Methadone Madness

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Originally Published (by me) on LinkedIn on August 26, 2016

Admit it. You had an image of that God-awful documentary Reefer Madness in your mind didn’t you? …And…you already associated the context of that with your errant notions regarding what you think you know about methadone. I’m telling you that if you think that methadone is evil, you’re wrong.

Methadone maintenance has been the red-headed stepchild of substance abuse treatment options for many years. It has received a really bad rap and doesn’t have a very good reputation or public image. It’s time that people learn the truth about methadone and how many lives it saves.

Methadone Maintenance Treatment is for people that have been dependent on opioids for at least a year. That does not mean using opioids for a year; it means dependent on opioids for a year. Opioid withdrawal symptoms include sweating, hot flashes, chills, watery eyes, runny nose, excessive yawning, goose bumps, muscle pain, headache, nausea, diarrhea, vomiting, crawly skin, irritability, anxiety…the unpleasant list goes on. Suffice it to say that opioid withdrawal is like the very worst case of flu you have ever had multiplied by a factor of 12, and it doesn’t relent. Imagine feeling that way and knowing that with one phone call to a friend of yours, who might happen to have some of his leftover pain pill prescription from having a tooth extracted and might agree to spot you some, you could feel better in a matter of about 15 minutes. Hmm, let’s see…flu symptoms…or…take a couple of pills and feel normal again? No brainer, huh?

This is the dilemma people with Opioid Use Disorder face daily. They can be hellaciously ill and in bed, unable to be a parent, or employee, or functional anything, or they can score a few pills (or fentanyl, or heroin) and be normal…for a few hours anyway. Therein lies the rub: you have to amass enough medication to keep you normal. That’s what the “chase” is all about. You chase more pills in hopes of having a sufficient amount to keep you functional so that you can be whoever it is you are required to be. That is what keeps you using. You want to stop, but you don’t have the time or the inclination to be sick for very long. So you get a few pills, or grams, or whatever “just to get you through the day.” Then you’ll quit…later. The problem is, tolerance builds and the amount you used to take to be fine, no longer works, and you need more at a time to keep you fine. This costs more money, and more of your time. Then, the more you use, the more your tolerance builds, and the more you need. The other problem is, at some point you’ll reach your fatal dosage.

Methadone has been around for a really long time, and has been intensely studied and tested, and retested. Can it be abused? Yes, like a lot of helpful medications, it can be abused. Does that mean it isn’t suitable for use? No. Methadone is a miracle drug for many, many people suffering from Opioid Use Disorder. When patients come into a clinic for treatment, they are evaluated for their appropriateness for the program, and if so, they see the clinic physician, and are started on an initial dosage, which cannot exceed 30 mgs on their first day. They are required to attend the clinic daily to have the effectiveness of their dosage assessed and adjusted up or down as needed, to be monitored for signs of sedation or possible over-medication, and to begin treatment planning and counseling.

The initial goals of treatment include harm reduction and stabilization of the medication. Stabilization refers to the point at which the patient’s dosage keeps him/her from craving the drug of choice and alleviating withdrawal symptoms for a 24 hr period. Stabilization takes time. Methadone stays in the system (i.e., will keep a patient from withdrawal symptoms and cravings) for 24-36 hours. (It may stay in the system regarding showing positive on a drug screen for much longer than that.) This is the reason for the initial dosage not exceeding 30 mgs, and the reason that the dosage has to be adjusted slowly, in order to avoid overdose. It is also crucial for a patient to be educated on the dangers of potentiation. Potentiation refers to two or more substances increasing the effect of each other when consumed together. Certain substances potentiate each other, including opioids, benzodiazepines (like Xanax, Valium, or Ativan), alcohol, and barbiturates (like Phenobarbital, or Fiorocet). Basically, it means that taking two of these together leads to an equation of one plus one equals six, or eight, or ten. The amount of medication in the system is exponentially increased, and this substantially increases the risk of overdose and death. The risk of overdose is highest during the stabilization period because a patient who may not yet be getting 24 hours of relief can be tempted to supplement his/her methadone with other substances in an attempt to get additional relief. This is why most clinics require a new patient to see the counselor daily in order to learn about what to expect to feel physically, emotionally and psychologically while they are stabilizing, and to learn how to manage symptoms without resorting to illicit substance use.

