1. Methadone is a medication used to treat opiate dependence
3. Opiate dependent people who are in treatment with methadone live longer
4. Long term treatment with methadone is better than short term treatment with methadone
5. A low methadone dose is not necessarily the best methadone dose.
6. Methadone is the gold standard treatment for pregnant women who are opiate dependent
7. Methadone has drug overdose risks and benefits that you should understand
8. Methadone treatment requires a strong commitment to recovery
9. Methadone-assisted recovery is real recovery
10. Methadone is the single most effective treatment for opiate dependence
If you want to get the maximum benefit from methadone treatment, then you have to be at the right dose.
The preferred term is a “therapeutic dose.”
Studies show that most methadone patients have better treatment outcomes at higher doses. In other words, the therapeutic dose is likely to be found at the high end of the dosing range rather than the low end.
Why would this be?
Think about what the dose needs to accomplish.
At a therapeutic dose you should not experience any significant symptoms of withdrawal. Any drug cravings should feel manageable. And your dose should be high enough to block most of the effects of other opiates.
For an opiate dependent person who has been using a significant amount of opiates over an extended period of time, it takes a significant amount of methadone to achieve these effects.
And that is okay.
The same stigma-driven thinking that puts pressure on methadone patients to terminate treatment prematurely, also puts pressure on methadone patients to accept a less than therapeutic dose of methadone.
Methadone patients often feel pressure, including internal pressure, to “get by” on the lowest methadone dose possible.
The feeling is, “I/You shouldn’t be on methadone at all, but if I/you must be on methadone then i/you should be taking as little methadone as possible.”
But the goal is to enjoy the best treatment outcomes. The goal is to be abstinent from illicit opiates. The goal is to feel well and feel normal. The goal is to have a stable home, work and social life. The goal is to be at less risk for HIV, hepatitis C, incarceration and drug overdose.
We know from research, and the experience of thousands of methadone patients, that this kind of success is not likely to be achieved by placing the opiate receptor sites in your brain on a starvation diet.
So, don’t let anyone make you feel like you are “med seeking” or engaging in “addict behavior” just because you are asking for an increase in your methadone dose. You and your methadone doctor should be working together to find the right dose for you.
If you are experiencing withdrawal symptoms, you should talk to your doctor about increasing your methadone dose.
If you are experiencing powerful drug cravings that you aren’t able to manage, you should talk to your doctor about increasing your methadone dose.
It often takes a higher dose to eliminate cravings than it takes to eliminate withdrawal symptoms, so it is likely that you will find your therapeutic dose by finding the dose at which you no longer have cravings.
A higher dose is also more likely to block the effects of other opiates, making it less tempting to use other opiates.
Part of the fear some people have about methadone in general, and higher doses of methadone in particular, is that the medication will cause euphoria (a feeling of being high) or sedation (especially to the point that it causes nodding off).
Certainly, methadone can cause euphoria if taken by a person who has not built up a physical tolerance to opiates. But methadone is a slow-acting opiate, so it still wouldn’t cause the rush of euphoria associated with fast acting opiates like heroin or oxycontin (especially injected heroin or oxycontin).
Contrast this with the effect of methadone on a patient participating in methadone maintenance treatment.
The methadone patient begins treatment at a methadone dose that is low enough to allow the person to go into some level of opiate withdrawal (often 30 or 40 milligrams per day for someone with a significant tolerance to opiates). Usually, this dose isn’t enough to even make the patient feel well, to say nothing of high.
From this point, the dose is raised (often every day or every few days at first) until the person is at a dose where they are no longer experiencing symptoms of withdrawal, and are not feeling cravings (often 60 to 120 milligrams per day, but sometimes significantly more or less).
Once the patient arrives at a therapeutic dosing level, the patient stays at this dose for an extended period of time.
Over time, the medication builds up in the patients body in a good way, so that the medication is always available to the opiate receptor sites in the brain. The body becomes accustomed to this dose of methadone.
