Does Methadone really help prevent relapse?

ms. papa RN AGAIN · Jul 19, 2008

First I would like to say that I am very sorry to hear what you are going through with your son. It must be very difficult for you to see him like that and to find out that he is that sick right now.

Secondly I would like to tell you what I know about methadone. I was on it for almost 2 years from 2003-2005 as a result of an addiction to narcotic pain medication (I started with Lortab and escalated to Oxycontin.) At the time I sought help from the methadone clinic I was in nursing school and the pills that I initially started out thinking of as my 'little study helpers' had turned into demons that I had to take every 4 hours to function at all.

(Before anyone says anything, yes I chose myself to that place by doing drugs and no I am not saying the pills caused it- just stating how it felt to me then as an active addict.)

I chose methadone b/c I wanted to be able to finish school without going through a month of debilitating withdrawls. I was ready to be done with the constant and growing need for pills, I just wasn't ready to totally deal with the reality I created. Methadone is a synthetic opiate that blocks the receptors in your brain that scream at you when you don't have the drugs that your body now thinks you need to live. You don't get the euphoric "high" typically associated with narcotics, but you stay "straight" for 24 hrs from one daily dose. They claim that if while the methadone is in your system you attempt to get high with your original drug of choice that you are unable to do so b/c the receptors used to do so are full of methadone and therefore unable to react to anything else. I do not know if that is true from personal experience b/c I really did not want to go back to the others like I said, I just wasn't ready to go all the way at that point.

The important thing to remember about methadone is that you are still addicted to it. If you miss your dose you will have withdrawls. I missed mine probably 10 times and the withdrawls from the methadone are worse then from the drugs that got me on it in the first place. Of those times I missed there was 2 times that with pressure (although it didn't take much) from my now ex-husband that was in the same place I was, I gave in and took Oxycontin to reduce the symptoms for a few hours. The next day I went and got my clinic dose so I didn't officially relapse but the fact remained that I was still weak and dependent on narcotics daily to live a "normal life."

I can't say that all of these clinics are the same, but the one I went to was very much in favor of methadone for life. They actively discouraged me from weaning down to get off by telling me that if I was not on it I would go back to using. If I insisted they said that they would do it but that I could not start the process until my bill was paid in full. They were like dealers and it is their bread and butter to have you stay on it. So when I got to the point that I could take no more and was ready to be totally free of addiction I went to my personal doctor and we weaned me off of it very slowly. I was at 70mg/day when we started in Oct. 2004 and it took 6 months. Honestly 70mg down to 30mg went smoothly but it was very hard to get below that and I went back and forth a number of times. 5 mg at a time until it was 5mg/day for three days and then none. And it took an entire month after to feel normal without any drugs for the first time in 6 years. And I have been clean ever sinc

Methadone is a viable option for those who need it. I would never condem it b/c it saved my life. I don't know if I would have been able to kick the pills cold turkey and I didn't have insurance or thousands of dollars for rehab. That said, it is not going to keep someone from relapsing by itself. You have to really want a different way of life. It may not be the best b/c you aren't "drug free" but some people need a bridge to get across the rapids. I did suffer some serious physical effects including loss of appetite and weight loss, loss of taste, irritability, depression, "dark mood" and according to my family I had a death like appearance. I did not see any of this in myself but my loved ones did.

I often compare methadone to cancer treatments. The drugs (cancer) would have killed me eventually, slowly I know but the methadone (chemo) made me sick too, more sick in ways, but it saved my life. And when it was over I recovered and healed. And 11 months ago I gave birth to a beautiful baby girl that proves how resiliant our human bodies are.

I wish you and your son luck. But the most important thing in all of this is that he really wants it for himself. That is truly the biggest deterent of a relapse. Sorry this is so long but I hope I helped. :heartbeat

sharona97, BSN, RN · Jul 19, 2008

mspapa,

Thank you for your frank,honest,educational answers. I'm trying to learn about the Methadone program to better help support my son.

A couple of points struck me: he was Rx'd oxycontin for is chronic pain and admits to using a months supply in 2 days. Then he hit the streets for the heroin. Would he take more than the prescribed dose of methadone this way? This is a thought in my mind. His rationale for methadone (and I agree) is that he will have a functional life, pain free.

