Frequently Asked Questions about Methadone Clinics

Is methadone medically safe?
YES. Research and clinical study, particularly the ongoing work at Rockefeller University, has demonstrated the unequivocal medical safety of long-term methadone; there are no serious adverse effects, no harmful medication interactions, and it is safe for pregnant women.

Are there any serious adverse effects with methadone?
NO. When taken as prescribed, long-term administration of methadone causes no adverse effects to the heart, lungs, liver, kidneys, blood, bones, brain, or other vital body organs. Side effects such as constipation, water retention, drowsiness, skin rash, excessive sweating and reported change in sexual drive may or may not occur in the initial stages of treatment. These symptoms generally subside or disappear as methadone dosage is adjusted and stabilized, or when simple medical interventions are initiated.

Is methadone a substitution of one drug for another?
NO. Methadone is not a substitute for opioids or any other short-acting opioid, and does not affect individuals in the same way. Methadone does not create a pleasurable or euphoric feeling; rather it relieves physiological opioid craving and is generally chosen by opioid-dependent individuals. Opioid addiction can be compared to other chronic diseases like diabetes. Methadone for the Opiate-addicted person is like insulin for the diabetic. Addiction doesn’t go away on its own, and o nly gets worse without proper treatment.

Is methadone used for heroin withdrawal?
Although it is used for withdrawal, it isn't its main use. Opiate addicts have withdrawn many, many times. Withdrawal isn't the problem. Staying off opiates is the problem. Methadone's main purpose is to replace the endorphins that opiate addicts' dysfunctional opiate receptor ligand system no longer manufactures (or manufactures to a lesser degree than the "average" person). Methadone is mainly used as a maintenance medication, and it is used to maintain those who have taken too many short-acting prescription opiates also.

Is methadone used as a painkiller?
Yes, it is. In fact, it is a very good painkiller. It is usually used at much lower doses as a painkiller than for maintenance for opiate addiction.

Does methadone impair mental function?
NO. Methadone has no adverse effects on intelligence, mental capability, or employability. Methadone treated patients are comparable to non-patients in reaction time, in ability to learn, focus, and make complex judgments. Methadone treated patients do well in a wide array of vocational endeavors, including professional positions, service occupations, and skilled, technical and support jobs. One recent study tested methadone patient's cognition, perceptual and motor functioning, reaction time, and attentional function, as well as performance of automobile driving behavior. It was concluded, confirming pervious findings, that methadone does not impair functional capacity.

What can you tell me about buprenorphine (Suboxone, Subutex)?
There is a new medication called buprenorphine (Subutex, Suboxone) that can be prescribed by doctors who have taken the proper training, but it may be difficult for some patients to switch from methadone to this medication. You should reduce your dose to 30 mg or less in order to switch over, or you could be thrown into withdrawal. If you are doing okay on 60 mg of methadone, you would probably do fine on buprenorphine. Anyone who needs more than 60 mg of methadone may not do well on buprenorphine.

Buprenorphine is more expensive than methadone because the pharmaceutical company still owns the patent; there is no generic drug yet. Your insurance company may pay for the prescription, but you may want to check this out prior to switching.

If you want to check into this, you should go to www.SAMHSA.gov. Click on Addiction Treatment, then click on Office Based Treatment Now Available, and finally, click on Physician Locator.

Who is eligible for Medication Assisted Treatment?
In order to be admitted to a clinic providing Medication Assisted Treatment, the Center for Substance Abuse Treatment/SAMHSA standards require: .. A minimum of one year of addiction to opioids as well as current evidence of opioid addiction. Special circumstances apply to opioid dependent pregnant women, who may be admitted without demonstration of the one-year minimum. .. Applicant must also be over 18 years of age. .. If the applicant is under 18, (s)he must have parental consent and demonstrate at least two prior treatment episodes in either drug free treatment or short-term tapering.

How are Medication Assisted Treatment programs monitored?
Medication Assisted Treatment is the most regulated substance abuse treatment alternative in the United States. Federal and state regulatory agencies monitor Medication Assisted Treatment programs through on-site program reviews. At the Federal level, regulatory oversight has been moved from the Food and Drug Administration to the Center for Substance Abuse Treatment, which requires programs to receive accreditation, a common requirement amongst health care providers. Programs also receive licenses from the DEA and the state in which they operate.

What are methadone patients to do when drug testing is required for a job?
Methadone does not show up as an opiate, one of the things for which companies test.  If they want to find out if you are taking methadone, they must check specifically for it.  Not all companies do.
If they do check for it and don't hire you simply because you are taking methadone, then you have a case.  Methadone patients are covered under the Americans with Disabilities Act (ADA), and you can file a grievance with the Justice Department.
If you don't get hired because you are taking methadone, you should try to get it in writing.  If you can't, that doesn't mean you shouldn't still file against the company.  Drug testing is usually the last step in the hiring process, so it is usually quite apparent what the deal is.

