Opiate Addiction Information
What is Dependency
Opioids have been used for thousands of years, and it has long been known that many people who have become dependent on opioids have extreme difficulty permanently ending their use of them.
Suffering through the withdrawal sickness is only part of the problem. The real difficulty has always been staying off the drugs once the period of withdrawal is over.
Just as in the case of those who are unable to stop smoking, it is difficult to explain why it is so hard not to return to the use of opioids. Reasons include long-term depression, lack of energy, drug cravings, chronic pain, and sudden attacks of physical withdrawal sickness. Some people find that these problems diminish over time and eventually disappear altogether—but others continue to suffer these symptoms indefinitely, and many of them eventually relapse to their regular use of opioids.
Relapse often has nothing to do with lack of will power or other personality problems. Instead, it appears that people with a long history of opioid problems have experienced changes to the part of their brains that Dependency allows a person to feel and function normally. This part of the brain makes and uses its own natural opioids.
The best known of these natural opioids are the chemicals known as endorphins. The word endorphin literally means “the morphine within.” Indeed, these chemicals are functionally identical to morphine or heroin.
We don’t yet understand everything that these natural opioids do in the body, but evidence suggests that they are involved with pain control, learning, regulating body temperature, and many other functions.
It is possible that people who develop a dependency on opioids were born with an endorphin system that makes them particularly vulnerable. For example, we know that addiction appears to run in some families.
Addiction might also be related to changes in the brain caused by the overuse of heroin or other opioids. Or it may be the result of a complex relationship between genetics and the environment.We do not yet know exactly how this malfunctioning occurs, or even whether all people who feel unable to stop using opioids have this damage. There is, however, an increasing amount of evidence that many people who find it difficult to end their use of opioids have experienced these physical changes—which are likely to be permanent.
There is not yet any test that can determine how much damage a person may have to his or her natural opioid system, or how hard it may be for that person to stay away from opioids. All that we know for sure right now is that relapse is a major feature of opioid dependency.
Methadone is not a cure for the problem of opioid dependency. It is a treatment—and one that is effective for only as long as a person continues to take it appropriately.
The Scientific Theory of Opiate Addiction
Each of us is born with a “natural supply of opiates reffered to as endorphins.” Some of us are born with more; some less. In addition, the ways in which each person maintains and utilizes these chemicals is also different.
Endorphins help us to feel good or bad; anxious or relaxed. They reduce pain and increase pleasure. It is important to our well being to keep an adequate supply at all times. Fortunately for most of us this is not a problem. Yet for others…it is a painful problem.
Those individuals with less natural opiates find an attraction to the unnatural opiates such as oxycontin, codeine, morhpine, heroin, demerol, fentanyl, etc. The continued use of these substances without appropriate medical supervision can lead to an addiction.
Opiate treatment that includes medical managment, counceling, and other needed services can provide each individual the necessary tools for his/her recovery.
What is an Opioid?
Opioid drugs include all the drugs that come fully or partially from opium and synthetic drugs that have similar effects. Morphine, heroin, codeine, methadone, dilaudid, LAAM,OxyContin, and fentanyl are opioids.
What is Methadone?
Methadone is a long-acting, synthetic drug that was first used in the maintenance treatment of drug addiction in the United States in the 1960s. It is an opioid “agonist,” which means that it acts in a way that is similar to morphine and other narcotic medications.
When used in proper doses in maintenance treatment, methadone does not create euphoria, sedation, or an analgesic effect. Doses must be individually determined. The proper maintenance dose is the one at which the cravings stop, without creating the effects of euphoria or sedation.
Although methadone is not a single product from a single manufacturer, the active ingredient is always the same: methadone hydrochloride. All manufacturers add inactive ingredients, such as fillers, preservatives and flavorings. Methadone is dispensed orally in different forms, which include:
- Tablets, also called diskettes. Each one contains 40 milligrams of methadone, is dissolved in water, and then is administered in an oral dose.
- Powder is also dissolved in water.
- Liquid methadone can be dispensed with an automated measuring pump. Dosages can be adjusted to as small as a single milligram.
Patients have different opinions about the various types of methadone. Each methadone provider usually offers a single type of the drug and obtains its supply from one source, which means that patients generally do not get to choose which form of methadone they get.
For most people, a single dose of methadone lasts 24 to 36 hours.
How is methadone different from heroin and other opioids (for example, morphine or dilaudid)?
