Heroin, for example, is often injected, snorted, or smoked, causing an almost immediate "rush," or brief period of intense euphoria, that wears off quickly and ends in a "crash.
The cycle of euphoria, crash, and craving—sometimes repeated several times a day—is a hallmark of addiction and results in severe behavioral disruption. In contrast, methadone and buprenorphine have gradual onsets of action and produce stable levels of the drug in the brain.
As a result, patients maintained on these medications do not experience a rush, while they also markedly reduce their desire to use opioids. Taking more methadone can cause unintentional overdose. Side effects should be taken seriously, as some of them may indicate an emergency. Patients should stop taking methadone and contact a doctor or emergency services right away if they:.
Women who are pregnant or breastfeeding can safely take methadone. When withdrawal from an abused drug happens to a pregnant woman, it causes the uterus to contract and may bring on miscarriage or premature birth.
Undergoing methadone maintenance treatment while pregnant will not cause birth defects, but some babies may go through withdrawal after birth.
This does not mean that the baby is addicted. Infant withdrawal usually begins a few days after birth but may begin two to four weeks after birth. Orally administered methadone remains effective for approximately 24 hours, requiring a single daily dose rather than the more frequent administration of three to four times daily which occurs with the shorter-acting heroin [ 4 ]. Methadone accumulates in body tissues, being released as the blood concentration falls, apparently buffering serum levels and minimising withdrawal and sedative effects [ 5 ].
Higher doses of methadone can "block" the euphoric effects of heroin, discouraging illicit use and thereby relieving the user of the need or desire to seek heroin [ 6 ]. This allows the opportunity to engage in normative activities, and "rehabilitation" if necessary.
Methadone is typically administered orally, reducing the health risks associated with injecting. It is quite a safe drug when administered in correct doses, and the side-effects are not significant [ 7 ] , especially when compared to the adverse effects of continued illicit drug use. It is the drug substitution that has made methadone maintenance treatment MMT the subject of much controversy, debate, and misunderstanding, and which has ensured that it has become the most thoroughly studied of all of the interventions for illicit drug dependence [ 8 ].
Methadone maintenance treatment is differentiated from methadone-assisted detoxification, as maintenance implies long-term stabilised dosing of methadone.
It is recognised that the long-term dosing may be for an indefinite period or for a substantial number of years with the view of eventual abstinence, although this is not a necessary goal. The differing conceptualisations of the use of methadone maintenance have differing underlying rationales for use. Where an abstinence goal is seen to be appropriate, conceptually the mechanism whereby methadone maintenance exerts its effects is that it allows the user to develop a life free of the need to seek opiates allowing the development of a social network, employment, etc.
Where long-term maintenance is the goal, methadone is considered by some to act to correct a permanent underlying pathology, in much the same fashion that insulin is used in the case of diabetes mellitus.
Top of page 4. The adoption of harm reduction as a goal has also had an effect on the goals of methadone maintenance treatment. This has been reinforced by the advent of epidemic human immunodeficiency virus HIV infection rates among injecting drug users in some parts of the world [ 9 ].
Accordingly, the national methadone policy has incorporated harm reduction as a major goal of methadone maintenance. More recently, the recognition of the high prevalence of other infectious diseases such as hepatitis B and hepatitis C has come to be seen as an important issue in the care of injecting drug users. It is clear that there are a number of goals that treatment might attempt to achieve sometimes to differing degrees depending upon a number of factors including the type of intervention involved and the perspective on drug use whether the user, the clinician, the community or the health bureaucrat.
There has been a recent tendency in the prevention and treatment of alcohol-related problems to accept more limited and realistic goals of treatment such as limiting consumption below agreed levels or reducing the degree of risk of certain patterns of illicit drug consumption by aiming to change only the mode of administration. To date, the status of these more limited goals remains controversial within the alcohol field. However, the achievement of more limited objectives may be tolerated in the context of persons with serious drug problems provided that other treatment goals have been met satisfactorily.
Sometimes the goal of total abstinence from all opioid drugs will be unattainable, as in the case of those on long-term methadone maintenance, where the use of methadone is criticised and where a small proportion of users who enter the treatment will continue to use illicit drugs occasionally. Even for those in drug-free treatment it is likely that there will be continued drug use among some of these individuals, albeit at a reduced rate.
The choice of goal must be realistic in terms of what is achievable with the opioid dependent. An associated objective is the reduction of vertical transmission among HIV infected injecting drug users.
HIV risk reduction as a treatment objective often explicitly emphasises public health benefits although not at the cost of a beneficial outcome for the individuals involved. Clearly the reduction of the spread of HIV is important to all sectors of the community.
A hierarchy of HIV risk reduction objectives has been accepted. Variations on this hierarchy exist, but essentially the hierarchy is as follows from least to most desired : sharing injection equipment but injecting less frequently; sharing injection equipment but decontaminating sterilising it effectively; using only clean needles and syringes for injection; administering drugs by means other than injection; and abstinence.
Most scales available for measuring physical health are designed for severely disabled clients and do not apply well to this population, although there is a scale recently developed in Australia for the estimation of the health status of opioid users [ 10 ].
Illicit drug users more frequently have infectious diseases including respiratory illness, skin disease, sexually transmitted diseases, and chronic liver disease, hepatitis B, C and D, HIV, infective endocarditis, osteomyelitis, and septicaemia.
A reduction in the transmission of viral infections closely associated with injecting drug use, such as hepatitis B, C, D, or HIV, is clearly of benefit to individuals as well as the broader society. Additionally, associated with drug use are problems such as poor nutrition, dental caries, menstrual irregularities, complications of injection as a mode of administration, and accidents occurring while intoxicated.
Specific conditions include pulmonary emboli, cellulitis, thrombophlebitis, and nephrotic syndrome [ 11 ]. Disturbances of mood and personality disorders are said to be extremely common in injecting drug users. Although psychiatric morbidity is common in injecting drug users receiving drug treatment, the extent to which psychiatric problems are a cause or a consequence of illicit drug use remains unclear.
Whether cause or consequence, these states must be detected via routine screening of those in treatment. Treatment should reduce these problems and promote psychological good health or at least leave the individual no worse off than before in terms of subjective well-being. At times, you may find that methadone has unpleasant side effects. Some people find that methadone makes them feel "foggy".
Others complain of weight gain, sexual side effects, tiredness and aches and pains. Everyone reacts differently to methadone. Methadone is an opiate and you can overdose on it. As with many medications, if you take too much methadone, or combine methadone with certain other medications, there is a risk of death. Methadone is physically addictive and a methadone detox requires medical supervision.
Do not attempt to detox yourself off of methadone. Methadone is a long lasting opiate.
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