He is already a pretty dark guy. Or can be. He's had 2 suicide attempts in 3 months. He's attempted 5 times that I know about. One he was very near death, unresponsive, and I found him (along with a 7 page letter). Could the methadone cause more of the same? In your opinion?

His goal is to be placed in a dual diagnosis program. This will be decided under civil committment in which I initiated at the time of his last hospitalization.

At this point , I am behind the methadone treatment program. It apears it's the only help line for the addiction part of this without relasping (hopefully).

He did not qualify for rule 25 (state program) because he made to much money. He has been denied inurance and his wife has never put him on her's........... We of course don't have the money for rehab and neither does he. His money went to the drugs.

He did say that he felt he could live a better quality of life off the drugs, but is concerned he wil live in pain the rest of his life. I realize that some of that needs to be talked through, but I am also realizing that with Methadone, he may have a brighter future in life and it will take work.

Thank you so much for responding, It really helps me to learn about this and to discuss the issue with someone who has been there. I'm very grateful for your honesty and your time.

Sharona

dria · Jul 19, 2008

so sorry to hear about your son, i know how hard it is to see a loved one go through this. i also know how hard it is to be there. i think ms papa has given you some great information. here's another perspective/follow up to your post...

re: taking his entire supply of meds-this won't be an issue for a while. daily visits to the clinic for dosing are required (i forget the exact minimum timeframe.) even when pickups are allowed, they are phased in-every other day, then 2x/week, then weekly etc. strict rules and guidlines for attendance must be followed. pickups are considered a privelege which can be revoked at any time. while attending the clinic, a nurse will dispense and observe dosing of the medication. methadone liquid is used, so while the potential for diverting that dose does exist (addicts are a sneaky bunch) it is reduced.

the first week or so of attending the clinic will be a challenge. the law in my state requires patients to be started at a dose of 30mg, then titrated up for maximal symptom relief. there is a limit to how much the dose can be increased each day-i want to say 5mg or 5%, but i could be wrong. the dose used for opiate abstience is generally much larger than that for chronic pain management by several fold.

whether treatment is lifetime or less should largely be left up to the patient. some are able to taper their dose and remain abstinent, while other do better on lifetime maintenance treatment. several studies do support the safety of lifetime maintenance. withdrawing from methadone is more difficult than the original drug of choice due to it's longer half life and because methadone binds to all of the opiate receptors while most drugs of abuse bind to only one or two. plain english: you're sicker longer. i do agree that most of the for-profit clinics really do pressure their patients to continue lifetime maintence, and i've found you really have to watch them. i've had to pull the "i'm a nurse, i know the laws and you cant do this" card several times.

like any other substance abuse program, you get out of it what you put in. if methadone is the only thing you're using to abstain, it's very likely that you will fail. my personal opinion (fwiw) is that methadone is a tool-it stabilizes you to a point where you have the ability to make the changes that you need to make, and learn how to prevent future relapses. like ms. papa illustrated, it is quite easy to relapse-all you have to do is miss your daily clinic visit.

a dual diagnosis program would likely be the best option. not all of the clinics provide mds that have any psych background. and do not underestimate the need to get help for yourself.

good luck to you and your son, you are welcome to pm me any time the need arises.

sharona97, BSN, RN · Jul 19, 2008

We are asking for a dual diagnosis pogram. It's been baby steps since we last brought him to the ER. Learn as you go I guess.

I see this opportunity for him to get well, stay well, and live well. I can only hope that with the group talk therapies his using his meds inappropriatley will be discussed and as an end result stop. Choosing to take his meds correctly is the goal and of course keeping him alive.

Thank you for your valuable input.

