Does Methadone really help prevent relapse?

jackstem · May 10, 2010

In an article titled: "Risk Factors for Relapse in Health Care Professionals With Substance Use Disorders", (JAMA, March 23/30, 2005--Vol 293, No. 12), their conclusion was:

The risk of relapse with substance use was increased in health care professionals who used a major opioid or had a coexisting psychiatric illness or a family history of a substance use disorder. The presence of more than 1 of these risk factors and previous relapse further increased the likelihood of relapse. These observations should be considered in monitoring the recovery of health care professionals.

In another study, "Methadone at tapered doses for the management of opioid withdrawal", (Amato L, Davoli M, Minozzi S, Ali R, Ferri M., Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD003409. DOI: 10.1002/14651858.CD003409.pub3), their conclusion was:

In the one study that compared methadone with placebo, withdrawal symptoms were more severe and more drop outs were found in the placebo group. The methadone starting dose ranged from 20 to 58 mg/day (mean 29 mg/day). Withdrawal symptoms were reduced with methadone but the majority of people relapsed to heroin use. There was no clear difference in completion of treatment or abstinence at follow up with the different agents.

The good news regarding relapse for addiction is that it's similar or better than other chronic diseases (when properly treated and managed). Here is a graphic that shows rates of relapse for several diseases, according to the National Institute on Drug Abuse (NIDA):

Is there any plan for tapering until he is finally off of the methadone?

Jack

sharona97, BSN, RN · May 12, 2010

Hey SillyRN,

Thanks for the post. I'm not sure if there is some confusion as to who has chronic pain and who is "the addict" in our family. I have chronic pain. I am not on methadone.

D, is my only son, now 31 and had been using all drugs starting from age 14 to age 30. We (his parents) answered his first distress call to us when he attempted suicide. We found him and did everything a novice to drug addict parents would do. We went everywhere including the ER every Holiday weekend for a year, which ultimately left us with no choice but to ask the Dr to sign a commitment referral and so he did.

D was under court commitment for 6 months in a rehab (lockdown) and then was moved to a ERTS facility for another 90 days. Then rather enter a "sober house" for 3 months he asked to come live with us. He lost his house, his car, his job, his wife, and after sitting with the counselors from an ERTS facility we realized his true fear of relapse. Oneof his relpases happpened at a sober house after a previous hospitalization.

I started this thread because I wanted to know about Methadone and it's uses for recovering addicts acute and longterm.

I disagree with your opinion on all people on methadone will relapse greater than before. I don't disagree with your opinion on methadone in general.

D's quality of life has improved from near-death to actively seeing a psychologist, psychiatrist, counselors at the Methadone Clinic, county social workers and support through his NA meetings.

Interestly enough the The TV show 20/20 just finished filming a documentary on methadone clinics that will show in about 2-3 months. It was filmed at the Methadone Clinic my son goes to. And the resaon for that they choses D's clinic is because they have the highest success rate for non-relapse patients. Their numbers are supposedly the highest in this country for replacement therapy.

D has made all of his own decisions for his recovery. He has followed our House rules (basically you use and you are out) and has now gone back to 120mg of Methadone for his perfuse sweating. The cravings are reduced. Also just as important is the follow-up care he's getting on his psyche. He started at 14, so we have a 31y/o who has the cognitive thinkin of a 14-15 year old.

Dr.s have discovered a underlying mental illness of severe depression and sever anxiety that he apparently felt as a teen, that I regret I did not know about. Smokin pot called him down apparently. Then he kept going furter up the ladder until he fell off from street drugs and Rx's of oxycodone.

My comment about having to use opiads in the future was a discussion he had with the Dr. at the the Methadone Clinic as D still has the fear of relapse and wondered what would happen if he got into a car accident. How do other's handle it, what if he had to have surgery? How do others handle it. D is very proactive in asking upfront questions. And his purpose is to have an even-keeled life as much as possible without the use of drugs. His heroin habit was $500/day. Everyday is different for him and for us. Some days he's in a panick attack most of the day, some days very depressed, some days not too lucid. It's a slow process but everyone is moving forward. D had never ruled out getting off methadone. He just doesn't know when it would be the appropriate time. There are alot of physical issues we've been able to treat (the Dr.'s). This kid has HTN, Hyperlipidemia An old eardrum surgery will need to be looked at again, he's been to the dentist and has had some teeth pulled and now he's looking at possible prostate surgery for a atypical problem for someone at his age. This could possibly prevent him from having children in the future (after surgery), thank the Lord no cancer.

So I'm feeling really good today about things. I pray his cognition will return to full status but that is an unknown. He's always been super talented with music and went to a private music school for college and has worked as a recording engineer with some moderate success. He just received some music beats from a national artist for the next album. This artist is Christian (his gendre in music is not) and when he finally hooked up with D he was right there as a friend and client who believes in him. D doesn't have to many friends left. He tells me today they weren't my friends. Ya think?????

So anyway, I am happy that you shared your story here, I really do mean it when I say I take all things in to help MY perspective. But it is really D making the decisions and for the past 18 of 20 months he has been clean from heroin and street drugs.

Take Care,

Sharona:nurse:

sharona97, BSN, RN · May 12, 2010

Hi Jack-

Good to see your post.

As I mentioned to SillyRn D does not know when that time might be. His cravings at 90mg were significant and then the perfuse sweating. He was pretty bummed out when he finally agreed to go up in dose to see where a dent could be made in the withdrawal sx's. He is at 120mg now. Doing better with sweating, and for the most part cravings. However he had a "pretty bad craving the other day ", "with the phone in my hand", and he made it through.

