Q.) What is the history of methadone?

A.) Methadone is a synthetic opioid receptor agonist that was developed more than 50 years ago. The circumstances surrounding its development have been, and perhaps still are, associated with an interesting myth. Methadone was said to have been developed in response to an order by Hitler to develop an alternative to morphine, which was in short supply at the end of World War II. The trade name Dolophine was said to have been derived from Hitler’s first name Adolph. The truth is that methadone was discovered at I.G. Farbendustrie at Hoechst-am-Main in Germany, in the course of work on spasmolytic compounds during World War II. Because it lacked any resemblance to known compounds, its narcotic analgesic properties were not expected. Despite the morphine shortage, methadone was not used as an analgesic until the post-war period. It is believed that Germany’s failure to realize methadone’s value as an analgesic was because initial doses were too high and intolerable opioid side effects resulted. Concerning nomenclature, the more likely etymology is that Dolophine was derived from dolor for pain and fin for end.

Q.) How is methadone used?

A.) Methadone is usually available as a liquid - linctus or methadone mixture - which is swallowed. Tablets and injectable ampules are sometimes prescribed. Like many other medicines some of these prescribed drugs are diverted and become available illegally.

Q.) What are the effects of methadone?

A.) Methadone's effects are less powerful than heroin. However, Methadone offers a similar, less intense, absence of pain combined with euphoric qualities. The combined methadone effects are a sense of well being, feeling warm, content, drowsy, and untroubled. Physically, the pupils of the eye become smaller, body temperature drops, and blood pressure and pulse slow down. Methadone may also affect a persons ability to drive a car or operate heavy machinery.

Research has demonstrated that when methadone is given in regular doses by a physician, it has the ability to block the euphoria caused by heroin if the individual does try to take heroin. Despite methadone's role in the treatment of heroin addiction, it has addictive properties and also a high potential for abuse on the street.

Q.) What are the side effects of methadone?

A.) Patients on methadone maintenance report a wide range of methadone effects. A long list of methadone's effects has be compiled and is presented below. Some of these methadone effects are easily mistaken as withdrawal symptoms or as other medical conditions.

Methadone side effects include but are not limited to:

• drowsiness
• lightheadedness
• weakness
• euphoria
• dry mouth
• urinary retention
• constipation
• slow or troubled breathing

Methadone side effects that are more rare include but are not limited to:

• allergic reactions
• skin rash
• hives
• itching
• headache
• dizziness
• impaired concentration
• sensation of drunkenness
• confusion
• depression
• blurred or double vision
• facial flushing
• sweating
• heart palpitation
• nausea
• vomiting

Methadone side effects that are more uncommon include but are not limited to:

• anaphylactic reactions
• hypertension causing weakness and fainting
• disorientation
• hallucinations
• unstable gait
• tremor
• muscle twitching
• myasthenia gravis
• kidney failure
• seizures

Q.) Is methadone addictive?

A.) Many people go from being addicted to heroin to acquiring a methadone addiction. They continue with this "treatment" for years, fearing the withdrawal that will occur when they stop. Methadone does not have to be the way of life for former heroin addicts. Gradual cessation followed by a drug-free program of rehabilitation may be the answer for many sufferers.

Addiction to methadone can take several forms:

• conning a doctor into prescribing a higher dosage than is required
• taking more than the recommended dosage
• taking methadone in combination with other drugs, including alcohol
• using methadone as a 'top up' drug while continuing to take heroin
• selling prescribed methadone in order to buy heroin
  

Q.) What are the symptoms of methadone withdrawal?

A.) Many former heroin users have claimed that the horrors of heroin withdrawal were far less painful and difficult than withdrawal from methadone.

Methadone withdrawal symptoms include but are not limited to:

• sneezing
• yawning
• tearing of eyes
• runny nose
• excessive perspiration
• fever
• dilated pupils
• abdominal cramps
• nausea
• body aches
• tremors
• irritability

After several days of stabilizing a patient with methadone, the amount can be gradually decreased. The rate at which it is decreased is dependent on the reaction of the individual . . . keeping Methadone Withdrawal symptoms at a tolerable level is the goal.