Sharona

kford50 · Jul 20, 2008

I have been accepted into the nursing program, I was once in a clinic and now I have a doctor who treats me for methadone, blood pressure, thyriod problems..what I am saying is he isn't a free giving methadone prescriber. Anyway I would say methadone saved my life...there are so many uneducated people out there who are against it and usually are the ones who never walked in the shoes of and addict and I praise them for that and hope they stay there, however I tried cold turkey so many times, Bradford rehab, being locked down by loved ones and truly it didn't work. I didn't get were I was over night and I wasn't going to recover overnight or even in a month or three. See people don't realize that being an addict is also a lifestyle one you have to change and with methadone clinic and the tools they have, going everyday and earning the right by staying clean to get a few days of take homes was all part of the changing the way you live. You can not give an addict a weekend or a weeks worth of meds they will take them or sell them to get their d o c. If you work the program and use the tools you will get better. I lost everything and now I have a home, building a house accepted into nursing school go on vacation several times a year, enjoy my family, bought a travel trailer and spend weekends camping at the lake and yes this is because I stayed in the clinic and got better. I hated going everyday but that is a good reason to get clean. I just wanted to feel normal and methadone makes me feel normal. I will soon come completely off of methadone but not until I want to, not anyone else. I am the addict not my friends and family an I am the one who will suffer from wrong decisions. I know you have to be patient with the program b.c it took me a few weeks to stop other things and realize that the drugs I wasn't getting was being blocked by methadone. So, I think the methadone clinic would be an excellent place for him, and a lot of love don't let people put him down for the clinic. Methadone is med that is made to help addicts and with the tools to go with it, you can get better.

sharona97, BSN, RN · Jul 20, 2008

I have been accepted into the nursing program, I was once in a clinic and now I have a doctor who treats me for methadone, blood pressure, thyriod problems..what I am saying is he isn't a free giving methadone prescriber. Anyway I would say methadone saved my life...there are so many uneducated people out there who are against it and usually are the ones who never walked in the shoes of and addict and I praise them for that and hope they stay there, however I tried cold turkey so many times, Bradford rehab, being locked down by loved ones and truly it didn't work. I didn't get were I was over night and I wasn't going to recover overnight or even in a month or three. See people don't realize that being an addict is also a lifestyle one you have to change and with methadone clinic and the tools they have, going everyday and earning the right by staying clean to get a few days of take homes was all part of the changing the way you live. You can not give an addict a weekend or a weeks worth of meds they will take them or sell them to get their d o c. If you work the program and use the tools you will get better. I lost everything and now I have a home, building a house accepted into nursing school go on vacation several times a year, enjoy my family, bought a travel trailer and spend weekends camping at the lake and yes this is because I stayed in the clinic and got better. I hated going everyday but that is a good reason to get clean. I just wanted to feel normal and methadone makes me feel normal. I will soon come completely off of methadone but not until I want to, not anyone else. I am the addict not my friends and family an I am the one who will suffer from wrong decisions. I know you have to be patient with the program b.c it took me a few weeks to stop other things and realize that the drugs I wasn't getting was being blocked by methadone. So, I think the methadone clinic would be an excellent place for him, and a lot of love don't let people put him down for the clinic. Methadone is med that is made to help addicts and with the tools to go with it, you can get better.

Kford50, I've heard some of the same language coming out of my son's mouth. I admit I wanted to be educated in the methadone treatment, I was fearful of it at first. Sounds like accountability is rewarded with enough drug to get you by a few days in a row. Did you work then? Were you able to have any normalcy in life while you were going to the methadone clinic? I'm so happy that your life has changed around for you and the most beautiful things in life are sometimes missed when using was the only agenda. Many times he wouldn't show up at Christmas or birthdays. This year in March he gave me a pink bracelet and said Merry Christmas, mom. It was even wrapped with a bow. I wish you the best in nursing school, I'm sure you will enjoy being a nurse. Thank you.

Sharona

Thunderwolf, MSN, RN · Jul 21, 2008

Here is web site to quick review, regarding Methadone:

http://www.minddisorders.com/Kau-Nu/Methadone.html

sharona97, BSN, RN · Aug 8, 2008

Victorium85,

Yeah it is pretty scary and hard to deal with. He will be getting DC'd on Saturday. My husband and I want to go to some meetings. Do we go to Alanon or to Alanarc if there even is one of those.................

You've come along baby.....eh? Thanks for sharing that story, you sound as if you are a very strong person with a very deep soul! Good luck with the baby and nursing school!

