|Frequently Asked Questions... |
Do you have any questions about methadone maintenance treatment? Click on any of the questions below for more information. If you have any additional questions beyond those that are listed below, please feel free to contact our organization for further assistance.
- What is methadone?
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. back to top
- 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. back to top
- How does methadone work?
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. back to top
- 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. back to top
- 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. back to top
- 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. back to top
- What is 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. back to top
- 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). 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. 1) It helps you escape from a drug-seeking lifestyle. 2) Itreduces the risks of contracting HIV, hepatitis and other infections. 3) It prevents erratic blood levels of drugs that put the unborn baby through dangerous withdrawal. 4) It improves your nutrition, leading to healthier weight and condition of the newborn. 5) It allows you to prepare for the birth, take baby care classes, and begin homemaking. 6) It reduces medical complications both before and during childbirth, allowing for a healthier newborn. In short, research has clearly shown that MMT is safe for pregnant women and offers you a much greater chance for a healthy baby. back to top
- 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. back to top
- 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. back to top
- 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. 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. back to top
- 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. back to top
- What else can you do?
Taking good care of yourself is vital for the health of your baby. Inform clinic staff as soon as you think you are pregnant. Attend all prenatal doctor's appointments and educational classes. Follow your health care provider's instructions for prenatal care. Eat healthy foods and watch your weight. Stop or at least cut down on tobacco smoking. Never take any drugs, vitamins, nutritional supplements, or alcohol that have not been specifically prescribed by your doctor. You must do your part to get the full benefits of what MMT has to offer. back to top
- 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. You will need painkilling drugs, possibly including opioid medications when appropriate. back to top
- 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. back to top
- 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. back to top
- 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. back to top
- What should you do?
Here are some suggestions for helping your health care providers help you deal with pain. 1) Be honest. Tell all your doctors, dentists, nurses, and other medical professionals treating you that you are on methadone maintenance and of your past drug history, so they can prescribe the best and safest medication. 2) Encourage them to talk to your MMT clinic doctor and staff, with your permission. 3) Ask for the name of the pain medication and for assurances that it will mix safely with methadone. 4) Understand that, for your own good, you may be given only enough pain medication for a day at a time. 5) Follow directions exactly, taking too much of any painkiller can be harmful. 6) Let your health care providers know how the medication is working, so they can change the dose or the medication if necessary. back to top
- 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. back to top
- 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. back to top
- 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 in a manner that minimizes falsification. This usually means that providing urine samples must be witnessed by a clinic staff member. This is unpleasant for everyone involved, but it is sometimes necessary. back to top
- 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. back to top
- Who is allowed take-home doses?
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. back to top
- What should you do?
You must do your part to get the full benefits of what MMT has to offer. 1) Always treat clinic staff as you would like to be treated in return, with courtesy and respect. 2) If a particular rule is causing you problems, calmly explain your situation to apapropriate clinic staff and listen carefully to their suggestions.
If you have a complaint, find out the proper way to go about letting it be know. 3) At all times, avoid behavior that may appear hot-tempered or threatening. 4)Remember, your clinic staff are there to help you, if you let them. Working together with them, cooperating with all the rules, will help make you MMT clinic experience much more satisfying and rewarding. back to top
- 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. back to top
- 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 may be unable to become pregnant. Sexual intercourse may be painful. Men may have difficulty getting an erection. This is called impotence. Or one may suffer premature ejaculation. back to top
- 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. back to top
- How can an MMT program help?
During ongoing participation in MMT, by not using illicit drugs or alcohol, your general health should get better. Bodily 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. back to top
- 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. back to top
- What should you do?
If you aren't enjoying sex as much as you would like to, 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. 1)Talk to your doctor before stopping or reducing doses of prescribed medications that you think might be causing sexual problems. 2) If you believe you methadone dose is affecting your sexual performance, discuss this with clinic staff. 3) Never take any unprescribed drug - such as a stimulant (for example, cocaine), heroin, alcohol, herbal remedy, or over-the-counter product - thinking it will improve your sex life. 4) Be patient. Years of drug abuse and emotional turmoil leading to sexual problems will not be quickly overcome. 5) Dropping out of MMT will not solve any sexual difficulties or improve relationships with a sex partner. back to top
- 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. back to top
- 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 alright 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. back to top
- 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 as-needed basis. Young children, relatives that 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. back to top
- 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. Certain reasonable 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. back to top
- Why does methadone make me put on weight?
