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How methadone works

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Posted: Saturday, October 27, 2012 12:00 am | Updated: 9:13 am, Sat Oct 27, 2012.

What is methadone used for?

Treating heroin addiction with methadone traces back to the early 1960s.

Now it is also widely prescribed for chronic pain associated with everything from joint aches and back pain, to migraines, to cancer. From 1998 to 2006, methadone prescriptions, largely to combat pain, increased by 700 percent, according to the Drug Enforcement Administration.

It has also been prescribed, though rarely, as a cough suppressant.

How does methadone work to treat addiction?

A narcotic, methadone provides some of the same pain-reducing results as heroin, but it does not create the same euphoric rush. Methadone is used to help addicts withdraw from heroin or other opiates.

Heroin users have to increase doses of heroin to get the desired high. But the body does not build up a tolerance to methadone, so consistent doses can be given over time. On a maintenance program, methadone blocks the euphoric effect of heroin, so former addicts are less tempted to relapse.

Once a person has been on methadone for a long period, they are no longer getting high, but instead are "getting well," which means stopping the painful detox symptoms, said J.R. Neuberger, a member of the board of directors for the National Alliance for Medication Assisted Recovery. The organization advocates for methadone treatment throughout the United States.

"There's this miracle that happens where people go from 100 percent of their lives being involved in seeking out illicit opiates to keep the sickness at bay to becoming productive citizens," Neuberger said about methadone treatment.

However, methadone's slow buildup in the system, and slow release, is one reason some researchers feel it poses unique dangers for overdose.

What is the treatment schedule?

Patients start with detoxification, which lasts 21 days for patients on Medi-Cal and 180 days for those with private insurance, said Dr. Ernie Vasti, who is opening the Lodi clinic.

Detoxification is where the physician sets dosing levels to ease the immediate withdrawal symptoms from heroine. At this time, Vasti said they also provide a variety of tests to see if there are other coexisting diseases, including Hepatitis C, AIDS and attachment issues. The clinic's staff also starts therapy with the patient.

"Remember, it's not just the drug addiction we are dealing with," Vasti said. "There's a whole life here we have to deal with that's complicated."

Once a patient is ready, they can move to a maintenance dose, which can last anywhere from months to years depending on the patient's needs. If a patient regularly tests clean and keeps their appointments, they can eventually transition to limited quantities of take-home medication, Vasti said.

Can a primary care physician prescribe methadone to treat opiate addiction?

No. Primary care physicians are not allowed to prescribe methadone as an opiate addiction treatment, experts said. Patients must go to a state-licensed and federally accredited clinic.

Neuberger said he has known methadone patients who drive five hours each day to receive treatment.

Physicians can prescribe methadone for other conditions not related to addictions.

How are the clinics regulated?

Treating opiate addiction with methadone is regulated on both the state and federal level.

The production, distribution and dispensing of methadone must meet guidelines the Drug Enforcement Administration sets to prevent illegal use.

The Substance Abuse and Mental Health Services Administration accredits all of the methadone clinics in the United States using a peer review process, which includes site visits.

The California Department of Alcohol and Drug Problems licenses the clinics in the state to ensure "that patients who enroll in the (narcotic treatment programs) receive therapeutic care in an environment that ensures and protects patient health and safety," according to the website.

The department does annual inspections and monitors clinics to make sure they are meeting the California Code of Regulations, other state laws and federal requirements as well.

What are major concerns about methadone?

Health officials are deeply concerned over the rising number of deaths linked to the use of methadone as a painkiller. According to The New York Times, the rate of overdose deaths involving methadone in 2009 was more than five times the rate in 1999. Also troubling to health authorities: Methadone was linked to almost a third of the accidental overdose deaths caused by narcotic pain relievers, though it was prescribed far less than similar drugs.

A Seattle Times investigation that won the Pulitzer Prize showed state health officials there pushed methadone as a preferred pain reliever because it was inexpensive, ignoring the drug's unique risks. The investigation showed that 2,173 people died after accidentally overdosing on methadone between 2003 and 2011, and that the deaths were concentrated among the state's poor.

A 2008 New York Times report showed that doctors have been prescribing methadone because it is effective and relatively cheap, but that many physicians were not fully aware of methadone's fatal risks. The report also examined how the U.S. Food and Drug Administration's own suggested doses for pain were dangerous and possibly lethal. Those dosing recommendations have since been revised.

Patients can become dependent on methadone and suffer withdrawal. As its use has escalated as a painkiller, some health officials are also concerned about the street abuse of methadone, especially when it is used with alcohol or other drugs.

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