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Frequently Asked Questions


We understand the numerous questions one might have when contemplating entering treatment. We are also intensely aware of the volumes of misguided nescience and negligent misrepresentations surrounding the use of methadone. Methadone is perhaps the most researched medication in history and what follows is accurate, educated, information based on 50 years of scientific research.

1.

What is methadone?

Methadone is a medication used to ameliorate the symptoms of narcotic dependency and in some cases it is used to control chronic pain. Methadone is a synthetic narcotic and mimics the action of opiates on opiate receptor sites in the brain. When used to treat opiate dependency, Methadone eliminates withdrawal symptoms and cravings.


2.

Who uses it?

Methadone is taken by people who are addicted to pain pills, heroin, or other opiates. Most have tried to stop using these drugs but have not been able to stay drug free for the long term. The inability to stop using substances and remain drug free is more pronounced in opioid use (more than any other substance) due to the opioid's effect in the brain and on the central nervous system. Brain chemistry and function is often permanently altered after long periods of opiate use. Methadone maintenance grew out of a need to find a form of therapy that would prove effective for the unique needs of opiate addicts.


3.

How does it work?

All opioid drugs affect the chemistry of the brain in similar ways. Opiates settle into neurons (brain cells) called opiate receptor cites. Opiates cause a release of an excess of chemicals in the brain which casue pleasurable effects and produce analgesia. Since opiods are short acting (4-6 hours) users need an opiate continuously occupying the opioid receptor in the brain. A single dose of methadone occupies these receptor cites for 24-36 hours and is a stabilizing factor that allows people to change their behavior and to discontinue the use of heroin and pain pills.

Methadone at Narcotic Treatment Programs is normally in liquid form and taken orally. When a stabilizing dose is taken on a daily basis, it does not have a euphoric effect or interfere with a person's thinking. It does not alter the ability to work, go to school or care for a family. It is non-toxic to the liver and does not contribute to health issues like other opiates. Additionally, it  blocks the euphoric effects of heroin and other opioid drugs, thereby reducing the attraction of using those drugs.

One of the amazing features of Methadone is its ability to eliminate cravings.  People whose minds previously could think of little else but getting the next fix find these thoughts fading as they stabilize on a therapuetic dose of the methadone.  

For more extensive details on methadone's mechanism of action and the effects of opiates on brain chemistry and the Central Nervous System, please see medical personnel or a licensed counselor specializing in the treatment of opiate dependency.  


4.

Why take Methadone?

To take any medicine or submit to any treatment regimen is a matter of personal choice, though circumstances often give direction to our choices.

Addiction to drugs has a devastating effect on people's lives. Seeking and using drugs becomes a fulltime occupation. Ties with family and friends may be stressed or broken and the ability to pursue a career or school is often compromised. A person's health and finances may suffer and he or she may be in legal trouble. Addicted to drugs is no way to live. 

When opiate use skyrocketed in the United States in the 50's, it became a major societal problem. Every means of treatment know to be effective at that time for other drugs of abuse, failed miserably for opiate addicts. We even created a new form of treatment, Narcotic Farms, to house and rehabilitate opiate addicts, but even that wasn't successfull.

The problem with opiate use and what makes it so difficult to overcome is bound up in brain chemistry; Opiates change the brain and leaves its users deficient in crucial ways. After long-term use, these changes continue even after the patient has stopped using the drug. The alterations in neurological functioning may be permanent, making opiates the most difficult class of drugs to overcome.

With most drugs, the physical nature of the addiction can be beat after a few days, leaving only the psychological component to be dealt with. With opiate users however, the physical nature of the addiction never seems to go away and continues to plague former users for months after cessation of the drug. For this reason, opiate addicts tend to return to active use at a much higher rate than for other drugs of abuse.

Methadone maintenance treatment was born out of these extreme set of circumstances and once its effectiveness was discovered, it rapidly became the most effective form of treatment for opiate dependency.  


5.

How long will I be on Methadone?

First let me distinguish between two types of dependent persons, those who have chronic pain issues and those who do not.

People who have become dependent to opiates due to chronic pain issues normally find that methadone can replace a host of other medications. For this reason, chronic pain patients usually take methadone for long periods of time with no desire to stop taking the medication.

People who do not have chronic pain issues do have an opportunity to taper the medication level and successfully discharge from treatment. So how long does it take? It varies. It varies from person to person and depends on a host of circumstances. Generally speaking, research has shown that if a person is committed to a solid plan of recovery, is active in counseling, and participates in treatment planning, 1 1/2 to 3 years is an acceptable time frame. Persons who discharge in less than a year typically are unsuccessful and usually return to active use and eventually to treatment.

Getting clean is not easy. Staying clean is even harder, and recovery, plain and simple, is hard work. It takes diligent effort, a commitment to change, a pursuit of personal growth, and the acceptance of help from others to beat opiate addiction.

Frankly, I think the question is incorrect. Instead of asking, "How long do I have to take methadone?", we shoud be asking, "How long will it take me to develop my character and change myself so that I'm no longer attracted to drug use"? This, I believe, frames the question in the proper context.