What is methadone treatment for opiate addiction?
Methadone treatment provides the chronic opiate dependent person with health, social and rehabilitational services, and medically prescribed methadone to relieve withdrawal symptoms, reduce opiate craving, and allow normalization of the body's function. Methadone treatment has been the most widely studied approach to opiate addiction and has been in use effectively for over thirty-five years.

Methadone treatment programs are staffed by professionals with extensive medical, clinical and administrative expertise. Patients receive individually prescribed methadone medication from a licensed medical staff member (physician, registered physician's assistant, registered or licensed practical nurse, or pharmacist). Patients routinely meet with a primary counselor (social worker, caseworker, or certified substance abuse counselor), attend clinic groups, and access medical and social services.

What is appropriate methadone dosing?
Methadone is a medication, and like all mediations, proper dosing is contingent upon the patient's individual needs. Taken orally, methadone is rapidly absorbed from the gastrointestinal tract, appears in plasma 30 minutes after ingestion, and peaks one hour later. Methadone is also widely distributed to body tissues where it is stored and then released into the plasma. This combination of storage and release keeps the patient comfortable by preventing opiate withdrawal. As is the case for any other medications (such as insulin or antihypertensives), proper methadone dosing is determined through the doctor-patient relationship, taking into account the patient's medical assessment, individual metabolic needs, and other medical conditions and treatments. Attitudes or opinions about methadone dosing that are based on rationale other than scientific evidence on effective dosing detract from the potential value of methadone treatment.

Is methadone treatment medically safe?
Research and clinical study, particularly the ongoing work of Dr. Mary Jeanne Kreek of Rockefeller University, has demonstrated the unequivocal medical safety of long-term methadone treatment.

Absence of Serious Adverse Effects: When taken as prescribed, long-term administration of methadone causes NO adverse effects to the heart, lungs, liver, kidneys, blood, bones, brain or other vital body organs. Minor side effects - constipation, water retention, drowsiness, skin rash, excessive sweating, and reported changes in sexual libido - may occur during the initial stages of treatment. These symptoms subside or disappear as methadone dosage is adjusted and stabilized, or when simple medical interventions are initiated. The myth that methadone is physically harmful has been shown scientifically to be unfounded.

Absence of Harmful Medication Interactions: No harmful interactions have been noted between methadone and other medicines. Patients with conditions such as HIV/AIDS, hypertension, diabetes, pneumonia, cardiac conditions, cancers, psychiatric disorders, etc., may be treated effectively with routine regimens and medications. Coordination of methadone with certain other drugs is necessary. Dilantin for epilepsy and Rifampin for tuberculosis increase the body's metabolism of methadone and thus prompt the need for methadone dosage increase. Opiate agonist/antagonist drugs (such as Talwin and Buprenorphine) should not be prescribed for methadone treated patients, as they will produce opiate withdrawal illness.

Safe for Pregnant Women: With proper stabilization, sexual function normalizes for both men and women in methadone treatment. Women can conceive and have normal pregnancies and deliveries. When properly prescribed for pregnant women, methadone provides a non-stressful, non-eventful environment in which the fetus develops. Because methadone crosses the placental barrier, babies born to methadone patients may at first be physically dependent on methadone, and may need to be weaned. Successful weaning using Paregoric is well established and uncomplicated. These children show normal physical, emotional, and cognitive development. The myth that methadone produces abnormalities in fetuses is unfounded.

Does methadone treatment impair mental function?
Methadone treatment has no adverse effects on intelligence, mental capability, or employability. Methadone treated patients are comparable to non-patients in reaction time, in ability to learn, focus, and make complex judgments. Methadone treated patients do well in a wide array of vocational endeavors, including professional positions, service occupations, and skilled, technical and support jobs. Methadone patients are lawyers, engineers, secretaries, truck or taxi drivers, roofers, gardeners, teachers, salespersons, architects, computer programmers, etc. One recent study tested methadone patient's cognition, perceptual and motor functioning, reaction time, and attentional function, as well as performance of automobile driving behavior. It was concluded, confirming pervious findings, that methadone maintenance treatment does not impair functional capacity.

Does methadone make a person irritable, angry, confused, etc.?
No, it will seldom make a patient irritable, angry or confused. On the contrary, it is great as an anti-depressant. And, unlike short-acting opiates, it boosts the immune system. Often doctors will refuse to treat an AIDS patient if s/he is on methadone. Many doctors are unfortunately ignorant of the fact that methadone, a long-acting opiate, is unlike short-acting opiates in that area (short-acting opiates depress the immune system). AIDS patients in particular should remain on methadone.

