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Methadone is a painkilling medicine discovered in the 1940's by German scientists as a substitute for morphine.  Soon, American companies brought methadone to the United States for use as a painkiller and, later, to help treat persons going through heroin withdrawal.

Methadone, heroin and morphine belong to a class of drugs called opioids.  They all act in the brain on pain, mood and other emotions.  However, methadone has some special qualities.  Methadone “blocks” the effects of heroin and other opiates and reduces cravings for heroin and other opiates. It is not a treatment for any other drugs.  Methadone produces no significant side effects.  There are no adverse physical or mental effects from methadone. People stabilized on methadone can safely drive a car or operate machinery.

What is Methadone Maintenance Treatment (MMT)?

In the early 1960's, two New York physicians, Vincent Dole and Marie Nyswander, discovered that if methadone is taken every day - called a “maintenance dose” - as part of a program offering supportive services, it is an effective medical treatment for opioid addiction.

Methadone works in several ways:

The right methadone maintenance dose doesn’t make you feel “high” or "drugged,” like other opioids do, so you can lead a normal life.  

Methadone’s gradual, long-lasting effects - 24 hours or more - take away the hunger or craving for other opioid drugs.

Methadone is taken by mouth once a day, so you avoid using injection needles with their risks of diseases like hepatitis and HIV. 

It helps you to live a healthier and better life, free of illegal drugs.

How Safe is Methadone?

Ever since its invention, over 55 years ago, scientific studies have proved that methadone is just as safe as any other medicine prescribed by doctors.  Methadone taken under a doctor’s care causes no harm to any of your body organs and does not change your ability to think clearly.

How Much Methadone?

The right methadone dose for you will depend on you overall health, and on other medications you might be taking.  An adequate maintenance dose will keep you from having unpleasant withdrawal symptoms between doses.  It will also eliminate craving for other opioid drugs or keep you from getting high if any are taken.

How Long does Treatment Take?

There is no specific length of time in methadone maintenance treatment that is best for everyone.  Generally, the longer you stay in the treatment program, the greater your chances for success.

Some persons taken methadone for their entire lives, and gladly so.  Others decide to try a completely drug-free approach once their lives get better, which can take some time.

Discuss this first with your clinic staff, so they can plan a gradual period of methadone reduction.  Never cut back on your dose or stop taking methadone on your own, or you may experience withdrawal symptoms and drug craving, leading to relapse.

What's next?

To more fully understand what MMT can mean for you, talk to some winners; those people who have completely turned their lives around for the better as a result of methadone.

What advantages does MMT offer?

Heroin and other opioid drug use can cause serious complications during pregnancy, including miscarriage or premature delivery of the unborn child (also called a fetus).  And children born to addicted mothers also are at greater risk of sudden infant death syndrome (SIDS).

Since the early 1970's medical experts have recommended MMT for opioid-dependent pregnant women.  Because MMT helps reduce the use of illegal opioids and the abuse of other harmful drugs, it offers a number of proven advantages:

In short, research has clearly shown that MMT is safe for pregnant women and offers you a much greater chance for a healthy baby.

What is the best methadone dose for pregnant women?

There is no single best methadone dose for pregnant women.  Your maintenance dose needs to be individually determined for your needs, to control drug craving and prevent withdrawal symptoms.  Because of changes in your body during pregnancy, you may need an increased methadone dose at some point.  This can be the case no matter how high your dose was to begin with and it does not harm the unborn child.

Does methadone affect childbirth pain?

While you are in the hospital, you should continue receiving your regular methadone dose.  Ask your clinical doctor to talk to the hospital staff about this if necessary.

Although methadone is a painkiller, your body becomes accustomed to its pain-relieving qualities.  This means that you will feel pain just like any women who has never taken methadone.

During labor and delivery, you should have the same choices for pain relief available to any patient - possibly including opioid pain medications.  Discuss this with your doctor.

How is the baby affected?

At birth, the infant may have a slightly lower than average birth weight than a drug-free newborn.  This is only temporary and can usually be avoided if you receive proper care before childbirth, and do not smoke or drink alcohol.

Some methadone crosses from mother to baby in the womb, the infant can experience some withdrawal symptoms during the first few days after birth.  Withdrawal usually develops slowly and is routinely treated by the baby’s doctor.

There is no long-last harm to the child from methadone.  And it is important to remember that a baby born to a mother in MMT is always much better off both physically and mentally than if the women was using heroin or other street drugs.

What about after childbirth? 

Your methadone should be continued daily as usual while you are in the hospital.  Ask your clinical staff for help in arranging this if necessary.

You can breast-feed your new baby while taking methadone.  Although methadone does show up in breast milk, research has shown that it is too small an amount to affect or harm the child.

However, you should not breast-feed if you use any alcohol or street drugs, or if you have an infection such as hepatitis or HIV.

