Methadone worse than heroin....ideas?

[Maevish]

I was wondering something. I got half my siblings from the foster care my family did when I was a kid and always as a result of poor/horrendous "parents" (not the giving up your child because you can't care for him/her thing). My parents are and never were "rich", but they offered to pay for my now sister's mom to go to rehab for heroin, but she wouldn't go. They also, however, wouldn't take her unless she was off of methadone.

She wasn't trying to quit heroin (and a good portion don't seem to want to, from the personal experiences I have had) and was going to the clinic to get her "legal fix" before shooting up at a hotel or in the streets.

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?

Most pts who use that along with their other drugs (I'm an ICU nurse) don't have ANY desire to get off the dope and just supplement with the methadone. From what I've seen they also act similarly when on methadone/heroin so what's the difference and why is it a good thing? 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 wish (and this is just me) that all drugs would be legal and people could take care of themselves, but I know that will never happen-even though it works in other countries.

I'm not trying to be uneducated and truly want to get your thoughts because it just seems like another drug to me and so rarely a catalyst for actually quitting the heroin.

I'd like to hear your stories and why it is/isn't a good thing.

What say you, Allnurses peeps??

xo

[yhl1975]

In some cases , methadone clinics justify putting young people on a medication that they will likely never be able to come off in an effort to prevent them from using illicit drugs so they are not involved in criminal activity.Then again our society wants everything easy and fast.

The 12-step program is not mandatory, so if the patient is "not spiritual ", he/she is on methadone program "forever".

[AlannaCT, BSN, RN]

Very well said AussieRN36! And I couldn't agree more. I work in as an addiction nurse and one of the biggest obsticals to care is all the mis-information and myths about methadone treatment out there. How can any person expect an addict to 'just stop using'. Our facility was one of the first to use a holistic whole patient model for treatment and we offer everything from inpatient detox, methadone and suboxone services coupled with mandatory Therapy, counseling, social work, medical and psychiatric services. What methadone does is stabilize the opiod addict, as you so eloquently explained, so they can have the time needed to learn coping skills, and develope behavioral chsnges that will stick with them and help them to succed once they taper off of the methadone or suboxone. One only has to imagine how addictive sugar is and how hard it would be to cut out ALL sugar in your life forever within a 5 day detox and never eat any item with sugar again or risk falling back into using. And now imagine opioids being 10x worse. Can anyone say they could do that without extensive help?

[RNOTODAY, BSN, RN]

Methadone exists, in a big part, simply because it's a " safe" fix, as in the addict doesn't have to rob steal and God knows what to get their fix... it's supposed to provide them with a routine, providing counseling with the program. Basically it's a safe , and legal fix, rather than the alternative-- getting it from the streets..

[sfbayRN94606]

Also, because methadone is given po (liquid or tablet), it eliminates the potential harm secondary to alternatives routes, like injecting. Lower rates of HIV/HCV infections. Lower risk of skin infection/injury. Lower risk of ruining veins d/t puncture.

[RNGummy40]

Dear Maevish, RN,

Methadone is a synthetic opioid and it is used (as others have already have mentioned) as tool to assist patients with sub-stance misuse.

Unfortunately, this tool is not well understood by all patients and all medical practitioners. Methadone is unique and complicated, that is why the safety concerns related to prescribing and managing it's use are significant. Methadone specifically inhibits the "CYP450 chain family" responsible for metabolizing it. In addition, methadone doubles it's own half life with each consecutive dose! These are two different affects and their is no other opioid that performs these two actions at the same time. This "brilliant" drug can cause significant problems for people on it and the education and training around it is not consistent. The protagonist and antagonist reactions whey prescribing any additional medications can significantly impact the patients health and well-being.

Methadone's job is to attach to the opioid receptors, lock on, activate, and block, other opioids from activating receptor sites. As AussieRN36, brilliantly described the tight rope of symptoms methadone is trying to prevent the patient from experiencing, this drug is not perfect. I have sat and listened to doctors at pain conferences, argue different opinions on how to treat pre and post surgical patients suffering from sub-stance misuse. What I have learned is that Methadone and even Suboxone are not iron clad in holding on to receptor sites. High does use of Heroin can unlock binding to receptor sites which presents an additional safety concern.

The Substance Misuse problems related to opioid abuse also include the negative physiological outcomes from chronic use. Hyperalgesia can occur within 2 or more years of chronic opioid use. The damage to the person's nervous system can magnify or create a chronic pain state which can be improved by reducing and or removing opioids from the patients regimen. In addition, side effects of sudden death, QTC prolongation, and respiratory depression are always a concern that may or may not be discussed with the patient.

When I have worked with patient's with co-occurring disorders and I give them methadone, I never think methadone is going to SOLVE there problems. I educate my patients that it is a tool to help them make better choices for themselves. I remind them that their futures are never locked in dried concrete, but are like play-dough! Knowing why they are using is a very important factor, and their maybe one or more reasons why they use, but they need to consciously know why and what it means to them. I always think of Maslow's pyramid and how can are my patients lacking in their basic needs. It's amazing how many patient's experience an loss of control when they are in the hospital, so close to death's door. When and if they make it through their treatment, they usually admit that they have anxiety about leaving because we provided a structured and safe environment for them to stay clean. More effort and resources needs to be in gaining access to housing, working, and reducing access to street drugs. I do not believe allowing more access to drugs will help, if anything it will allow more people to hide what ever pain or neg experience they are feeling. I do feel drugs should be more affordable, and do I think pharmacist should be used more in the medical system.

I believe when methadone is just the primary focus of patient's treatment plan, we as medical community are failing to adequately treat. Education, specifically informed consent needs to be provided. Patient's need more mental heath and addiction specialists available, as well as providers in hospitals and in the primary clinics. Opioids were used with little understanding of their effects and future impact, and now we are dealing with those consequences.

[Persephone Paige, ADN]

The people who claim Methadone does good things are right, in one sense. Previous rapid acting opiate addicts no longer need to lie, steal, rob to get their fix. So, in that respect it's almost a kindness done for the community, as well as the addict.

However, there's a place, it's called Methadonia. Everything is great, no worries about bills, no motivation, weight gain, inertia, nodding out, drooling...

Methadone does help the addict to stop their thieving, dishonest ways. That's about it. And God help you if you get fat on it, Methadone loves to hang out in the fat cells. And it slowly comes out, leaving a pretty protracted withdrawal.