A methadone patient may experience periods of sedation after taking their methadone dose during the period of increasing doses. But once the patient is taking the same dose every day, they are unlikely to experience significant euphoria or sedation.
A methadone patient at a stable therapeutic dose is able to function normally. They have normal motor skills and cognitive skills. They can do anything that other people can do, including drive.
A methadone patient who is not at a stable and appropriate dose may feel drowsy, and may not be safe to drive. Use common sense. If you aren’t able to function normally, then you aren’t at the right dose. Talk to your doctor about lowering your dose.
A methadone patient at a stable and appropriate dose feels well because all of the opiate receptor sites in their brain constantly remain occupied and satisfied. And they function well because they are not high, not sick, not craving and not sedated. They just feel normal.
Feeling normal, means you can get on with the rest of your life.
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Another informative post. I happened to write about methadone today too.
Just found your site today, and I’ve found it very helpful and informative. Just one quick question, is methadone designed to be used for the rest of an addict’s life?
Hi jj…glad you found the site helpful!
Research shows that people have the best outcomes if they remain in medication-assisted treatment with methadone for at least two years. Methadone is used as a detox medication, but relapse rates remain high as with all forms of detox (at least the detox itself is more comfortable with methadone).
Many people stay on methadone for a period of years…sometimes 20 years or more. People stay on methadone for a long time because the treatment is working for them, and because long term use is generally safe.
I urge people to continue methadone treatment for as long as they want to continue methadone treatment. At a minimum, I urge people to continue methadone treatment:
1. as long as they have corrections involvement (they are on probation or parole) because the incarceration risk is high if they discontinue methadone treatment too soon and relapse
2. until they are stable in all major areas of their life
3. until the times in life they were using seem like they must have been lived by another person (in other words they have so moved on that they don’t feel connected to that life anymore)
And I encourage them to taper slowly, at their own pace, over a period of six months or more.
They should feel free to stop and hold at a dose until they feel ready to reduce the dose again. And if they feel any sense that their recovery is destabilized, they should consider returning to a higher dose for a while.
The goal should be to avoid the feelings of withdrawal/cravings that can come with a taper that is moving too quickly because this can often result in relapse.
Thank you for your question!
Thank you for your response. I’m just kind of at the end of my rope with a friend who I consider my sister. Here’s a little bit of what I’m going through with her right now, which is why I’m getting information before I just cut her out of my life.
She has been in a methadone treatment program for three and a half years, and while she is no longer popping pain pills like candy, the methadone has had horrible effects on her (lost her teeth, she’s almost “zombie-like” at times). She was going through an “administrative withdrawal” since she wasn’t paying the bills at the clinic and was telling me about some of the side effects of methadone withdrawal, and it seems to me to be worse than the opiate withdrawal. As a matter of fact, she recently told me that while that was happening, she has since paid the bill and is back on the program, she was so “sick” that she was snorting heroin to help her. I am so pissed off at her that she ran for the drugs as soon as things got a little hard and I’m really worried about her daughter. She never went to rehab or therapy to deal with the issues behind her addiction, and the only reason she got help in the first place was because she was pregnant. I’m not sure if it’s time to cut her out of my life, but it’s been many, many years of ups and downs, and I’m tired. I love her and I’ve known her for over twenty years, but her addictive behavior has been going on for almost 10 years now, and I have reservations about having an addict around my teenagers. They know what’s going on with her, and they also know that I told her if she started using again, I was done. Her “real” family is no help, as they are almost all addicts themselves, and are enablers. Right now her brother and his girlfriend, who are both junkies, are living downstairs from her and her daughter, with their (my friend and her brother) parents. She is in a very unstable environment and is not doing anything to get out of it, and I’m very worried that she’s going to start taking pills again, as I know for a fact that she’s started smoking weed and drinking again, as a way of dealing with her family. My sister and I have tried to help her as much as we can, but I think we’re fighting a losing battle and as cold as it sounds, we have families and problems of our own, and she’s kind of making things worse. My husband and I are having a serious battle right now because I want to rent her a house we own, just so she can get away from her family. She does make a steady, livable wage, but my husband’s afraid of letting an addict live in this property again (we had a bad experience with a relative of his a few years ago, and both agreed not to let anyone with drug issues rent from us) and I just want to get her out of this situation.