There is actually nothing about methadone or the way if affects the body that would make a person put on weight. However, this is a very old complaint of patients in MMT programs. A survey in 1984 reported that about 1 in 10 patients had gained weight, although 1 in 20 persons lost weight while on methadone. So, the situation is entirely opposite in different folks, which supports the view that methadone itself is not the cause. One common explanation for the weight gain is water retention but, in most cases, it is found that the patient is taking other medications that cause water retention or there is another reason. Many medications, such as some (but not all) antidepressants, cause weight gain as a side effect. Furthermore, there is the fact that many persons in MMT are simply taking better care of themselves, and eating much better, than they did while leading a life of substance addiction. A more healthy diet (talk to a dietitian) and some regular exercise could go a long way in helping control weight problems. Some persons have believed that the prepackaged liquid form of methadone is fattening. This is untrue. For example, Methadose®, cherry oral concentrate does contain sucrose syrup (a natural sugar) to deter potential injection of the product. However, in a 100 milligram dose there are only about 15 calories (or 1.5 calories in each milliLiter of Methadose) ? about the same calories as in one Life Saver candy and ten times less than in a single can of lemonade or Pepsi. (This also means that the amount of sugar in this methadone product would not be harmful for persons with diabetes.) back to top
- Is methadone harmful for MMT patients with HIV/AIDS?
Research in MMT patients has demonstrated that methadone does not make HIV or AIDS worse, nor
does methadone interfere with treatment for this viral infection. However, there has been some confusion regarding this. Laboratory experiments reported in 2002 from the University of Pennsylvania found that the HIV virus was able to more easily infect certain cells when methadone was added to the mix in a test tube. Also, when methadone was added to cells in which the HIV infection was inactive, the virus began to grow again. These cells, however, were not from MMT patients, so nothing can be said here about HIV in such patients. Other research had found that steady doses of methadone actually inhibit viral activity. Of interest, the methadone doses used in the Pennsylvania experiments were extremely low. Similarly, other experiments had shown that very low, inadequate doses of methadone can hinder the immune system, possibly allowing infections like HIV to become worse. Studies in human subjects ? MMT patients ? have shown that methadone is not harmful and, in fact, may boost recovery from HIV. In one investigation, patients with HIV in MMT were compared with HIV-infected former injection drug users (IDUs) not in MMT and individuals still injecting illicit drugs. In the methadone-maintained patients the progression of HIV disease was three times less than in the IDUs and also less than in the opioid-free former IDUs not in MMT. Importantly, over time, 10 persistent IDUs died of heroin overdoses and 2 drug-free former IDUs relapsed and died ? there were no such deaths in MMT patients. Although methadone does not appear to be damaging in persons with HIV or interfere with anti-HIV therapy, two conclusions should be noted: 1. continued use of injection drugs makes HIV worse; 2. MMT patients must receive adequate doses of methadone. In fact, one small study of MMT patients being treated for HIV found that their response to drug therapy was excellent; however, they needed about a 50% increase in methadone dose (on average) due to an interaction of the anti-HIV medications with methadone. back to top
- Is methadone bad for the heart?
Used appropriately as part of an MMT program, methadone does not appear to cause any heart problems, even at quite high doses. There were some concerns during 2001 when LAAM (a long-acting cousin of methadone) was associated with disturbances of normal heartbeat, called cardiac arrhythmias. LAAM was taken off the market in Europe and American doctors were advised to first test patients for any existing arrhythmias before prescribing or continuing LAAM therapy. To some extent, all opioids, including methadone, have an influence on heart function. Some of these effects are helpful. For example, persons having heart attacks are sometimes given morphine. Other effects, which have been demonstrated mostly in animals or test tube experiments, are less certain to be helpful or harmful. However, methadone has not been found to be harmful to heart health in actual patients. A panel of MMT medical directors, collectively representing 117 years of experience in treating more than 29,000 persons with methadone, noted that they had not seen a single heart problem that they would directly attribute to methadone. Similarly, a small study of patients receiving very high doses of methadone ? from 500 to 1,400 milligrams per day ? did not find any methadone-related heart problems. This is not to say that MMT patients do not experience heart problems just like other persons. However, the health risks, heart-related and otherwise, for opioid-addicted individuals not in treatment are great and death rates are high. The MMT program, of which methadone is a central part, provides a total healthcare environment potentially contributing to better heart health. back to top
- Are nutritional supplements, like herbal products, safe to use with methadone?
