Methadone: Therapeutic use

Last modified: Monday, 1. June 2009 - 6:05 am

The most well-known use of methadone is for treat-heroin addiction. It is calculated that between 500,000 and one million Americans are addicted to heroin. Along with the obvious infectious risks to heroin users such as HIV/AIDS and hepatitis, heroin addicts often engage in criminal activity to obtain heroin, an illegal drug, to support their addiction. Methadone is an agonist, which means it fits into the brain’s opiate receptors and blocks heroin. It reduces the intense cravings addicts experience when they try to give up heroin and enables them to participate in therapy and other aspects of their treatment. Methadone also reduces the need for addicts to commit crimes to obtain heroin and protects them from disease. Recent studies have found that persons in a methadone maintenance program were three to six times less likely than heroin users to become infected with HIV, even if they continue to use illegal drugs.
Methadone generally lasts about one day in the body, meaning that a person in a maintenance program has to take methadone at least once a day. Federal regulations require that to be eligible for enrollment in a methadone maintenance program, potential patients must be at least 18 years of age and demonstrate that they have had at least a one-year history of heroin (or other opiate) addiction. An exception is made for patients between the ages of 16 and 18 who can document a history of at least two unsuccessful detoxification trials.
Methadone maintenance programs are generally managed through methadone clinics, which also provide counseling and rehabilitation services. There are currently 42 states that have methadone maintenance programs, along with the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.
The goal of a methadone maintenance program for people who are just coming off heroin is to decrease their withdrawal symptoms and their desire to use heroin. Initially, people starting in a methadone maintenance program will be given 30^-0 mg of methadone a day, although there are addiction specialists who recommend higher initial doses such as 60-80 mg a day. In fact, most programs today are switching to the larger dose because research shows the larger dose is required for methadone to work effectively. Further into a methadone maintenance program, the dosages of the drug will be adjusted so that a person will not have cravings for heroin but also will not have any side effects from the methadone, such as sedation or euphoria.
Besides its use in treating illegal opiate addiction, methadone is occasionally used in other areas of medicine. All of the opiates, including methadone, are powerful pain control medications. Since pain is one of the most frequent, and least well-managed, aspects of cancer care, physicians often use multiple medications to try to control cancer pain. Methadone can be given in 20 mg tablets or by intramuscular injection every four to six hours to control moderate to severe cancer pain. Methadone is often used when there is a desire to let the patient sleep because of its high sedating properties.
Methadone can also be used to treat a common condition called restless leg syndrome. This condition generally affects middle-aged to older adults, although it is occasionally seen in adolescents. In restless leg syndrome, people complain of a strong, almost uncontrollable desire to move their legs, especially at night. In people who are unable to sleep because of this disorder, 10 mg of methadone, given at bedtime, often is effective at slowing or stopping the leg movements.

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