I’m not exactly asking for advice, but sometimes a stranger’s perspective is needed. Any thoughts would be welcome, and I’m a big girl, so I can take any criticisms directed at me. Thank you.
jj –A couple of thoughts…
First, methadone doesn’t hurt your teeth. If her teeth are falling out, it is for the same reason that people who are not in methadone treatment sometimes lose their teeth (lack of good dental care, gum disease etc.).
People on a correct and stable dose of methadone should not be “zombie like.” It’s hard to say if what you are describing is related to her methadone dose or not. People with serious trauma, or other mental health issues may have a flat affect. Or other substances may be an issue.
Isn’t it telling that her medication is used by the clinic as a bill collection mechanism? Don’t pay your bill? See how withdrawal feels!
Can you imagine if an unpaid medical bill resulted in a reduction in someone’s insulin dose, or chemotherapy dose? But people who are opiate dependent are treated very differently than other patients.
Obviously, the decision to withhold medication was a financial decision by the clinic, not a therapeutic decision. This placed her at a foreseeable and serious risk for relapse. And she did relapse to heroin use. This also placed her at high risk for drug overdose.
In my opinion, this is professional negligence. I wish treatment programs were held more accountable, but the victims of their negligence have few resources to hold them accountable.
I can’t tell you whether or not you should distance yourself from her. But your friendship is not enabling her addiction, and your withholding your friendship is not going to enable her recovery. You don’t have that much power.
I don’t know about the specifics of your situation, but there are many opiate dependent people that I would be comfortable having interact with teen children. Her opiate dependent status alone is not a reason to keep her away from your children. Maybe your reservations are based on more than that?
Also, keep in mind that your teens are observing how you talk about her and how you treat her. This is your chance to model your values to your teens.
You have a chance to show them how to treat someone with addiction issues with compassion and respect, support them appropriately –and set appropriate boundaries for yourself and your family at the same time (for example, it may not be sending your teens the best message to refer to people as “junkies.”)
You have a chance to show them that it is safe to talk to you about drug use. You have a chance to help them learn about opiate dependence, and recovery. They may need this information some day –maybe when they are parents.
Keep in mind that if you rent her a house, you aren’t just her friend any more, you are her landlord. It sounds like the friendship is strained already.
A rental house is a serious investment, and you have a family to take care of. You should run your rental business like a business, or you may lose your business.
You’ve also identified that renting to her will likely cause conflict in your marriage.
If she makes a livable wage, she can get an apartment without your help.
If she needs financial help (and you choose to help), it would be safer to rent to a tenant with good credit and a good rental history and help your friend with money rather than a place to stay.
You could help her pay a security deposit or something like that if that is the barrier to her getting her own place.
It’s good to set boundaries that protect you and your family, and it is good to support your friend in recovery to the extent that you are able. These are not mutually exclusive. Just own what you are doing for yourself and your family, and don’t try to present it as something you are doing “for her own good.”
JJ I agree very strongly with the advice you were given by RecoveryDesk. I am a Certified Methadone Advocate and recovery educator, and I administer two major websites for MMT patients. I also have a degree in nursing and training as a substance abuse counselor.
A couple of things I would add…..
You say she is drinking and smoking pot. Keep in mind that methadone ONLY treats opiate addiction. It does NOT treat alcoholism or dependence on other drugs. And sadly, the fact is that many MMT patients are poly-addicted (addicted to more than one drug). This complicates treatment.