He believes when the underlying problems in mental health are fully discovered and treated he and his doctors will be able to make an informed decision.

One current theme concerning Methadone I'm seeing is that the stigma for it's use is almost as rempant as the stigma for an active user drug user using. I have come to believe that the underlying factor(s), if any, and most times are, need to be discovered, corrected or treated. With treatment for the depressiona and anxiety and any other DX and maintenace, I believe that D will come to the day where he will say I'm ready now. The psyche is so powerful and the potential of the good things a psyche can do is lost so easily with this drug use. At first it was very frightening to me, because I didn't get it. I'd think what's up now, he's off the drugs, but who is this guy? And in a very candid conversation with D he told me Mom I know there is something else going on and he has a 2 hour psyche appointment coming up.

There is still alot of shame instilled in his thinking, as well as lower cognitive reactions and thinking. I see improvement weekly.

All of the outside professionals helping him have bben a blessing. As D is on MA for insurance reasons, he is allowed only 26 visits a year to his psychologist. She is going to see him on a comp basis. She feels he will need at least another year to year and a half. So Good to hear from you!!!!! Take Care Sharona:redbeathe

jackstem · May 12, 2010

Thanks Sharona...:redpinkhe back at ya!

Regardless of how much tolerance builds, the studies I've read (and there are always exceptions...and as an addict, we ALL think we are the exception!) show that cognitive and manual skills are always "off", even if it's just a "hair". I have no argument one way or another when it comes to opioid replacement therapy, UNLESS you are in a profession where alterations in cognitive and/or physical skills are part of the professionals practice. My brother-in-law is a truck driver. He follows whatever the DOT rules and regs are for testing, etc. If he's had a single beer on the weekend and they call him the same day to see if he would like to drive a load somewhere for the OT, he turns them down because he doesn't want to take the chance of having a problem.

I've always been pretty choosy about having the pilot of the plane I'm on not being on methadone or other ORT meds while flying.

Also, cravings are worst during taper and for the first several months of being off whatever the drug of (no) choice happens to be. Cravings diminish significantly over time as the brain recuperates. Sometimes just anticipating the beginning of a taper regimen can cause a "craving". This is one of the reasons some people are on methadone for years. Tapering is going to be uncomfortable no matter how slowly the process happens to be. The other problem with tapering/detox is addicts don't handle discomfort very well in those early months of abstinence. Their body doesn't produce the natural endorphins because of the prolonged use of large doses of exogenous opioids. It takes time for the body to begin to produce those chemicals in adequate amounts again. So when their is an injury, even something that used to be well tolerated prior to the addiction, the addict's body doesn't produce the endorphins and the person is "hyperalgesic" (overly sensitive). There definitely has to be a conscious decision on the part of the recovering individual to be committed to the detox and to do whatever it takes to remain abstinent for the time period needed for the body to recuperate.

Triggers and cues, on the other hand, can occur at any time no matter how long abstinence has been. I had an experience that was very unsettling a little over a year ago. I was approaching my 14th anniversary at the time. I had been asked to give a presentation to the anesthesia group I worked for when my addiction had become active. I hadn't been inside that hospital since the day I was asked to leave after my first relapse. When I walked through the lobby and just glanced down a hallway of the main lobby, I broke out in a sweat, my heart pounding and feeling nauseated. The hallway led to the outpatient lab where I used to give my urine samples. I was not ready for that experience! Thankfully, my recovering daughter was with me. She said something to me and when I didn't answer she turned to see that I had stopped and was "glued to the floor". She recognized what was happening and came back to me, took me by the hand, pulled me toward the elevator and told me we needed to get our Visitor's badge. It broke the "spell" I was in and the physical sensations quickly subsided. But that was very, very unpleasant simply because I wasn't prepared.

I keep you guys in my prayers everyday. Hang in there!

Jack

all_over_again · May 12, 2010

Just adding 2 cents worth of addict sharing. I rarely share because I was an I.V. abuser and I feel like that makes me the bottom feeder of the addict world. I have scarred over "tracks" and a whole host of vascular issues because I used for so long.

Ugh. So now with that bit of dirty laundry aired... I can imagine methadone being useful for someone who has no intention of ever quitting opiates but wants to limit the physical harm of injecting or snorting. And maybe for tapering. I think that if someone had promised me a sufficient dose of methadone to keep me as numb as dilaudid and fentanyl did without having to inject, I would have taken it in a heartbeat. I wanted to die but not so fast that I didn't get to get high several more times before checking out.

Fortunately, it wasn't offered. I realized that eventually I had to get completely clean if I really wanted to live. I suppose the body would survive if it was given methadone for the remainder of its life, but I don't think the person inside would ever really live again.

sharona97, BSN, RN · May 13, 2010

That's right all over again. Your last statement nailed it. Unfortunetly an addict's experience and years of use somewhat defines the recovery road when the addict quits using his DOC.

I don't think anyone starts out with anything to become an addict.......That is why I am so powerfully full of hope for D, that now we see an underlying problem that D recognizes and is working diligently to fix. It is a long road just for that reason alone.

I think at this point the good news is that D knows he has an option to taper. He just doesn't want to fool himsef again when he last tapered at an unresonable rate.

He has so many good people around him, helping him, and he is trusting them. They are committed to him, thank God.

Jack, I can understand the terror of walking into the hospital. When D had to go meet a client at a show in MPL, he was terrified. We talked about it in depth. And he agreed he needed to make this step, the worst he could do and stay straight is to turn around and come back home. Good for your daughter.

Stay Cool!!!

Sharona