Methadone

[Paprikat]

Hi. Just wondering if anyone can answer some questions for me:

Last Sat., a man collapsed in front of me while I was out for a walk. He appeared "drunk" to me, slurring speech, uncoordinated movements. I could not smell alcohol on him. One of my first thoughts was that he was diabetic. He was 36, well dressed and answered yes that he was diabetic and that he took a "white pill." He denied being a drug addict, denied taking anything, but did say he was hepatitis positive from a blood transfusion. While waiting for the paramedics, he pulled out his ID and a piece of paper fell out of his pocket, it was a receipt for methadone, which he suddenly remembered that he did take it. Well, the paramedics got there and I guess they knew this guy because they called him by his name, before I even mentioned it. I told the paramedic that he was hep positive and he replied, "they all are, honey." His blood glucose was normal....

So now I am wondering what is methadone and how does it work to wean people off drugs. Can you become addicted to it? How is it dispensed? I was under the impression that they have to take it at the clinic or the doctor's office. How did they let him leave in the condition that he was in?

In Vancouver we have so many heroin addicts, it is an epidemic. They say that 80% have hepatitis...

Thanks for any answers you may have....

[burger914]

Hello,

I hope I can answer some questions for you. I used to be a dispensing nurse at a methadone clinic. First off, methadone is an opiate and it is addictive. It is often used to detox other opiate addictions, but is mainly used as a long term treatment. Methadone decreases the patients urges, but doesn't get them "high" . Too high of a dose can make them tired and even cause respiratory depression. There are some people on methadone who are holding good jobs and have healthy families. On the other side of things, there are people who take the methadone daily and continue to abuse other drugs. This could have been a possibilty with the man you seen. Also, methadone is being sold on the streets illigally. Yes, it is the dispensing nurses job to assess the person when they come in for their dose, but we have know idea what they do when they walk out the door. Most methadone clinics do drug test as part a requirement to continue in the program. Also, at many clinics patients can receive "Take home" doses...some up to two weeks worth of methadone. But this takes a long time and a lot of clean urines as well as attending counseling. Hope I could help you out. Some people do not believe in methadone treatment programs, saying that it is just replacing one drug with another , which is true, but I have also seen it change whole families lives.

[Mary Dover]

Have no experience administering or monitoring tx of methadone at the outpatient mental health/substance abuse clinic where I work. But have had experience with people coming in SEEKING it, even DEMANDING it. In my state, these methadone tx clinics are few and far between. They, in fact, MAY provide tx that is beneficial to those seeking to get off heroin, but not having seen the individuals that have had positive outcomes, perhaps my opinion is biased by the negative behavior of those individuals simply looking to get a 'fix'. I do not work primarily with substance abusers, I am self aware enough to know that I don't have the objectivity it would require to be very therapeutic. ( that is stating it as professionally as I know how)

Mary

[fiestynurse]

Methadone is just as addicting as Heroin and most methadone programs have not been successful. You are just substituting one narcotic for another.

The Swiss have come up with another solution. Their program has been so successful that they are expanding it this year to other parts of Switzerland.

Swiss Heroin Maintenance Program Declared a Success

August 1997

After a three-year evaluation, Switzerland's state-distributed heroin maintenance program has been declared a success by law enforcement and health officials (Clare Nullis, "Swiss call heroin program a success," Boston Globe, July 11, 1997, p. A2; Associated Press, "Swiss call heroin giveaway program a success," Chicago Tribune (Southwest Edition), July 11, 1997, s. 1 p. 19; Clare Nullis, "Swiss heroin program cuts crime," Philadelphia Inquirer, July 11, 1997, p. A20).

The program provides daily doses of heroin to addicts at certified medical clinics and one prison. Swiss doctors administer the heroin for a $10 daily charge, which is waived for those addicts who cannot afford it. The country legally imported 440 pounds of heroin for the program, an action approved by the United Nations. During the three year time period 1,146 addicts were involved in the program.

When the program began three years ago, more than two-thirds of the addicts were involved in some form of criminal activity. An evaluation of the program by the World Health Organization shows that the number has now dropped to 3%. "I know of no other crime prevention program with such a big reduction in theft and other serious crimes," said Martin Killias of the Institute of Police Science and Criminology.

Felix Gutzwiller, M.D., a doctor involved with the program, told the Associated Press that the incidence of AIDS, hepatitis and other blood disorders dropped dramatically, and the number of deaths was cut in half. When the program began in 1994, Switzerland had an estimated 30,000 addicts.

The evaluation is available online at the Lindesmith Center at: http://www.lindesmith.org/presumm.html.