Methadone - Friend or
Foe?
by Dr. Clifford Bernstein
The United States has added yet another menacing substance to the
ever-growing problem of drug abuse. Methadone, a medication typically used as
replacement or maintenance for opiate-dependent patients, has become the
substitute drug of choice for heroin and the popular painkiller turned street
drug, OxyContin.
The Drug Abuse Warning Network reported
that across the nation, Methadone-related incidents requiring emergency room
treatment has increased 37 percent between 2000 and 2001. Florida saw an 80
percent increase in Methadone related deaths in the same period, and North
Carolina's fatalities increased eight times from 1997 to 2001. Virginia is
witnessing similar trends, and data predicts that we will soon be seeing
significantly more Methadone-related abuse than OxyContin.
Like Vicodin and Lortab, the frequency in
which Methadone is being prescribed for pain is also increasing. Patients who
were prescribed Methadone by their physicians to treat the pain of common
ailments such as chronic back pain, sports-related injuries, or migraine
headaches, are now seeking treatment for a dependency on a drug that was
originally intended to help them.
For many years, Methadone was not
considered an addictive threat because of the length of time (several hours)
between taking it and experiencing the narcotic effect. Additionally, it has a
sedative, rather than stimulant, effect. As an opiate-based painkiller,
Methadone can serve as an adequate stand-in for heroin or OxyContin. This can
be extremely dangerous due to the delayed and subtle effect of the "high".
People can overdose because they don't anticipate or feel the actual damage
being done until it is too late.
Methadone has become more widely available
in recent years, due in part to the increased number of clinics using Methadone
to treat heroin and OxyContin addictions. This makes it difficult to determine
whether the drug is friend or foe. Ryan Curry, a 21 year-old Maine resident,
began taking OxyContin to get high with his friends several years ago. Like
many people who use OxyContin recreationally and for medical purposes, his body
became dependent. Ryan decided he wanted to break his dependency so he sought
treatment at a local Methadone clinic. Ryan was put on a low dose of Methadone
to replace the OxyContin he had been abusing. As he became tolerant of the
effects of the Methadone, doctors gradually increased his dose.
Ryan
continued to take the Methadone supplied to him by the clinic for two years
with his prescribed dose having more than quadrupled during that time.
"I couldn't understand why they kept
increasing my dose when I was supposed to be getting the drugs out of my
system," said Ryan. "My body would grow accustomed to the dose and I would need
it increased just to make it through the day. It was not helping
me."
Methadone treatment facilities
traditionally service the patient on an outpatient basis, administering
medication with a drive-thru mentality. A patient's vulnerability, compounded
by a lack of sufficient medical supervision and psychological support, can
sometimes result in the emergence of the new dependency. More so, a doctor may
have difficulty judging the proper Methadone dose for a first-time user.
Additionally, patients are escalated to Methadone doses much higher than the
original opiate in order to allow for 24-hour dosing. The consequence of this
is that Methadone patients are much more difficult to detox.
Experts argue that people who are
prescribed Methadone for dependency on heroin or another opiate can lead normal
lives and should be praised for giving up their addictions. However, these
people may need to take Methadone forever, unable to function without it. Like
any other dependency, quitting Methadone can cause withdrawal symptoms because
the user is still dependent on opiates. Fundamentally, Methadone treatment
neither addresses nor reverses the core issue of dependency, and studies of
former heroin dependents have shown that withdrawal from heroin was far less
excruciating and lengthy than withdrawal from Methadone.
Is substituting one form of dependency for
another really the way to approach this life-threatening problem?
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