What else can you do?

You must do your part to get the full benefits of what MMT has to offer.

Why doesn't methadone in MMT block pain?

An adequate maintenance dose of methadone every day takes away cravings for opioid drugs and allows you to live a better life.  But your body becomes accustomed to the pain-relieving quality of methadone.  This is called tolerance to the drug.

It means that you will feel pain just like someone who has never taken methadone.  And you will need painkilling drugs, possibly including opioid medications when appropriate.

What if pain goes untreated? 

Besides the obvious physical discomfort caused by pain, there can be some serious health consequences.  Healing may be delayed.  Increased stress may disturb appetite and sleep.  You may have feelings of powerlessness, hopelessness, and depression.

How is pain treated when you are taking methadone?

The are many different painkilling medicines, called analgesics.  The World Health Organization has recommended several levels of treatment, depending on the type of pain.

Are there any painkillers to avoid? 

Certain painkillers fight against methadone and can cause uncomfortable withdrawal symptoms.  Known as opioid partial agonist or mixed agonist/antagonist drugs - like Buprenex, Nubain, Stadol, Talacen, Talwin - they should be avoided.

Can you stay on methadone?  

While you are being treated for pain, there is no need, nor would it be helpful, to stop or change - increase or decrease - your methadone maintenance dose.  If you are treated by outside professionals, such as at a hospital, you can ask your clinic’s staff to help make sure you are continued on methadone as usual.

What should you do? 

Here are some suggestions for helping your health care providers help you deal with pain: 


Clinic Rules- who makes all the rules?

Rules and regulations governing MMT clinics come from federal, state, and local authorities. Clinics must follow these to stay licensed to practice medicine, to distribute methadone, and to remain welcome in the community.

MMT clinics are subject to regular, unannounced inspections, so they must abide by every one of those rules, without exceptions, all the time. This may seem rather rigid, but your clinic has no choice.

Some clinics also have their own rules for your safety, such as those dealing with behavior in the clinic. Other rules help your clinic stay in good standing with neighbors; for example, no loitering outside the building. Whatever the rule, there is a reason behind it.

How are clinic hours determined?

All businesses, including medical clinics, operate only at certain times. MMT clinics hire staff to work specific hours and days that are most convenient for the majority of the people they serve.

There is rarely flexibility to open earlier or stay later to accommodate individual situations. Knowing this, you need to plan your schedule and travel to the clinic accordingly, allowing extra time for unforeseen events.

Why are urine tests necessary?

Taking street drugs, even occasionally, defeats the purpose of MMT. Yet some people in treatment do this. Random urine screenings to detect methadone and drugs of abuse help clinic staff provide the best treatment tailored to individual needs.

Urine tests also are required by government regulations and they must be performed Ain a manner that minimizes falsification.@ This usually means that providing urine samples must be witness by a clinic staff member. This is unpleasant for everyone involved, but it is sometimes necessary.

Why is methadone so restricted?

Ever since its development as a maintenance treatment for opioid addiction more than 35 years ago, methadone has been strictly controlled by the government. That is, specific rules and regulations determine how much methadone may be prescribed, when, where, and to whom.

This is because methadone is a very powerful drug with potential for abuse. It could be extremely harmful if used improperly or by the wrong persons.

An MMT clinic must account for every drop of methadone it receives and dispenses. For this reason, there are many rules to follow concerning the proper handling and care of methadone doses.

MMT medical staff tailor methadone doses to individual needs. However, special permission may be required from state or federal authorities to prescribe methadone doses above certain limits. So there may be clinic rules regarding who might qualify for higher doses and under what circumstances.

Similarly, there also are rules for methadone does reductions or stopping the medication entirely - called Adetoxification@ or Amedically supervised withdrawal@ - which are for your safety and welfare. Methadone should never by stopped abruptly or reduced too fast, or you could get sick and feel intense drug craving.

Who is allowed take-home does?

Normally, methadone doses must be taken every day under supervision at the clinic. Federal and state regulations control who may have doses of methadone to take home - take-homes - and how many days at a time. Take-homes are an earned privilege.

Generally, take-homes are available only to persons comfortable on their methadone dose, avoiding all drugs of abuse, following clinic rules, cooperating with staff, and having a stable home life. Take-home dose privileges can be canceled if certain rules aren=t followed requiring proper care of the medication and ongoing participation in treatment.

What should you do?

You must do you part to get the full benefits of what MMT has to offer.

How common are sexual problems?

Some surveys have found that nearly 9 out of 10 men and women entering MMT programs have sexual difficulties of one sort of another.

Some persons have sexual problems that started before their involvement with drugs. For many others, the problems developed along with their drug abuse and addiction.

However, sexual problems are often a well-kept secret, rarely discussed.

What are the problems?