So-called "nutritional supplements" ? including certain herbs, plants, and other "natural" substances (that is, found in nature) ? have been used since ancient times to treat almost every human ailment. However, for several reasons, their use is not always safe or recommended. For one thing, such products are not regulated by the US Food & Drug Administration (FDA), which means there is no control over the purity and quantity of ingredients in any product. Second, some products can interact with methadone to make the usual dose feel stronger or weaker, or harmfully with other prescribed medicines. Third, the effectiveness and safety of some supplements are still in question. For example, recently (June 20, 2002) the government issued a warning about herbal products containing ephedra, also called ephedrine. The Ephedra species of herbs (also known by the Chinese name "ma huang") is found in many products, such as those promoting weight loss, increased energy, or better sexual performance. However, in some people, the products can have powerful stimulant effects on the nervous system and heart that may cause serious harm. The interaction of ephedra-containing products with methadone is unpredictable. Similarly, St. John's wort, widely advertised to help overcome depression can interact harmfully with prescribed antidepressant medications and other drugs. It may reduce methadone's effects and bring about withdrawal symptoms. Therefore, at the least, anyone on methadone maintenance should let the clinic medical staff know what non-prescribed products they are using. It also is advisable to let staff know before taking any new supplement or drugstore product, even vitamins. The government has formed an organization ? the National Center for Complementary and Alternative Medicine ? to more closely examine nutritional supplements and other therapies, such as acupuncture. back to top
- Can MMT patients participate in 12-Step programs?
Through many decades, 12-Step programs following the basic principles of Alcoholics Anonymous (AA) have helped millions of persons in recovery from addiction. Yet, at one time, the notion of someone on methadone maintenance attending 12-Step meetings was unthinkable. There are perhaps as many myths and misunderstandings surrounding 12-Step programs as there are MMT. The continuing use of methadone was unacceptable among many AA members, because the person was considered as continuing to take an addictive drug. For the same reason, some Narcotics Anonymous (NA) groups shunned persons on methadone. They did not understand, or care to acknowledge, the use of methadone as a legitimately prescribed medication and they failed to observe the unwritten tradition that, "No AA (or NA) member should play doctor." Some old-time AA/NA members discourage the use of any medications for mental problems, including antidepressants or other drugs acting on brain chemistry. Part of the problem might have come from an insistence by MMT patients on openly acknowledging their taking methadone, even though discussions of one's medical treatments have no place at AA or NA meetings. Today, many AA and NA meetings are more hospitable to MMT patients, especially if they do not make a big issue of their taking methadone. In 1991, special groups were started for MMT patients, called "Methadone Anonymous" (MA), and these have spread around the US to some extent, with MMT clinics often providing meeting space. MA was founded on the belief that methadone is a therapeutic tool of recovery that may or may not be discontinued in time, dependent on the needs of the individual. Persons in recovery who regularly participate in 12-Step meetings of any sort enjoy many benefits, including building a network of sober friends and ongoing personal development. back to top
- Is it safe for a methadone-maintained patient to drive a vehicle?
The public has been greatly concerned about persons using alcohol or any drugs that might impair mental function driving motor vehicles. However, it is clear that methadone itself does not in any way hinder persons stabilized in MMT from driving safely. Various research studies involving patients in MMT have examined important skills required for safe driving, such as the ability to pay close attention, reaction time, eye-hand coordination, and accurate responses in emergency situations. In some cases, driving simulators were used to test these skills. In all studies, persons maintained on adequate methadone doses had normal functioning. In some cases, their reactions times were better than comparison group members not taking methadone. To examine "real world" driving performance, some researchers looked at reported traffic violations and accidents among methadone-maintained patients compared with others having no history of drug addiction. MMT patients did not differ in any way from other drivers of the same age. Therefore, the research consistently shows that methadone itself is not a source of concern when it comes to driving motor vehicles. However, it should be noted, that the patients tested were well-established in MMT and receiving adequate methadone doses. Patients going through opioid withdrawal due to insufficient methadone doses, or experiencing methadone overmedication effects, such as sleepiness or fatigue, might not perform as well. back to top
FAQ is a courtesy of Addiction Treatment Forum which is made possible by an educational grant from Mallinckrodt, Inc.