Q.) What are the symptoms of an overdose of methadone?

A.) A methadone overdose is a serious medical emergency. In the event of suspected overdose call an ambulance. If the person is losing consciousness lie them on their side in the recovery position so that they will not choke if they vomit. Inducing people to vomit is not recommended because of the risk of rapid onset of CNS depression/unconsciousness which could lead to choking.

Symptoms of an overdose from methadone include but are not limited to the following:

• muscle spasticity
• difficulty breathing
• slow, shallow and labored breathing
• stopped breathing (sometimes fatal within 2-4 hours)
• pinpoint pupils
• bluish skin
• bluish fingernails and lips
• spasms of the stomach and/or intestinal tract
• constipation
• weak pulse
• low blood pressure
• drowsiness
• disorientation
• coma
• death
  

Q.) Why was methadone maintenance treatment created?

A.) When methadone treatment originated it was to be a 20 day process to help ease the pain of withdrawal from opiate addiction. Today methadone treatment facilities are run based on their financial success. They base their success on profit from their customers. Think about it this way, if a methadone treatment center is licensed to treat 200 individuals and they are currently only treating 199, you are not going to get off methadone. This is due to the fact that they need you as a customer. Their twisted outlook on helping fight the battle of drug addiction is atrocious. How can one possibly conceive that the trading of opiate addiction for methadone addiction is a step in the right direction. Methadone treatment clinics claim that they help in reducing the spread of HIV and Hepatitis due to the fact that their customers receive their "treatment" orally. This is a very naive philosophy, having done an extended amount of research it is know that many of these individuals not only inject the methadone they receive, but abuse other drugs as well.

Research that investigated the expectations and experiences of heroin addicts on the Methadone Maintenance Program has revealed a mixed bag of positive and negative responses to the program.

The results of the study, funded by the Alcohol and Drug Foundation - Queensland, were released at a Statewide videoconference to community alcohol and drug agencies today.

The study carried out by Dr Gayre Christie and Richard Hil of QUT and commissioned by the Alcohol and Drug Foundation - Queensland, has placed major emphasis on the perceptions of clients of the program, examining their motivations to take part in the program, their goals, and desired outcomes.

The research conducted in depth interviews with clients and staff of a Methadone Maintenance Program. While the study is not able to generalise the results across the State, the outcomes are strong indicators of the need for a review that extends the research to a larger sample of clinical staff and users in Queensland.

The reasons that people chose to participate in the program included the cost of heroin, their fear of going "cold turkey" to detox from heroin, their desire to break from their criminal activity to support their habit, and to obtain relief from pain. Their health and relationship issues also influenced their decision to participate.

Methadone was seen as the only realistic option available.

Their expectations were that methadone would eliminate the perceived stigma associated with being an addict, that they would receive support, help, and guidance from the clinical staff, and that their level of dependence would be reduced.

These expectations were only partly met. The expectation that was fulfilled was the high standard of professional help from clinical staff. They also reported the positive effects of having more money to meet the costs of food and rent, and the reduction in the health risks from needle usage.

However, their main areas of disappointment were the new health problems from the side effects of methadone, their increased dependence on a more addictive drug, the stigmatisation and privacy violations of regular attendance at clinics and pharmacies to obtain their dosage. They also reported that this resulted in depression and anxiety.

The need to obtain their daily doses of methadone also restricted their ability to obtain and maintain full time employment.

Q.) Why is methadone detox necessary?

A.) Methadone detox is invaluable to those who have tried to discontinue using opiates with methadone maintenance. Individuals are as physically dependent on methadone as they were to heroin or other opiates; this is not recovery from drug addiction. Detox from Methadone may be more difficult than other substances, but the end result is a body clean from drug polluting toxins.

