WHAT IS METHADONE?

Methadone is a well-tested synthetic opiate medication that is safe and effective for the treatment of opioid withdrawal and dependence. When administered once a day, orally, in adequate doses, methadone can suppress opioid craving and withdrawal for 24-36 hours. Patients will become physically dependent on methadone but will be free from the uncontrollable, compulsive, and disruptive behavior seen in people who are addicted to heroin or other opioids.

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Use of illicit opioids creates a cycle of craving, drug use, and intoxication, which leads to withdrawal and continued use. This cycle, that repeats every 4 to 8 hours with the use of heroin or other opiate medication, is eliminated by methadone maintenance treatment. This is possible because methadone’s effects are realized more slowly and last much longer than is the case with most other opioids. Methadone works as an opioid agonist and occupies the brain receptor affected by opioids. After stabilization on the proper dose, methadone does not produce the rush or “high” associated with illicit opioid abuse. What is more important, an adequate methadone dose prevents all opioids from producing such effects.

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METHADONE FAQ

How does methadone react with other drugs or medications?
Methadone does not block the intoxicating effects of non-opioid drugs (sedatives, benzodiazepines, stimulants, alcohol, etc.).  Most overdoses occur when patients in treatment supplement their prescribed methadone with other central nervous system depressants.  Particularly dangerous when used in combination with methadone are:  Xanax, Valium, Klonopin, illicit methadone and large amounts of alcohol. Patients who are taking other medications should inform the CAP physician at time of intake.

What is the proper dose of methadone?
Doses are determined individually due to differences in opioid tolerance and metabolism. Each patient works with their counselor, nursing, and the CAP physician to determine their proper dose.

What is the expected length of time in treatment?
The length of time a patient remains in treatment depends greatly upon the patient. Methadone is meant to keep withdrawal and cravings at bay so the patient can focus on making life changes that are necessary in order to remain illicit drug free. The more time spent in treatment the more likely a patient is to remain illicit drug free and avoid relapse.

Are there any serious adverse effects with methadone?
When taken properly as prescribed long-term methadone treatment causes no adverse effects to any of the body’s organ systems.  Some side effects such as constipation, water retention, drowsiness, skin rash, excessive sweating, and alteration in sexual drive may occur in the early stages of treatment.  These problems typically decrease or stop altogether as the body adjusts to the methadone dose or if necessary, simple medical interventions may be offered.

Is methadone a substitution of one drug for another?
Opioid addiction is similar to other chronic illnesses like diabetes or high blood pressure which must be managed with medical intervention. Methadone is a long acting synthetic opiate, which makes it useful as a treatment medication for addiction to the fast acting opioids.  Methadone’s long acting nature keeps it relatively stable in the blood stream throughout the day. Opioid craving and withdrawal symptoms are suppressed when methadone occupies the same opioid brain receptors that short acting opiates such as heroin occupy.

Methadone maintenance not only treats craving and withdrawal, but addresses the life style of addiction. Methadone used as prescribed is safer and cheaper than having a heroin addiction and methadone is legal. Therefore a patient on methadone is freed up from having an expensive drug habit, usually maintained by illegal and dangerous activities. This relieves pressure from the patient and allows them to focus on personal health, family, and employment. Methadone treatment is not simply “substituting one drug for another.”

Does methadone impair mental function?
Methadone does not usually have adverse effects on mental functioning.  Patients on a stable dose of methadone are mentally sharp and comparable to non-patients in tests of reaction time, the ability to learn, mental focus, and in making complex judgments.  However patients who receive increases in methadone or begin new medications (even over-the-counter medications such as antihistamines) should use caution and not drive or operate machinery until they have determined that they are not experiencing drowsiness or other effects in mental functioning from an increased dose of methadone or a drug interaction. Methadone patients work in a wide range of occupations, and do well in handling other life responsibilities such as taking care of their family.

How are Medication Assisted Treatment programs, such as CAP, monitored?

Medication Assisted Treatment is the most regulated form of treatment for substance addiction in the U.S.  Both Federal and State regulatory agencies watch over the implementation of Medication Assisted Treatment programs. The Federal oversight agency, the Center for Substance Abuse Treatment (CSAT), requires programs to be accredited like other health care providers.  Medication Assisted Treatment programs are also inspected and licensed by the Federal Drug Enforcement Agency (DEA) and by the state in which they operate.

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WHAT IS SUBOXONE (Buprenorphine)?

From suboxone.com*

SUBOXONE is the first opioid medication approved under the Drug Addiction Treatment Act of 2000 for the treatment of opioid dependence in an office-based setting. SUBOXONE also can be dispensed for take-home use, just as any other medicine for other medical conditions.

The primary active ingredient in SUBOXONE is buprenorphine.
Because buprenorphine is a partial opioid agonist, its opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. SUBOXONE also contains naloxone, an opioid antagonist.

The naloxone in SUBOXONE is there to discourage people from dissolving the tablet and injecting it. When SUBOXONE is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.

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SUBOXONE at the appropriate dose may be used to:

  • Reduce illicit opioid use
  • Help patients stay in treatment by:
    • Suppressing symptoms of opioid withdrawal
    • Decreasing cravings for opioids

*Used with permission from Reckitt Benckiser Pharmaceuticals Inc.

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RESEARCH

Alcohol and Cocaine Use and Abuse Among Opioid Addicts Engaged in a Methadone Maintenance Treatment Program,  I Maremmani, MD, P P Pani, MD.  A Mellini, MD , M Pacini, MD, G Marini, M Lovrecic, MD, G Pertugi, MD and M Shinderman, MD  J Addict Dis. 2007;26(1):61-70.

Cytochrome P4503A4 Metabolic Activity, Methadone Blood Concentrations, and Methadone Doses, Shinderman, M, Maxwell, S, Brawand-Amey, M, Golay KP, Baumann P, Eap CB, Drug Alcohol Depend, 2003, Mar, 1:69(2).205-11

When “Enough” Is Not Enough:  New Perspectives on Optimal Methadone Maintenance Dose,
   Leavitt, S, Shinderman, M, et al, Mt Sin J Med Vol 67 N. 5 & 6, Oct/Nov 2000 

Optimizing Response to Methadone Maintenance Treatment Higher-Dose Methadone,  Maxwell,S., Shinderman, M. (Abstract Only) For full text, contact: J Psychoactive Drugs, Vol Apr-Jun, 1999

The “Dear Doctor” Letter,   Dr. Shinderman and Showalter’s (CAP’s) letter for use by their MMT patients to educate their physicians regarding the treatment of pain, drug interactions, anti-viral therapy and organ transplants as they are related to methadone maintenance.  MMT practitioners are encouraged to adapt CAP’s letter to their needs.

Methadone Symposium Part I, and Part II,  Mount Sinai Journal of Medicine Articles by Experts, 2000/2001

Methadone Dose and Retention During Treatment of Heroin Addicts with Axis I Psychiatric Co- morbidity, Icro Maremmani, MD, Orietta Zolesi, MD, Mirella Aglietti, MD, Giada Marini, MD, Alessandro Tagliamonte, MD, Marc Shinderman, MD, Sarz Maxwell, MD.,  J Add Dis Vol 19, No 2, 2000

Chronic Use Of Opioids and Antipsychotic Drugs: Side Effects, Effects On Endogenous Opioids, and Toxicity,  Mary Jeanne Kreek and Neil Hartmann, Annals New York Academy of Sciences pp151-172,  Rockefeller University, NYC, New York 10021