Patients in Methadone Maintenance Treatment are required to submit to random weekly urine drug screens to monitor whether they are still using other illicit substances or alcohol, until they show compliance in the program as evidenced by having an observed urine drug screen whose results indicate no illicit substance use. (An observed drug screen is one where a counselor of the same sex as the patient goes into the restroom with the patient to ensure that the urine sample given is authentically that of the patient, and that the urine has not been obtained and brought into the facility.) If they show compliance for a period determined by the facility (usually for a minimum of 30 days), the patient is then placed on a random monthly drug screen schedule, where he/she is asked at a random and unannounced point once each month to provide a sample. If he/she continues to test positive for illicit substances after the 30 days, he/she is required to remain on a random weekly drug screen schedule to closely monitor the illicit use and to provide more interventions as needed.

So, now you know a bit about Methadone Maintenance Treatment and how programs work. I can hear you saying, “But these patients are just trading one drug for another.” That’s not the whole story. After years of using and/or abusing opioids, a person’s opioid receptors become dysregulated. Methadone works on a patient’s dysregulated receptors to normalize the patient. Patients are not getting high in treatment, they are getting normal. You wouldn’t tell a diabetic person, “Just lock yourself in a room for ten days, tough it out, and you’ll be fine. You won’t need that insulin anymore.” I can hear you saying, “That’s different.” It isn’t. Insulin normalizes the system of the diabetic person and keeps him/her from being sick. Methadone normalizes the system of the person with Opioid Use Disorder and also keeps him/her from being sick …with withdrawals. You say, “But the opioid addict did that to themselves. He/She shouldn’t use medication.” Okay, then, I guess you also believe that someone who smokes like a chimney for a lot of years and gets lung cancer shouldn’t get treatment either then?  …Thought provoking, isn’t it?

Addiction is a disease. It is primary, chronic, and fatal if left untreated. It bears repeating…FATAL IF LEFT UNTREATED. In the case of Opioid Use Disorder, it is a disease with horrible physical symptoms. Methadone makes people suffering from this disease functional and productive members of society again. They are better spouses, better parents, better family members, better employees. I promise you that you know someone on methadone, and you probably don’t even realize that you do. I work at a Medication Assisted Treatment facility that offers methadone and suboxone. We treat people of every kind, all races, religions, economic backgrounds… Addiction is an equal opportunity destroyer. It can affect anyone, no matter your upbringing, your intelligence, your socioeconomic status. For Opioid Use Disorder, Methadone Maintenance Treatment has the highest efficacy, and the best outcomes. I have seen it change so many lives for the better.

If you know anyone suffering from Opioid Use Disorder, you now have the knowledge to help them to get the help they need. You may locate a clinic by going to the SAMHSA website (www.samhsa.gov), and clicking on the treatment locator. You can put in your location, and then specify Methadone or Suboxone (buprenorphine) services on the pull-down menu once you open the link. You’ll want to ask the facility if they are CARF accredited before you seek admission.

Thank you for your time and attention. I appreciate your consideration.

-Tricia Gordon CAC II, NCAC II

Keepin’ It Real

Just a snippet about me. Who I (think I) am, what I do, and why I am the way I am.

I’ve been a Clinical Addictions Counselor working at two different methadone clinics since 2008. Let’s just say I’ve seen a few things. And let me thank God right now for my sense of humor, because without it, I wouldn’t have made it this far! I’m currently a Clinical Supervisor at a methadone clinic, which means I’ve been doing this long enough to know what I’m doing, to know sh…poop from Shinola, and to have been promoted.

So…I’m gonna get on my soapbox for a minute… People suffering from addiction …argghhh… I mean, Substance Use Disorder (thanks for the mouthful, DSM 5, I truly appreciate that) deserve the same dignity and respect as everyone else. In general they consist of good people suffering from a bad disease. Yes, addiction IS a disease. (Even the medical community has realized this and affirmed it now. Check out the updated ASAM definition of addiction. Go ahead, google it. I’ll wait.) It is a disease that is chronic, progressive, and FATAL IF LEFT UNTREATED! There are many reasons someone may become addicted. Yes, those people choose the behaviors that lead to their addiction, but once they become addicted, there is no going back. There is no cure, only management. And it doesn’t take very much effort to go from using drugs recreationally to becoming addicted. If something makes us feel good, we humans want more of it, and want it more often. It seems that we’re almost wired for addiction…whether it’s to drugs and alcohol, or something else, like food, technology, sex…The difference is, drug addicts and alcoholics can’t as easily HIDE their addictions as can those addicted to those other things. And for some odd reason those people addicted to those other things don’t get the same bad rap as those addicted to drugs or alcohol. So maybe our instant judgement of those we so casually label “junkie”  warrants reconsideration. People who suffer from addiction (sorry dsm 5, it’s an easier term to use) need help and support to get their lives together, not criticism and judgment.

Okay, I’m done. I’ll get off my soapbox now. For a short while anyway.