Our methadone detox method is designed to cover all the parts of an individual's methadone detox. The removal of methadone residues is a key point in methadone detox. Without this process, methadone residues can remain in ones body and cause cravings for years after methadone abuse has ceased. A vital step in a successful methadone detox is flushing out the accumulated toxic residues, so that the individual no longer experiences unwanted adverse effects from the methadone they have taken.

Q.) Is methadone sold on the streets?

A.) Some addicts manage to resell the methadone they receive in order to buy heroin This and other illegal diversion have resulted in methadone joining the group of addictive drugs sold on the street.

Is methadone more likely to kill you than heroin?

-By Dr. Marcel Buster & Giel van Brussel, MD
 (Municipal Health Service Amsterdam)

   Based on literature and analysis of mortality figures, Dr. Russell Newcombe concluded that methadone programs as a form of harm-reduction possibly cause more victims than they prevent. We have doubts whether the conclusion about 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 program 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 program, it has to be carefully evaluated whether a patient has a clear and unambiguous heroin dependence. In methadone maintenance programs, 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 in a methadone maintenance program 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.The combination of these different drugs was probably 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.

Wrong quotes: Dr. Newcombe assumes that the drug related deaths among participants of a methadone program studied by Oppenheimer et al., were methadone related deaths (5). The correct quote should have been 18 of the 28 deaths were caused by overdose, an opiate as a primary overdose drug was mentioned in only 22% of the cases. Methadone is not mentioned as the cause of death of these persons. The suggestion that methadone would be the cause of death ('invariably methadone') is not based on the findings of Oppenheimer. Also, the suggestion by Godse et al. that deaths due to medically prescribed drugs were caused by methadone ('invariably methadone') is not completely true (6). The most frequently encountered drugs as main cause of death were barbiturates (287 of the 745 cases where the used drugs were known). However, the number of deaths where methadone was implicated was high; 107 cases. Dr. Newcombe is quoting Harvey with "up to 1977 methadone accounted for the majority of drug deaths attributed to strong analgesics." However, he did not quote the next sentence which says "in 1979 the position has been reversed with 11 heroin/morphine deaths to 2 methadone, possibly indicating a greater availability of heroin." (7). Interpretation: For estimating the death rates, Dr. Newcombe uses cumulative figures of drug users (only deceased persons are subtracted) from the Home Office. Drug users have been registered since 1968. He assumes that two thirds of this group still uses heroin. He multiplies this number by five and calculates an annual death rate of 6 per 10,000 heroin users, which is a very low mortality figure that is unlikely to be true. The low figure is probably caused by a considerable overestimation of the actual number of active heroin users. The calculated mortality figures on deaths caused by methadone are higher. Based on the calculation of the death rates caused by methadone, Dr. Newcombe accuses physicians of prescribing a deadly drug. He concludes that clients of methadone programs are at high risk of death due to an overdose. To draw conclusions like this he should restrict his study to clients of methadone programs. Dr. Marks already made an effort in this direction but he divided all methadone deaths by the officially registered methadone clients and found an astonishingly high mortality rate. (8). If he would have limited himself to those occurring within the population of methadone clients this mortality figure would have been much lower. There are studies were drug users in methadone maintenance programs are compared with drug users on a waiting list for methadone programs or drug users who left treatment. Grönbladh et al. for example, report mortality among clients of methadone programs to be 1.4 % per year; among the drug users on a waiting list mortality was 7.2% per year (9). Significantly, mortality due to heroin overdose in this group was high (4.8% per year). Also Davoli et al. report that the risk of overdose is lower during methadone maintenance. 'A high risk of overdose death occurred among subjects who left treatment compared with those still in treatment (odds ratio 3.55, 95% confidence interval 1.82-6.90)' (10).

Therefore, these figures suggest that participants of methadone programs 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 program or bought on the street. It also should be evaluated at what point during the course of the methadone program death takes place. Further instruction for 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."

In our opinion heroin users can get great benefit from participation in a well-implemented methadone program. Denigration of methadone programs before a profound study of the real causes of the observed methadone deaths has been performed carries the risk that the baby will be thrown out with the bath water.