick of the life you have been living and putting your family through . Now two years later things are great I have a great life now. I can say I finally have my life back . It feels good. I hope this post will help someone . Good luck to anyone who faced with this battle.!!!!

Tammy G
7:40 am February 4th, 2012

Hello again Dr Jana!

well it has been a year since my original post, just a few days after I wrote to you I was in contact with an out patient center (right in my hometown) where I went for help. I was processed and asessed quickly, was sent to a doctor and put me on Suboxone, and I went to classes 3 times a week to learn more about addiction. In the past year I have maintained very well on the Suboxone and have tapered down on that as well. I didnt really think anything would work- I was so tired of this life. I was so surprised! The med did not make me feel “high” it simply blocked my withdrawls so I could function. I will cont with the meds for about another year according to my dr and cont tapering down. I am an absolute believer in this treatment- I only wish I had found it earlier:) Life is good today!

art cohen
6:42 pm December 9th, 2012

TO BRAIN LOVELY:

You wrote “the fact that I willingly stopped taking opiates and was able to stop methadone should prove that I was never addicted only physically dependent. Does anyone have any recommendations”.

CAN YOU TELL ME THE DIFFERENCE BETWEEN PHYSICALLY DEPENDENT AND ADDICTED ?

Art Cohen

katrina
1:33 am March 22nd, 2013

I have been on oxycodone 30 mg 10x a day plus 150 dilaudid and 300 40 mg methadone and 2mg xanax qty 90 my dr no longer practices obviously and now i have been going to the methadone clinic and this helps me alot im on 60mg a day i have been on this 4 months now i have no cravings whatsoever i prefer methadone treatment over anything any day hope everyone else can find help and im gradually going down my 2mg i feel great i have energy i have money in my pockets and im not chasing this evil drug, by all means methadone is powerful but its beneficial to me and its keeping me alive and well and i have a great support systems great couslors and a great doctor!!!

kandy
12:41 am October 4th, 2013

I am a 44 yr old chronic neck and back pain issue. I have used all kinds of opiates, muscle relaxers, nerve meds etc. I have abused all. I got on methadone about 2 yrs. I had functioned and didn’t abuse any drug (never did heroin and still haven’t). Seemed like a miracle drug with no misuse of even alcohol (which had in past) and helped with pain along w moodd (25mg).

My meds got stolen, dr wouldn’t refill w no bad history and had pd report taken. Now going through w wds and seems inhumane with no alternative. What should I do. Falling bk in old habits and have had to getting thru basically illegal means but no methadone. It gets bad wrap and bad stigma but don’t know what is lesser of two evils. Been 13 days and feel like crap. Any ideas? Yes or no? Felt so much better mentally and physically……

Worried and afraid
1:25 pm October 19th, 2013

Hello. I am a 28 y/o female in mmt and have been for 2 years this month. I got pregnant in January and decided to keep the baby after my 18th week. I was on “take homes” weekly and have a daily dose of 100 mg. I did not report the pregnancy to my counselour in fear of having the take homes suspended. I initially thought I would do a medically supervised wean during pregnancy but found I could not and risked losing the baby (It was also considered child abuse). I also took a non prescribed medication at 18 weeks thinking about termination of the pregnancy. I want to add that I have not taken any other medicines of abuse since then and have months of “sobriety” and clean drug screens. My bf had no children. In September, I gave birth to a boy who has been in a NICU for a month for Abstinence Syndrome. His meconium tested + for methadone and the non prescribed medicine. Because I did not report the pregnancy, my take homes were revoked and now I have been visited by Child Services and was required to enter an outpatient treatment program. The man who runs this is constantly telling me to wean 10 mg a week to 60 mg and then enter an inpatient treatment program where I would be given Neurontin and a sedative. My counselour at the mmt center say a medically supervised wean is more appropriate. All this time, I don’t feel I am stable enough to try to come off. I want to finish nursing school, become meaningfully employed, marry my bf (I feel so bad for him cause he is 43 and this is his first child and shouldn’t be going through this). I also have 2 other children and know if I try to do this inpatient treatment, their father could take them from me. As an unbiased doctor, how can I convince this man, who is not a doctor, that the doctor who is watching me is working in my best interest and, more importantly, in an inbiased medical opinion, when should I try to come off mmt?? The clinic has always been there for me, grief counseling, group sessions, education, checking my blood serum every 3 months to make sure my dose is right. The clinic supervisor did give me weekend take homes back after one week because of my 100% compliance………. After seeing my son go through withdrawal, I fear the same would happen to me and he only has 5 % reductions where this man is asking for 10% a week. I am sure I would relapse and lose everything I have worked for. Advice please????

Alan
8:08 pm January 17th, 2015

I’m going to a job intervie and they drug test what can I do I’ve been on methadone for 4yrs

4:07 pm January 20th, 2015

Hi Alan. It will show up on the test anyway, so you can tell them in advance that you have been using it medically.

mary
1:49 pm April 27th, 2015

Need advice!!!!! This is complicated. In same clinic over 12 years. Maintenance 80 mg for 21 years. Monthly take homes. Never gave a dirty UA. Five years ago got a disease with extremely painful leg ulcers. Put on dilaudid. Worked well. Clinic changed hands. First they took away my take homes saying because I was on medicaid I wasn’t “allowed” take homes for more then 6 days. Then they said I could not take both methadone and dilaudid. They wanted to call my PCP and let him know he could write me scripts for methadone. I TLD them he wasn’t a rehab.They said it didn’t matter. Bottom line they have put me on a twenty one day detox. What on earth can iI do? I’m very worried and scared. Can you help me? No one has any answers.

Ellen
2:15 pm April 30th, 2015

Do you have information on the pharmacology surrounding missed doses in a methadone clinic? How do you determine the length of days missed with amount of methadone given?

I am a program director and am trying to find evidence based information on this topic

Kelly
4:08 pm May 22nd, 2015

I have been in a methadone maintenance program for several years. The first two years I wasn’t serious about getting clean and relapsed several times. I had left the program but 6 months later I had finally hit rock bottom and WANTED TO GET CLEAN AND WANTED MY LIFE BACK. I became addicted to OxyContin at the age of 40 and that’s when my life got turned upside down. I eventually started using heroin and other illegal drugs and that went on for a few years. Today I am clean for 6 1/2 years thanks to a great Methadone Clinic. Sure in the beginning you have to go daily but it’s well worth the time. State law where I live only allows 6 take home doses per week so I go once a week and it only takes a few minutes. I see my counselor there regularly and everyone there is very supportive. My marriage was saved Andy relationship with my children is once again wonderful. It was a tough long road but I would recommend Methadone maintenance to anyone who is SERIOUS ABOUT RECOVERY. I am at a point that I would like to consider coming off of the methadone, but I am a bit scared of the idea and keep thinking if it isn’t broke, why fix it. I don’t know what to do as I am now 51 years old and don’t want to be on it forever. Been thinking long and hard about it and maybe will start a very slow decrease as I know it may take a good year to come off of it properly. Thanks for letter me share… Hope this helps someone else.

Leave a Reply

About Dr. Jana Burson, MD

Jana Burson M.D. is board-certified in Internal medicine, and certified by the American Board of Addiction Medicine. After practicing primary care for many years, she became interested in the treatment of addiction. For the last six years, her practice has focused exclusively on Addiction Medicine. She has written a book about prescription pain pill addiction: "Pain Pill Addiction: Prescription for Hope." Also see Dr. Burson's blog here.

Trusted Helpline
Help Available 24/7
1-888-882-1456
PRIVACY
GUARANTEED