What
is methadone dependency?
As
an opiate, regular use of methadone causes physical dependency
- if you've been using it regularly (prescribed or not)
once you stop you will experience a withdrawal. The physical
changes due to the drug are similar to other opiates (like
heroin); suppressed cough reflex, contracted pupils, drowsiness
and constipation. Some methadone users feel sick when they
first use the drug. If you are a woman using methadone you
may not have regular periods - but you are still able to
conceive. Methadone is a long-acting opioid; it has an effect
for up to 36 hours (if you are using methadone you will
not withdraw for this period) and can remain in your body
for several days.
Personal
stories of methadone withdrawal:
~I've
been on both ends of withdrawals, heroin and methadone,
every patient of methadone will always tell you the same,
as I do; I can kick heroin anytime, but methadone that is
something else. In 15 yrs of heroin addiction, I've kicked
3 times, 'cold-turkey'. In 10 years on methadone I've never
kicked methadone.
Once
I landed in jail, I had to do 72 hours of jail time before
I got to see the judge. I was literally on the floor screaming
my guts out. About 12 hours before I was to see the judge,
I demanded to be taken to the hospital, I just couldn't
take it. I was cuffed, and looking like a 'chair' was glued
to my back, I limped to the ambulence, since I couldn't
lift my leg to climb into the back, the police grabbed me
on both sides and shoved me in like a sack of potatoes,
I fell flat on my face. The doctor realizing my condition
and that it was severe, gave me a shot of methadone. The
relief was immediate.
I
was returned to the precinct and 2 days later I was in the
same condition! Never did I go through such hell in all
my days.
The
intensity of methadone withdrawal is just too much! I could
never do it, by the way, about 5 years ago one inmate went
into convulsions and upon falling, he hit the metal bars
and died!
~On Sunday morning, March 30, I took my last dose of methadone.
I have been on 80 mgs of methadone for the past 6 months.
My
doctor, an anesthesiologist, writes prescriptions for 125
tablets. This lasts 15 days. I signed a contract with him
that basically says I will use the same pharmacy, I will
not get meds from other physicians, and if I run out before
the 15 days is up I just have to go without. I didn't mind
signing the contract at all, and I have abided by all the
stipulations. I called him for a refill on Friday. No response.
I called again on Saturday. No response. I called his home
on Sunday. No response. On Sunday I took my last dose. I
hate anything having this much control over me. I find it
very demeaning to be so dependent on a bottle of pills.
On
Monday I called his office. They informed me that he was
on vacation this week. Panic descended . . . and so did
withdrawal symptoms. At first I just got kinda nervous,
jittery. My doctor has told me that methadone is not addicting.
That is contrary to everything and anything I've ever heard
or read about the drug. I never questioned him why he thought
methadone wasn't addicting. I was hoping I'd never have
to find out. What my body went through for the next 48 hours
was one severe blow after another. I kept trying to tell
myself I just had the flu. Just crawl in bed for 3 days
and sweat it out. Of course I knew this wasn't true but
I was going to play whatever mind game it took to get me
through this. After the jitters, the muscle contractures
started. It felt like the muscles in my legs and then in
my arms were like rubber bands, being stretched and pulled
to their max and then constricting to a shape that wasn't
natural. Then came the sweats, diarrhea, hallucinations.
I
remember trying to dial the phone. It was a number I've
called a thousand times before, only now I couldn't remember
it. For that matter, I couldn't even hold the phone . .
. I kept dropping it. My muscles were out of control. The
pain that led me to methadone returned with a vengeance.
In a strange way it was like an old friend. I knew it well
and understood it completely. The combination of withdrawal
and pain was too much. The all too familiar thoughts of
suicide were returning.
It
was now Tuesday morning. I called the pharmacist and explained
the situation. By 1:10 PM I had 8 methadone tablets. I took
the entire dose at once all 8 tablets. Within 2 hours my
muscles had stopped screaming, my head was beginning to
clear, and the pain was lessening.
It's
now Thursday morning. I'm still not back to myself . .. .
but much better. The assault on my body was indeed very
traumatic . . . I lost 7 pounds and am still very shaky.
Addiction is indeed a dangerous thing and should be avoided.
I must admit when I was in the throes of withdrawal there's
not much I wouldn't have done to relieve the symptoms.
What
are the dangers of methadone?
Following
is an article by two doctors addressing this question
Is methadone more likely to kill you than heroin?
By Drs Marcel Buster & Giel van Brussel, MD
Municipal Health Service Amsterdam
Based on literature and analysis of mortality figures Dr
Russell Newcombe concluded that methadone programmes as
a form of harm-reduction possibly cause more victims than
they prevent. We have doubts whether the conclusionabout
methadone is fully justified. Looking at the mentioned literature
gives a one-sided view at the problem. Moreover, the conclusions
drawn are beyond those justified by the results of the analyses.
Several points of debate come to mind:
Methadone is not an innocent substance; 'one's methadone
maintenance dose is another's poison' (2). A regular user
of opiates develops a certain tolerance. Therefore, it is
possible that a tolerant person can function normally with
dosages which can be fatal to a non-tolerant person. Also,
methadone dosage in the case of first entry to the programme
has to be evaluated carefully. It is wise to begin with
a low dosage that has to be increased slowly in the course
of weeks or even months. At entry to the programme it has
to be carefully evaluated whether a patient has a clear
and unambiguous heroin dependence. In methadone maintenance
programmes, methadone is dispensed to tolerant persons,
moreover, this tolerance remains high because of daily use
of methadone. Therefore, it is not surprising that deaths
at the King's College Hospital caused by methadone were
not those of participants of a methadone maintenance programme
but were those of 'recreational' users of illicit methadone.
In cases where more than one drug is used, the drug responsible
for death due to overdose is difficult to establish. Moreover,
the same drug prescribed by physicians can also be bought
on the street. In seventy percent of the deaths due to overdose
studied in Glasgow and Edinburgh a combination of different
drugs was found (3).
Prescribed
drugs such as temazepam were often encountered in deaths
in Glasgow. However, among only 14 of the 34 persons who
died in 1992 and where temazepam was found, this was prescribed
by their physician. Because of the presence of other drugs
it is not clear whether temazepam really caused the death
of these people. Probably the combination of these different
drugs was fatal to them. This was also the case with the
methadone deaths in Edinburgh. However, in Edinburgh, the
authors could not determine whether methadone was prescribed
or not. Both Hammersley and Obafunwa report that heroin/morphine
deaths seldom occur in Edinburgh (4). 'The fall of the deaths
due to overdose in the Lothian and Borders Region of Scotland
(LBRS) after 1984 reflects in part the strict policing that
took place, in particular in the Edinburgh area'.
'The
increase of methadone deaths is probably due to the introduction
of a street trend to use this agent as a substitute to heroin'.
The author suggests that methadone deaths are mainly caused
by the use of illicit methadone.
Therefore, these figures suggest that participants of methadone
programmes are at lower risk of death due to overdose. However,
this does not mean that methadone is an innocent substance.
The high and increasing number of methadone deaths in Britain
is alarming and certainly needs more attention. The first
priority should be to establish whether the methadone causing
death has been prescribed within a methadone programme or
bought on the street. It also should be evaluated at what
point during the course of the methadone programme death
takes place. Further instruction doctors prescribing methadone
could be necessary. The use of non-prescribed methadone
without medical supervision can lead to high risks, especially
when it is used as a substitute for heroin in order to get
a 'high' instead of to prevent withdrawal symptoms. Physicians
have to be aware of this danger and they should make sure
that the prescribed methadone (as well as other psycho-active
drugs) does not end up in the 'grey market'.
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