- Methadone lasts longer. The body metabolizes methadone differently than it does heroin or morphine.When a person takes methadone regularly, it builds up and is stored in the body, so it lasts even longer when used for maintenance. Most people find that once they’re stabilized on a dose of methadone that’s right for them, a single oral dose will “hold” them for at least a full 24-hour day. For some, the effect lasts longer; for others it lasts a shorter time.
- Stability is easier on oral methadone. Most people who are on a stable, appropriate dose of methadone for several weeks will not feel any significant sense of being “high” or “dopesick.” Some patients may feel a transition”—or temporary, mild glow—for a short time several hours after being medicated, however. Others may feel slightly “dopesick” prior to taking the day’s medication, but most will feel very little or no effect from the proper dose of methadone once they have stabilized.
What is Methadone Maintenance?
Methadone maintenance is intended to do three things for patients who participate:
- Keep the patient from going into withdrawal. The standard initial dose, as currently recommended, is 30 to 40 milligrams a day. After several days, providers adjust a patient’s dose as needed.
- Keep the patient comfortable and free from craving street opioids.Having a craving means more than just having a desire to get high. It means feeling such a strong need for opioids that people may have regular dreams about using drugs, think about doing drugs to the exclusion of anything else, and/or do things that they wouldn’t normally do to get drugs.Methadone won’t control a person’s emotional desire to get high, but an adequate dose of methadone should prevent the overwhelming physical need to use street opioids.
- “Block” the effects of street opioids.If the dose is high enough, methadone keeps the patient from getting much, if any, effect from the usual doses of street opioids. This result is often called the “blockade” effect.If a person’s opioid tolerance is elevated high enough with methadone treatment, a great deal of heroin would be required to overcome it and produce a significant high.
What is Detoxification?
Doctors do not advise that people quickly taper off of their dose of methadone—but there are, unfortunately, many situations where this occurs. For example, a methadone patient may be in jail or in a hospital where methadone is not prescribed. Or the person may be complying with a demand from family court in order to be reunited with children who are in foster care. Public policy is slowly changing, but some methadone patients are still being forced to detox from their medication.
If you are being “administratively detoxed” by your methadone provider, you should find another provider quickly. If your provider is not helping you find another, contact a harm-reduction program, needle exchange, or your state’s health department for assistance. A directory of state alcohol and drug-abuse agencies can be found at http://www.treatment.org/states/.
Some people also use gradually tapering doses of methadone for a short period of time (three to seven days) to relieve the initial discomfort of heroin withdrawal. This method may be successful for people who haven’t been dependent on heroin or other opioids for a long time.
If you do start using drugs again after your detox, you are not a “failure.” Time that you spent away from street drugs was a period of reduced risk—risk of arrest, exposure to disease, and overdose. But remember, if you relapse, the first weeks of use (again) are a time of higher risk of overdose.
How Detox Works
Methadone patients have two options: inpatient and outpatient treatment.
With inpatient treatment, the patient is admitted for overnight care to a clinic or hospital. The patient usually must spend several days and take medication to relieve the withdrawal symptoms. In outpatient detox, medication also provides relief from withdrawal symptoms. The medication is administered during daily clinic visits over a period of several weeks or longer. Often methadone is used in doses that are gradually reduced.
Any “cross-tolerant” opioid— such as morphine, dilaudid, methadone, heroin, or LAAM— can suppress withdrawal. Methadone is used because it is long-acting, gentle, eliminates craving, and does not produce a “high” when it is used properly.
Other medications, including drugs such as buprenorphine and clonidine, are also used—and may be used more widely in the future.
The usual detox program for methadone requires that the patient use it as a tapering dose for 21 to 30 days. During induction, the doctor determines the right dose to overcome withdrawal. Afterward, the dose you take gradually becomes smaller, until you no longer need the methadone. The medical and counseling staff in your program can help you develop a plan for further treatment if you need it, and will guide you through the physical changes you experience during the detox period.
Methadone & Pain
Severe pain has long been under-treated in the United States.This is partly because of ignorance and prejudice, but also because of the laws that made drugs like heroin illegal.The government has actively pursued and prosecuted physicians for prescribing opioids.
If you are on methadone maintenance, your regular maintenance dose of methadone will provide little or no pain relief. You will still feel pain, just like everyone else. In fact, you may need more pain-relief medication than people who are not taking methadone.
Greater public awareness of how many people have needlessly suffered because of this undertreatment of pain is beginning to force changes.To manage pain, doctors are beginning to more freely prescribe opioids—including methadone, which has been recognized as an effective pain medication.
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