Does Methadone really help prevent relapse?

[sharona97]

I wasn't sure where to post this question, so don't mean to step on any toes.

I have civally committed my son recently for depression, suicide attempt #2 and my new found awarness of his heavy heroin use.

I am concerned that Methadone may preempt relapse. He has chronic pain from a motorcycle accident 10 years ago. His addiction started with pain meds and then esclated to heroin.

His feedback to me is that on low doses of Methadone he can keep a quality of life that would be better for him. I don't know much about long-term use of Methadone if there is such a thing.

I'm just happy to have found him "barely" alive, and took him straight to the hospital.

Any helpful information concerning how Methadone works would be appreciated. How is a person weaned off of this?

Thanks,

Sharona:cry:

[jurmag]

I suggest looking into buprenorphine versus methadone. There are prescribers that can prescribe this med in a regular physicians office without needing to go to a methadone clinic. Buprenorphine is superior to methadone and usually physicians can write for a 30 day supply. Just google it and you should be able to find helpful info.

[jackstem]

I'm a recovering addict with 13.5 years of recovery. I'm also a peer assistance advisor and chair of the peer assistance committee for a state nurse anesthesia association. There is a HUGE disconnect between clinicians and current knowledge about the disease of addiction. That's probably the biggest chunk of my time...providing education to health care professionals.

Chemical dependence is a chronic, progressive, potentially fatal disease. But it's unnecessarily fatal! The lack of understanding by health care professionals is one of the biggest hurdles we have to overcome.

Addicts are not bad people trying to become good. We are sick people trying to become well. Relapse is a sign of advancing disease OR the failure to follow the treatment plan. What is the number one reason diabetics, those with coronary artery disease, gout, depression, etc. end up in the hospital? Failure to follow their plan of care. We just don't judge them as evil, weak, no good people like we do when an addict relapses.

Your son has 2 complicating factors that make sustained recovery difficult (but not impossible)...chronic pain and depression. If those two factors aren't treated aggressively and followed up consistently, he will always struggle with his addiction.

There is a continuing debate in the recovering community regarding the reason(s) someone first begins using mood altering drugs. One of the most common reasons is it's an accepted part of our culture. What's one of the first things someone says when a 21st birthday is celebrated? "Let me buy you your first legal drink!" Wine is used in a variety of religious rituals. Beer, wine and other alcoholic drinks are promoted as an integral part of celebrations, sporting events, house warmings, etc. etc. etc.

Another reason is some folks are born with a CNS that may be deficient in certain neurotransmitters which lead to depression and a sense of "not belonging". When this person drinks, or takes a mood altering substance (marijuana, cocaine, demerol, morphine, dilaudid, valium, xanax, etc.) it helps them feel "normal". Unfortunately, in a person who is genetically vulnerable to addiction, chronic exposure can lead to the physical and chemical alterations in the brain that guarantee the continued use of these substances. Once these changes occur, the line has been crossed and the disease of addiction is in full bloom.

These changes lead to decreased function in the pre-frontal cortex which is the area charged with making decisions about delaying gratification to a later, more appropriate time. They also decrease the "satisfaction" we experience from natural activities that normally provide a feeling of satisfaction and contentment (sex, food, caring for our children, winning a tennis match, getting the big sale, etc.). The brain is wired to reinforce activities that keep us alive (eating) and propagate the species (sex). When an activity is perceived as doing one of those two things, the brain rewards itself by releasing dopamine in the pleasure centers.

Here's where drugs of abuse exert their biggest effect. Opioids, sedatives, alcohol, stimulants all cause a release of dopamine. In a person with the genetic predisposition to addiction, their brain releases huge amounts of dopamine in response to taking these substances. The more potent a substance, the larger the response, and the faster the changes happen in the brain. But even mild mood altering substances (caffeine, codeine, alcohol) cause this over-reaction. The longer the exposure to these "mild" substances in the genetically susceptible, the more the brain changes. With continued "social" use of these "mild" drugs, the brain will eventually change and the disease of addiction is now active.

The only way the brain recuperates is to abstain from using these substances. The problem is, the brain reaches maximum recovery in about 18 to 24 months, but it never returns to pre-addiction levels. This is the reason there is always a danger of relapse. It's why we have to practice our program of recovery every day, avoid old triggers (people, places and things associated with our addictive use), and take it one day at a time.

Now, when we're talking about the use of methadone or buprenorphine, we're talking substitution therapy. We change from a drug that causes intense euphoria associated with the big release of dopamine (heroin, cocaine, methamphetamine, etc.) to a substance that has a slow onset and slow elimination (no big dopamine release and prevents withdrawal syndrome). The permanent use of methadone or buprenorphine should not be the intent of replacement therapy. Preventing euphoria and withdrawal while slowly weaning the person off these substances is the way to go. But education about coping mechanisms, stress reduction, appropriate treatment of co-occurring conditions such as depression, pain, bipolar, OCD, etc. are a must, or relapse will bealmost guranteed.

Treating chronic depression with SSRI's is not the same as using a benzodiazepine. SSRI's allow a normailization of serotnin and don't cause euphoria.

Your son needs a good pain management team, a good psychiatric team for his depression and any other psychiatric conditions, and an addictionologist/chemical dependency counselor to oversee his addiction. The "glue" that holds all of this together is the regular attendance at support group meetings which are mostly 12 Step in nature. There are other groups, but 12 Step based groups seem to have the best success rate.

Mom...you and your husband need to regularly attend al anon support groups to develop the tools to deal with your worries and the need to "be sure" your son does what he's supposed to do. As nurses we are "professional codependents"! We need as much help with our co-dependencies as the addict does with their addiction. It's not easy. My daughter just celebrated 2 years C&S (cocaine).

There is hope...we're living proof. Take it one day at a time.

Feel free to check my profile and PM or email me.

Jack...a grateful, recovering addict.

[tiak41]

Hi Ms papa, I appreciate your story...I had back pain and was put on methodone twice a day 20 mg in the am, 20mg at night, I was also on loratab 7.5mg 2 tabs every 6 hours prn for over a year..I agree on the methodone, my back felt better, closer to "normal" in a long time and I didn't get high or a buzz, so I thought it was"safe" especially since my pain management dr put me on it knowing my history...when my daughter was 1 1/2 yrs old, i found out I was pregnant and as soon as I found out, I called my dr....they told me to stop all meds immediately or my baby could have problems, so i did and it was the worse thing in the world, for 3 days straight i couldn't sleep, sit, diarrhea, vomiting, shaking, restlessness, it was like how withdrawal is on tv, absolute hell...it took me quite awhile to straighten myself out but once I was clean, I swore no matter my future pain or surgeries, im never going back on methadone.......

[sharona97, BSN, RN]

Jackstem,

Thank you for your beautifully written and excellent insight. I plan to print your post and give it to my son.

He is currently involved with an aggressive pain clinic. He is seeing a psychiatrist. He also is being followed by an addiction specialist, who is closely watching his BP. His BP is elevated and currently on Clonodine. I've come to understand that the BP may improve upon itself with continued recovery. Physiological reasons for the increase was new to me.

I so appreciate your expertise and knowledge and first hand experience. I am learning that the addiction is a very deep and lonely place for our son.

He is spending alot of time with us at home. He has great days, good days and quiet days. I continue to worry and of course try not to show that as obcession. My dh said that when D is home that I become anxious. I feel it is anxious with worry. Worry that he's not feeling well, and not being able to fix him. Yet I know I can not do that.

My husband and I are getiing to know different groups of people in recovery as co-dependants. Very insightful and helpful.

At this time D is NOT on methadone. His pain medication is directed towards ANSAIDS and such. PT, psychological talk therapy and lots of support. He has returned to work. His employer has been so supportive not only for D, but also to our entire family. Some really good people out there. Thank God!

He is still in aftercare recovery going to night classes. He has asked his social worker to switch some of his meetings as D felt there were alot of "whiners" there. He said he wants to be around forward -looking people. He frequently talks about I keep being referred to the 90% relapse group. He completes that thought with I want to be in the 10% I'm making a difference group.

It is so beautiful to see the D we have known and loved and suppported. He himself said, yeah Mom, I missed myself. WOW.

Thank you,

Sharona

[Elvish, BSN, DNP, RN, NP]

This is great news, Sharona. :icon_hug: Thanks for keeping us updated on his recovery.

[jackstem]

Sharona,

Thank you for the update on your son and your kind words. I too know the pain of having a child with addiction. My youngest daughter shares this disease with me. She just celebrated 2 years clean and sober. I do know that I wouldn't have handled her addiction very well if I hadn't gone through it myself.

You and your son (the whole family) are in my prayers.

Jack

[southernbeegirl, BSN, RN]

I'm posting my reply before reading the thread so forgive me please.

Methadone is one of the drugs i used to take to get high. It gave me the same high that I got from other narcotics.

IMO, methadone is simply swapping one addiction for another. It isnt recovery. Your life is still controlled by a narcotic.

I'm gonna hush now before I get on my soap box, lol

[jackstem]

I'm posting my reply before reading the thread so forgive me please.

Methadone is one of the drugs i used to take to get high. It gave me the same high that I got from other narcotics.

IMO, methadone is simply swapping one addiction for another. It isnt recovery. Your life is still controlled by a narcotic.

I'm gonna hush now before I get on my soap box, lol

I agree with you completely! In fact, it's called REPLACEMENT THERAPY! Originally, it was intended to decrease withdrawal symptoms and then be weaned off the methadone. Because it's pharmacology, it has a slow onset of effect and long duration, you SUPPOSEDLY don't have the same intense high you get with short acting, immediate releaseopioids like heroin, oxycodone, morphine, demerol, etc.

As you said, the bottom line is we're replacing one drug with another. Recovery is about living a substance free life.

Jack

[chelebelle]

Yes, it is a "replacement therapy", and whoever said you don't get the same intense high was lying, lol! It is not until you stabilize on the methadone that you do not get that intense high. I am in a Methadone Clinic, however, I am in the Methadone Detox program. I know that my recovery does not start until I am discharged from the clinic. But, it is a better option for some people like me, simply because by trying to quit cold-turkey (in a sense), it is basically like signing a paper saying "i'm taking a vacation from my drug use, and will return on such&such day...." You know what I mean? This is a way for me to lay the foundation to the start of a successful recovery....and in no way do I consider myself "off drugs". I have a more realistic perception of this program than a lot of people who are also in it.

[chelebelle]

Oh, and also, one of the big parts to the Clinic's is that the having to go and dose daily at the clinic and whatnot is supposed to bring normailty and balance to your life that wasn't there before - it elimantes the having to search for the drugs & eliminates every minute of everyday being consumed by the whole drug thing. With a clinic, you walk in, tell em your number, dose, and go on about your day. It makes it possible to have a steady job and yadda yadda im gonna stop now lol

[bossynurse101]

First of all, let me say that I am sorry for the pain you are feeling. It sucks to be so powerless over our children.

I am a past heroin addict that went on the Methadone program many many years ago. It was a joke. For myself, it was an easy out and a legal way to get high. Problem was, after a few weeks the "high" didn't do it for me anymore. Thats when my ex and I started doing crack cocaine. We hit bottom is a matter of months and ended up in jail. Thank God.

For me, anything I tried to "fix" myself with outside of recovery failed. As an addict, I am limited to what I can put in my body. I know many people with pain issues who "try" to practice recovery and it is very difficult to say the least. I don't envy any addict with pain issues. How is it possible to practice recovery with a head full of narcotics? I don't have the answer to that one. My heart goes out to those people. But I do know that recovery and sobriety are two separate worlds and it is possible to have one without the other, unfortunately for some.

Go to an open meeting and learn about the disease and about recovery. I personally choose AA, although my drug of choice is not alcohol.

Prayers and hugs.

[sharona97, BSN, RN]

First of all, let me say that I am sorry for the pain you are feeling. It sucks to be so powerless over our children.

I am a past heroin addict that went on the Methadone program many many years ago. It was a joke. For myself, it was an easy out and a legal way to get high. Problem was, after a few weeks the "high" didn't do it for me anymore. Thats when my ex and I started doing crack cocaine. We hit bottom is a matter of months and ended up in jail. Thank God.

For me, anything I tried to "fix" myself with outside of recovery failed. As an addict, I am limited to what I can put in my body. I know many people with pain issues who "try" to practice recovery and it is very difficult to say the least. I don't envy any addict with pain issues. How is it possible to practice recovery with a head full of narcotics? I don't have the answer to that one. My heart goes out to those people. But I do know that recovery and sobriety are two separate worlds and it is possible to have one without the other, unfortunately for some.

Go to an open meeting and learn about the disease and about recovery. I personally choose AA, although my drug of choice is not alcohol.

Prayers and hugs.

Hi Bossynurse101:

Thanks for your insight.

My Son is doing well. Today he told me that his increase in activity and exercise along with his daily stretches is finally giving in to relief!

He is doing well and is pretty focused. Going to 3 groups a week and also still heavily involved in aftercare in the evening.

It's great to have him home again (straight) for Sunday dinners and just to hang out with mom and dad.

To have a conversation, even just listening as he jaws away and is making sense again.

He is peaceful in his own way. He also continues to see a psychologist and also has a pain management team incorporated in his care.

AND....No methadone!!

God is good!

Sharona