Every person should be able to experience intimate relationships with a partner and enjoy sex. Yet, both men and women coming into MMT program may experience a lack of sexual desire, or an inability to perform sex or achieve orgasm.

Women may have irregular periods, or none at all, and be unable to get pregnant. Sexual intercourse may be painful. Men may have difficulty getting an erection, call impotence, or suffer premature ejaculation.

What are the causes?

Sexual problems may have physical, emotional, and/or drug-related causes.

Some drugs of abuse - like cocaine, alcohol, heroin, marijuana, and others - may at first seem to enhance sex for some people, but the drugs end up ruining both sexual desire and performance. One reason is that many of those drugs upset the delicate balance of chemicals in the brain and body, called hormones, that control normal sexual function.

Making matters even worse are the anxiety, depression, fear, guilt, and daily stress of a drug-abusing lifestyle. Some persons, especially women, may have been sexually abused either as children or adults, which can later lead to sexual problems.

Physical illness also can cause problems. Obviously, when you are not feeling well it is difficult to have an active, enjoyable sex life.

How can an MMT program help?

During ongoing participation in MMT, by not using illicit drugs or alcohol, you general health should get better. Body functions, including sexual functions, typically improve.

Furthermore, over time, hormones in the brain and body can return to a more normal balance. Interest in sex and sexual performance may automatically increase as a result.

Today, there also are new medications and treatments that can help overcome sexual difficulties in both men and women. These can be prescribed by your doctor after a thorough evaluation of the problem.

However, there is still a need to deal with the emotional side of sexual problems. Learning to achieve intimate and satisfying relationships with a sex partner can take many months of hard work. Participating in groups and individual counseling at your MMT clinic can assist you in addressing these concerns and in locating other helpful resources.

Does methadone effect sexual problems?

Methadone has been used for more than 30 years as a treatment for opioid addiction. During all that time, it has not been found to create sexual problems when taken in adequate doses and exactly as prescribed. Methadone itself also is not a cure for such difficulties.

Many prescribed medications can have individual side effects causing sexual difficulties in some persons. These medicines usually can be changed or the doses adjusted to eliminate most or all of these effects - if you tell your doctor about the problem.

Unfortunately, many persons in MMT programs are embarrassed to talk about their sexual problems. Rather than suffering in silence or trying to find a solution on your own, you should try to overcome any embarrassment and ask for the help that is available.

What should you do?

If your aren't enjoying sex as much as you would like, talk about it with a trusted member of your clinic staff, such as a counselor, nurse, or physician. Remember, they are there to help you - if you let them.

Here are some other things to keep in mind:

What to tell others about MMT- will others understand?

Most people do not understand what addiction and addiction treatment are all about. Worse yet, many people have negative feelings about individuals who become addicted to drugs - addicts are stigmatized, even when they are in treatment.

This is especially so when it comes to MMT. Some people falsely believe that taking methadone is just substituting one addiction for another. Or that methadone is just as bad as heroin.

So, when you tell anyone about your participation in MMT, you must also be prepared to educate them. That way, they can be more supportive of your new life in recovery.

What should others know?

Opioid addiction is an illness and methadone is an opioid prescription medicine to treat it. Methadone has been used this way for more than 35 years and has helped millions of recovering addicts.

People need to understand that methadone does not make you Ahigh@ and you can function perfectly well while taking it. They also need to know that, just like medications for diabetes or heart problems, methadone often must be taken daily.

Focus on how MMT has allowed you to live a better life. Avoid discussing how horrible things were in the past - those close to you already know about it; others do not need to know.

Should family & friends be told?

In most cases, you will want to tell close loved ones - such as a spouse or companion, older children, parents. These are people who have worried about your past drug addiction and will want to know about you methadone treatment so they can encourage you.

Others might be told on an Aas-needed@ basis. Young children, relatives you see only occasionally, or close friends may ask questions about your new and better life - answer them truthfully.

Past friends who are still abusing drugs might be jealous of your success or miss your companionship as a fellow addict. Generally, they would not be very supportive and it is best to avoid these people when possible.

What about people at work?

For certain jobs, drug testing is required. Or an employment application may ask if you are taking prescribed medicines. Honesty is your best policy. If you fail to provide complete application information or neglect to mention before drug testing that you could test positive for opioids, it would raise concerns about your trustworthiness.

However, you participation in MMT cannot be used against you. Laws, such as the Americans with Disabilities Act, protect persons in treatment for addiction from job discrimination. An certain Areasonable accommodations@ must be made, such as a work schedule allowing clinic attendance.

In most cases, there is no reason for co-workers to know that you are in MMT. If the subject comes up, and you decide to tell them, keep in mind that they may not understand and might view you differently from that time onward.



Courtesy of 

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Made possible by an educational grant from Mallinckrodt Inc.


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