Most centers that treat other addictions will not accept methadone patients. They (incorrectly) view methadone as “active drug abuse” and will not treat the patient unless they agree to cease their methadone immediately. Of course, doing so would make them VERY VERY ill and put them at very strong risk of relapse, not to mention it would make it nearly impossible for them to participate in any meaningful way in treatment due to being so sick. There are only a handful of places in the US that will continue MMT while treating other addictions. So if you feel she has an actual addiction to one of these other substances you may want to look into that.
Also, as Recovery Desk stated, methadone does NOT cause tooth decay. This is a street myth. Like ALL opiates, methadone reduces the flow of saliva, which can create “dry mouth”–an environment that is conducive to bacterial growth. However, methadone itself does NOT “rot the teeth”. Careful oral hygiene, as well as taking care to remain hydrated and using products such as Biotene (a line of dental products made just for people who take meds that cause dry mouth–available anywhere) should prevent any problems from developing. Many folks neglect their teeth terribly while using. Then, when they get into treatment and begin taking care of themselves, they go to the dentist where the years of neglect and rot are discovered. And they blame……..the methadone! When in fact it was the years of neglect and not methadone at all. There are many street myths about methadone, such as that it “rots your teeth”, “gets in your bones”, “turns your internal organs orange”, “was named after Hitler”, etc., none of them true.
One other thing–you mentioned how she returned to heroin use during admin. withdrawal and that it seemed to you that the methadone withdrawals were worse then heroin withdrawals. I would like to address this.
Methadone WD’s are not “worse” than heroin WD’s–they simply last longer, due to methadone’s long half life. The same traits that make methadone such a good choice for maintenance (stable levels in the blood over a 24 hour period, etc) make it lengthy to withdraw from. However, if we could “cure” patients by simply getting them off the drug, then all we would need to do is lock them in a room for a few days (as with heroin) and let them out once the drug is out of their systems and they would be cured. But it doesn’t work that way.
During an administrative withdrawal, the patient is tapered off at a rate FAR faster than they should be. As a result they are usually made VERY ill within a few days’ time. While I am not excusing her behavior, please know that she was not just dealing with a “little bit” of discomfort–I am sure she was dealing with severe physical symptoms as well as the mental terror that comes from such an event, and I agree with Recovery desk that this treatment is immoral and unethical in the extreme. Just about everyone relapses under such circumstances.
You mentioned that she was not addressing the “reasons” she used in the first place. Most rehabs and 12 step programs try to convince patients that they are using because of various “character defects”–i.e., selfishness, self centeredness, etc–or because of some childhood abuse issues–and that this can be cured by prayer. meditation, making “amends” to those wronged, making lists of every sin you ever committed, and so on. This is not based on ANY scientific evidence and in fact can be harmful to many. Lip service is given to opiate addiction being a disease, but then it is treated as a moral flaw. Success rates for this type of treatment are VERY VERY low. This is due in large part to the IGNORING of the medical aspect of the disease.
Those who have abused opiates over long periods of time usually experience changes in the brain chemistry–specifically in the brain’s ability to produce endorphins, our natural opiates. Once “clean”, it can be some time before the brain begins to produce endorphins again, during which time the pt. experiences severe depression, anhedonia, anxiety, cravings, exhaustion, irritability. For many, this disruption in brain chemistry may be permanent–it may never return to normal–or, they may have never had normal endorphin production to begin with, and were trying to self-medicate the condition with opiates. These folks may require long-term—even life long treatment with methadone to stabilize and normalize the brain chemistry, in the same way that a diabetic whose pancreas no longer produces insulin needs it from an outside source.
Once this chemical imbalance is treated, many patients will return to a normal life (i.e., whatever was normal for them before drug abuse began) without requiring further interventions such as counseling, group attendance, etc. Many patients were simply using to self medicate the chemical imbalance, not because they were “selfish”, wanted to “party”, or were suffering from abuse issues.
Others may require counseling and referrals for various things. I don’t know your person’s situation and so cannot say what she may need–but not everyone is using for the same reasons.