Believe it or not, the best inidicator of whether one is ready to begin tapering a dose and working towards successfull discharge is having the support of their counselor. Counselors are crucial instruments in preparing a client for MSW and determining readiness.

 There are no set time frames for beginning MSW but there are some objective criteria that research cites as a good basis for decision making and succesfull outcomes. Cross Roads, Inc. provides an assessment that helps gauge one's condition and chances of success against known outcomes. As a general rule, most of the people who are successful (do not return to active use) proactively work a recovery plan and participate in counseling, goal setting, and making lifestyle changes for about 1 1/2 to 2 years before attempting MSW.

Fundamental to the understanding that Methadone is maintenance treatment is the concept that opiate addiction is a chronic, relapsing, destructive, but treatable condition.  This of course, is precisely the orientation to diabetes, hypertension, coronary artery disease, ect., and has been the universally accepted foundation for over half a century of the approach to the disease of alcoholism. The objective of methadone maintenance treatment flows out of this orientation: to improve function, lessen symptoms and discomfort,  lower the rate of mortality associated with addiction, improve health, and decrease the economic and emotional toll of drug use on families and community. As measured against each of these key criteria, methadone maintenance is extremely effective.


6.

Is Methadone safe?

Methadone is safe if it is taken as prescribed and not mixed with other medications contraindicated for its use. Methadone does no harm to the liver and does not utilize calcium in the metabolic process as other opiates do.


7.

Is it safe to take with other medications?

 

Pharmacotherapy is increasingly complicated by the introduction of  new drugs and the use of multi drug regimes for acute chronic diseases. During clinical use spanning over 40 years, oral methadone has proven to be  a well tolerated medication with minimal reactions when prescribed in appropriate doses and in combination with other drugs, however there are certain drugs that produce adverse affects when used with methadone either by increasing or decreasing its affect.

It is imperative that you inform Cross Roads, Inc. staff and your primary care physician (PCP) of all medications that your are taking. Methadone drug interactions may occur when taking prescribed medications, illicit drugs, OTC products, and other substances that can be difficult to predict and may be potentially harmful.

All opiates depress the Central Nervous System (CNS) which means that respiration (breathing) is slightly reduced. If a CNS depressant is taken as prescribed, it is generally safe - assuming your physician is aware of all medications.

When CNS depressants are taken in combination with one another, the potential for overdose is increased. The term used to describe this increased affect is 'synergistic'. A simple example using numbers: Normally if you add 2+2, you get 4. But when "synergism" is involved, 2+2 equals 6.

This  is why it is imperative that all physicians who are prescribing medication to you are aware of all other prescriptions. Failure to disclose medications to your physician can have devastating consequences.

If possible, CNS depressants should be avoided when taking Methadone. Common CNS depressants include: alcohol, benzo's (valium, xanax, librium), pain pills, heroin, morphine, demerol, fentanyl, oxycodone.


8.

What are the side effects?

During the first few days that your body is adjusting to the medication you may experience constipation, lightheadedness, dizziness, drowsiness, sweating, stomach upset, decreased libido, and nausea. If these symptoms persist or become bothersome, inform our staff, particularly medical personnel. 

To minimize constipation, increase your intake of fiber, drink plenty of water, and exercise. Stool softeners may be helpful. Ask your doctor or pharmacist about stool softeners and laxatives.

In the unlikely event you have a serious allergic reaction to this drug, seek medical attention immediately. Symptoms of a serious allergic reaction include: rash, itching, swelling, severe dizziness, or trouble breathing.


9.

Is it safe to take if I'm pregnant?

If you are pregnant and using opiates, methadone is not only safe, it is the "gold standard" of treatment.

Opiates are implicated in birth defects and abnormal fetal development. Methadone, however, is safe for the mother and for the developing fetus.


10.

How hard is it to stop taking the medicine?

Abrupt cessation is not recommended and will lead to withdrawal symptoms.

After you have stabilized on a the medication, participated in counseling, met some of your treatment goals, and meet the criteria for tapering readiness, you may want to begin the process of slowly decreasing your medication level. This process is known as Medically Supervised Withdrawal (MSW).

In MSW, the amount of medication is slowly decreased, allowing the body proper time to respond and adjust before the next decrease. The goal of MSW is to get to a point where you no longer rely on any opioid without returning to active use. Using opiates during this phase of treatment is not only ineffective and defeats the purpose of tapering, it could set treatment efforts back months or even years. Because of this, treatment professionals are normally extremely cautious and vigilant to protect their clients against relapse. 

Our goal is to help you accomplish your goal and ensure your success. If you succeed, we share in that joy, and if you fail, we share in that disappointment. MSW is not going to happen overnight. Diligence and persistence will yield greater rewards than hurrying through the process. Do it once, do it right, and you won't have to do it again.

When it comes to something as important as MSW, it is much better to focus on the process rather than the time frame. The time frame and the journey itself is unique to each individual.