Methadone may make the patient sleepy, but once stabilized, there is no difference between a person on methadone and a "normal" person. Studies have shown that stabilized methadone patients can operate machinery, drive a car, etc. with no impairment. Most opiate addicts have a dysfunctional opiate receptor ligand system, and methadone normalizes it. That brings us to your next question.

What other pharmacotherapies may be useful in the treatment of opiate addiction?
Naltrexone, a non-addicting long-acting narcotic agonist, was approved by the FDA in 1985, for the treatment of opiate dependence. It is effective from 1 to 3 days depending on dosage level, and it blocks the euphoric effects of heroin and other opiates. Thus far, research has demonstrated that naltrexone may be most helpful in preventing opiate relapse once an abstinence state has been achieved.

Naloxone is also a narcotic antagonist, blocking the effects of opiate drugs, but has a relatively short duration of action. It is used as an 'antidote' in treating opiate overdose by rapidly reversing the effects of opiate drugs.

Buprenorphine, which was approved for the treatment of opiate dependence by the FDA during October, 2002, is another medication. Early clinical findings suggest that Buprenorphine, a partial opiate agonist, is safe and produces few side effects of withdrawal symptoms.

How is success in methadone and other pharmacotherapy treatments defined?
The primary goals are to help chronic opiate dependent individuals cease heroin use and lead more stable, productive lives. But, as knowledge about opiate dependence and effective treatment practices has grown, so too have the objectives of most methadone treatment programs, which also aim to:

• Decrease criminality and reduce the numbers of substance abusers entering the criminal justice system.
• Assist patients in addressing multiple substance abuse (including crack/cocaine addiction and alcoholism).
• Assure treatment for general health matters, especially those related to drug use, such as HIV/AIDS, tuberculosis and hepatitis.
• Promote patient employability and educational development.
• Identify and treat mental health problems and alleviate homelessness, family substance abuse, and child and family dysfunction.

Reduction in illicit opiate use is the ultimate measure of methadone treatment's effectiveness. But 'success' in methadone treatment is also observed by positive outcomes in the patient's health and social functioning.

Who is eligible for methadone treatment?
In order to be admitted to methadone treatment, Center for Substance Abuse Treatment/SAMHSA standards require:

• A minimum of one year of addiction to opiates as well as current evidence of opiate addiction. Special circumstances apply to opiate dependent pregnant women, who may be admitted without demonstration of the one-year minimum.
• Applicant must also be over 18 years of age.
• If the applicant is under 18, (s)he must have parental consent and demonstrate at least two prior treatment episodes in either drug free treatment or short-term tapering.

Methadone treatment is voluntary and available to persons of any sex, ethnicity, and physical or mental condition, including pregnant women and mentally ill substance abusers.

How are methadone treatment programs monitored?
Methadone treatment is the most monitored and regulated medical treatment in the United States. Federal and state regulatory agencies monitor methadone treatment programs through on-site program reviews. At the Federal level, regulatory oversight is being moved in a multi-year initiative from the Food and Drug Administration to the Center for Substance Abuse Treatment, using an accreditation model. Programs also receive their license from the United States Drug Enforcement Administration.

I want to get off methadone. What is the best way to do it?
If you really must withdraw from methadone, it is best to do so very slowly. You should not withdraw from more than 10% of your dose per week at doses over 100 mg. That is, if you are on 150 mg, you could probably safely lower your dose to 135 mg. Once you get down to doses under 100 mg, you probably won't want to drop more than 2 mg per week until you get down to 50 mg. Then I would say you should drop only 1 mg per week or 2 mg every other week. Of course, not everyone is the same, and some people can drop more quickly. Others might not be able to drop this fast.

And by all means, if you put yourself on a schedule but find that you don't feel well, stop dropping and stabilize until you feel better. You may even want to go up a few milligrams until your body adjusts. Don't decide that you want to be completely off methadone by the next season coming up because your body might not listen to you. It might tell you that you shouldn't be completely off until next year--or the year after.

Before you even attempt to withdraw, ask yourself why you want to do so. If it is because your counselor or your parents or your significant other wants you to, forget it. You won't be successful. You must be the one who wants it, and you need to have all your affairs in order. That means you need to be working or doing something that you like to do, your finances should be in order, and you shouldn't have any issues you haven't dealt with. If you are ill or under stress, you absolutely do not want to try to withdraw at this time.

Q's & A's from - "Regarding Methadone Treatment…and Other Pharmacotherapies." A Review.
Committee of Methadone Program Administrators, Inc., New York, 1999