Sharona

iwanna · Aug 20, 2008

I am pro-methadone for opiate addiction. I was anti-methadone and nine years ago I worked in a drug rehab that was against methadone treatment. I must admit to how pathetic I was. I had sympathy for addicts, except for nurses who stole their pts. drugs and pregnant women. However, I have a friend that is a recovering addict, and she helped to change my vews. She told me an addict is an addict is an addict. I thought that pregnant women that used drugs were the scum of the earth. How dare I be so judgemental of anyone, as I have many faults of my own.

I have been dealing with my daughter's drug addiction for several years. Rehabs, relapse, etc. Two years ago, I learned that my pregnant daughter was an active opiate addict. How could I have not seen it? I was a nurse and worked in addictions at one time. I started to become suspicous when I caught my daughter in one too many lies. She never had money, although she worked. She was good at explaining things away. I started researching on what to do if she had relapsed. I was thinking about intervention and sending her to rehab. However, I learned that methadone was the best for my unborn grandchild. When a pregnant women goes through withdrawal so does her baby. There is a strong chance that the baby will die. Methadone is much safer and not that much passes through the placenta. I did much research and decided that methadone would save my grandson. When I approached my daughter, and told her what I learned about methadone is when she finally admitted to relapse. I got her into methadone clinic ASAP. At time of her delivery she was weaned down to 30 mg. My grandson is now 19 mos. old and has not shown any signs of complications from the methadone. He was not born addicted to it. I know this is getting wordy, but I promise to get to my point soon.

After my daughter had the baby, she wanted to be totally weaned off of methadone. She remained clean for two weeks. Then she relapsed to her oxy addiction. It was way too soon for her to discontinue her methadone. She came to me and admitted another relapse, and that she is going back to the clinic. At first, I was furious with her. I was okay with her on methadone to save the baby, but how dare she relapse after all she put me through! (this was my thinking at the time) However, I now admit to being very wrong. I became more and more educated along the way. I am on the fence as to how long one should be on methadone. But, it really does not matter, as long as they are living productive lives. It sure beats the alternative. They do not feel the high, and it beats their craving. Okay, that is the upside to it.

My daughter, and I believe many addicts are dual diagnosis pts. as well. I believe that her addiction is secondary to her bi-polar/borderline. The primary diagnosis needs to be treated as well. I believe that just taking methadone is just puting a band-aid on it. However, at the clinic they must be involved in groups and individual counsel.

I found a wealth of information at www.medicalassistedtreatment.org . Another option you may look into is suboxone. You can find a link that information off the same site.

As a mother of an addict I can empathize with you. Please feel free to pm me.

sharona97, BSN, RN · Aug 28, 2008

Well here we are on the eve of another holiday weekend. My son is still in the half-way house he was accepted in upon discharge.

He's made a supervised trip home last week. Precious, precious hours. He is active in attending and participating in Ala-Narc meetings. He accepted a position of secretary.

Yesterday, he called 6 times. RED FLAG. Maybe I'm over reacting, I don't know. By 10:30 pm last noc he was here, supervised and collected his money that he had been saving.

I did tell him I hope you reach out for help if thoughts of relapse occur and was honest about my worries of him having a large sum of money. He does have to pay for his laundry and gas for rides, personal items. We laughed about that as our phone bill for the last 2 months totals $300. He gave us $200.

Finally, he said mom the money is going in the bank tomorrow morning.

The last 2 holiday weekends we were in the emergency room at one point. So I guess you can see why I'm worried.

He has been weaned off methadone. He is starting treatment at a pain clinic, which addresses psych, PT, pain, life skills etc. He still worries about pain the rest of his life.

He's been sober from herion since07/05/08. No methadone for apprx 7 days.

wow just needed to vent I guess!

Thanks

Sharona

jbtampa · Sep 1, 2008

wow, thank you all for the memories of the greatest gift one could give, or receive: treatment for addiction. my experience was similar to most here. injury, chronic pain, pain management, and off to the races. I do want to share what did work for me, buprenex and residential treatment at a quality center. that was seven years ago, guys, and three major surgeries and a zillion meetings later, I remain happy, joyous, and free. :bow: