Methadone worse than heroin....ideas?

elkpark · Apr 15, 2016

Methadone itself isn't a "catalyst" for anything. It doesn't make people want to quit using heroin. It is a tool that people who want to quit using heroin can find helpful. You're right that there is a lot of abuse of methadone.

WinterLilac · Apr 25, 2016

I only have a personal experience in this area. I used to be friends with a woman who used to inj oxycontin. She then went onto methadone but as she called it, 'my medicine'. She was on methadone for far longer than her oxycontin habit and she had no desire to wean herself off the methadone. I perceived she saw methadone as truly a 'medicine' which she could take for the rest of her life so she never had to go through full-on withdrawals. IMO methadone is losing it's credibility...

Psychcns · Apr 29, 2016

Methadone uses a harm reduction model. It stabilizes the persons opiate addiction so they can develop coping skills. I worked in methadone for several years and I was always intrigued why people stayed on it. People organized their lives around getting their daily dose between 6am and9 am and there was mandatory individual and group counseling.

elkpark · Apr 29, 2016

Methadone uses a harm reduction model. It stabilizes the persons opiate addiction so they can develop coping skills. I worked in methadone for several years and I was always intrigued why people stayed on it. People organized their lives around getting their daily dose between 6am and9 am and there was mandatory individual and group counseling.

You're correct about methadone maintenance therapy, but methadone can also be used as a taper to get people off opioids entirely (including methadone). Two different models of treatment.

EKUGRAD, BSN, MSN, RN, CNS · May 11, 2016

"My sister's mom was just as fall down wasted off of that as she was the heroin so is it just a safety thing?"

I have been an addictions RN for over 24 years. I am a recovering addict. If this sentence is true, then your sister's Mom is stashing her Methadone to abuse a higher dose. After a certain amount of time and success in the program patients become "trustees" and weekly are given a box of seven daily doses to take home. Methadone dosing is carefully assessed, measured and prescribed to prevent Abstinence Syndrome (withdrawal), the reason almost all addicts keep using drugs, especially opiates. Every state has a Maximum Daily Dose and addicts move from state to state to increase their dosage as tolerance sets in. Heroin came into use to help people get off of opium, morphine to get off heroin, methadone to get off morphine, oxycontin to get off other opiates. When this tortured soul has had enough and really wants to stop for good, send her to Narcotics Anonymous. It's free and very successful.

Purple_roses · May 14, 2016

This is such an interesting topic to me, and I doubt I'll ever have a firmly planted stance on this. During my psych clinical, I was able to go to both a methadone clinic and a recovery clinic. They both had completely different philosophies and they both made a lot of sense to me.

The methadone clinic held that most people never fully beat their addictions and that detoxing and then running back to heroin (as they said many inevitably would) causes more overdoses and deaths; keeping a tightly regulated control on methadone, according to the employees I met with, results in harm reduction for the patients who, realistically speaking, will never beat their addictions.

On the flip side, the other clinic I went to was adamantly opposed to methadone. Methadone obviously still has addictive properties, and the patients' lives still center on the methadone (some patients were waiting in line at 0500 for their dose and most patients had to plan vacations around where the nearest methadone clinic was located). Patients still OD on methadone. The patients who are able to reach a state of being entirely clean definitely are safer and have more freedom.

I'm glad you asked this question and I'm super curious to see all of the opinions and responses. As I've said, I have no idea where to stand on the issue. One of my loved ones is addicted to drugs, and my heart truly goes out to people battling addictions.

Maevish, ASN, RN · May 17, 2016

"My sister's mom was just as fall down wasted off of that as she was the heroin so is it just a safety thing?"

I have been an addictions RN for over 24 years. I am a recovering addict. If this sentence is true, then your sister's Mom is stashing her Methadone to abuse a higher dose. After a certain amount of time and success in the program patients become "trustees" and weekly are given a box of seven daily doses to take home. Methadone dosing is carefully assessed, measured and prescribed to prevent Abstinence Syndrome (withdrawal), the reason almost all addicts keep using drugs, especially opiates. Every state has a Maximum Daily Dose and addicts move from state to state to increase their dosage as tolerance sets in. Heroin came into use to help people get off of opium, morphine to get off heroin, methadone to get off morphine, oxycontin to get off other opiates. When this tortured soul has had enough and really wants to stop for good, send her to Narcotics Anonymous. It's free and very successful.

This was back when my little sister was 6 and she's now 23 and she had no desire to speak with her mom again after the painfully long adoption process (she was tired, even as a child, of being a mother to a 32 year old instead of the other way around and my parents let her make the decision herself). Maybe her mom never got the the point of where she got the doses to take home (this is California and maybe the rules are different) cause she had to get a ride every day to the clinic.

It's too late for her to get help or do NA (she didn't want to right up until the last time I heard of her, about 3 years ago), but if people are willing to go into treatment, I think NA is wonderful thing.

Also, maybe I'm being slow (I'm actually curious), but how are opiates used to get off other opiates? That makes no sense to me.

Thanks!

xo

elkpark · May 17, 2016

Also, maybe I'm being slow (I'm actually curious), but how are opiates used to get off other opiates? That makes no sense to me.
Thanks!
xo

Heroin (and other commonly abused opioids) has a v. short half-life, and methadone has a v. long half-life. With heroin, you shoot or snort it, you get a big rush and get high, the high wears off pretty quickly, and you start craving the next high pretty quickly (and going into withdrawal). Methadone you take once a day, you don't get any kind of "rush" or high from it, and it (is supposed to, depending on the dosage) prevents cravings or withdrawal all day long and into the next day.

Sort of like the difference between burning a bunch of newspaper in your fireplace vs. your central furnace to heat your home. It's winter, your house is cold, and you're miserable. You pile up a bunch of paper in the fireplace and light it, it burns like crazy, you get big flames and lots of heat, you get toasty warm right away, but it burns out quickly and, ten minutes later, you're feeling cold again (where's more paper???) Your central furnace doesn't make any pretty flames or big blasts of heat, but it keeps the house consistently warm all the time.

Methadone maintenance treatment (MMT) works by substituting the addiction to heroin or other short-acting opioid with an addiction to methadone, which is legal, monitored, and doesn't provide the "rush" or high of the illicit opioids (and, therefore, also avoids the subsequent "crash")

Using methadone as a taper to get off opioids entirely works by, again, eliminating the highs and lows of getting high on a short-acting opioid, crashing afterwards, getting high again, crashing afterwards, always thinking about where, when, and how you're getting your next fix, and getting people on a level path day to day, and then tapering them slowly down on the methadone until they are able to get off the methadone entirely. It's a lot easier to taper off that steady state than it is to taper down in a high/crash/high/crash pattern.

Neither method is any kind of "miracle cure" and they both require that the individual be motivated and willing to participate in the treatment. And, yes, methadone can be, and frequently is, abused, too.

chare · May 17, 2016

[...]
The clinic said methadone can be even harder to kick than heroin so they would rather have people on heroin and detoxing than methadone. I just wondered what the thoughts were on that?
[...]

Use a substance obtained illegally, of unknown dosage, and possble contamination, as opposed to a medication of known dosage and purity?

Am I the only one that finds this odd?

elkpark · May 17, 2016

Use a substance obtained illegally, of unknown dosage, and possble contamination, as opposed to a medication of known dosage and purity?
Am I the only one that finds this odd?

It is true that it takes a lot longer to detox from methadone than it does from heroin, because of the much longer half-life. A lot of people in the substance abuse treatment community are opposed to methadone treatment entirely, and would rather people just detox from heroin directly and be working on a 12-step program to stay away from heroin, rather than going through the intermediate step of becoming addicted to another opiate before getting clean. I'm sure that's what the person the OP spoke to meant, not that they want people to keep using heroin.

AussieRN36 · Aug 17, 2016

The clinic said methadone can be even harder to kick than heroin so they would rather have people on heroin and detoxing than methadone. I just wondered what the thoughts were on that?

Think of heroin like xanax and methadone like diazepam. Drugs with short half lives are excruciating to get off and that's why we need to use long-acting drugs to help with the main issues - which is the horrendous withdrawal which is typically why people keep using heroin.

Heroin addicts need to use at least 2-3 times a day just to stave off withdrawals and function normally. Methadone maintenance provides them with an opportunity to take one dose per day at a fraction of the cost. In my neck of the woods, a seasoned heroin addict would need to spend $100 on a hit just to feel something. Methadone costs around $4-$6 per day - depending on the pharmacy dispensing fee.

Taking methadone allows the individual to alleviate the physical symptoms of withdrawal - this in turn enables them to relearn how to live life without constant intrusive thoughts about using heroin, enables individuals to have a better social/family life and look after their children better, enables people to return to education and the workforce when they're ready (it's hard to do this after years of addiction, so it takes time for preparation/readiness). Ohh and the ability to sleep! When in heroin withdrawal, one cannot sleep for days if not weeks, one cannot enjoy the comfort of being able to sit/lay comfortably without restless legs symptoms - with the feeling like there are electric spiders crawling inside your bones and across every nerve in your body, the feeling of not being able to have a comfortable temperature - imagine feeling cold to the core but sweating profusely, and being hypersensitive to the touch of another, or even something as simple as feeling a cool breeze - instant gooseflesh, but not normal gooseflesh like you or I experience, it's a horrible, uncomfortable torturous sensation and it just gets worse. I understand that detox regimes are structured around the theory that withdrawals peak at day 3-4, but they get worse beyond that and can last up to 2 weeks.

Methadone also enables people to keep items of value and keep money for more important things in life (food, rent, etc). Imagine living a life where you took everything to cash converters to loan/sell because the withdrawals literally drive you insane. A drug like heroin that will call to you and put ideas in your head of ways you can make cash/get cash and make those god awful withdrawals go away. People will do anything to make them go away - even crime and prostitution. Yeah, methadone doesn't do that to a person.

I understand that some people continue to use when they're on methadone, but they use a heck of lot less. If a person uses once a week or once a fortnight on their pay day - it's progress because seasoned heroin addicts will use every day of the week and the cost of doing so is financially, socially, and psychologically devastating.