Methadone: Usage trends

Last modified: Monday, 1. June 2009 - 6:06 am

Scope and severity
The number of people entering methadone treatment programs to help them fight their heroin habit has steadily increased since methadone was first approved to treat heroin addiction. The latest statistics show that there are 170,000 admissions to methadone treatment programs throughout the United States every year.
Several major studies have been undertaken to gather data on opiate drug abusers who enter methadone treatment programs. The first of these was the Drug Abuse Reporting Program (DARP), which gathered data between 1969 and 1973. The second study, which examined patient characteristics of heroin addicts entering a methadone maintenance program, was the Treatment Outcomes Prospective Study (TOPS), which ran from 1979 to 1981. The most recent nationwide research, known as the Drug Abuse Treatment Outcomes Study (DATOS), collected data from 1991 to 1993.
There were many significant changes noted between the studies. In DARP, the earliest study, the patients entering methadone treatment programs had been, on average, addicted to heroin for at least nine years. In the 1990s, that number had increased to 13 years. Furthermore, the number of patients who had received previous treatment for heroin addiction increased from 50% in the 1960s to 75% in the 1990s. The proportion of addicts that had at least three prior treatment attempts increased from 13% in the 1960s study to 40% for the 1990s study. Use of other drugs such as cocaine among people entering methadone treatment programs increased from approximately 30% in the 1960s to 50% in the 1990s.
Age, ethnic, and gender trends
Based on data from these studies, there has been a significant change in the past three decades in the age, ethnic, and gender composition of methadone users. The proportion of women entering methadone treatment programs increased from 22% in the early studies to 39% in the most recent studies. The proportion of African Americans entering methadone programs decreased from 58% in the 1960s to only 28% in the 1990s, while the percentage of Hispanics rose from 10% to 24% over that same time period. The percentage of whites entering methadone programs increased from 29% in the 1960s to 38% in the 1990s. Forty-six percent of the methadone program participants were between the ages of 35 and 44. Only 20% were below the age of 30.
Methadone and all other opiates produce multiple effects on a user’s psychological and mental status. These effects are generally dose-related, with more powerful effects seen at higher doses.
In order to influence a person’s mental state, methadone, along with any other drug or substance, must first be able to cross what is known as the blood-brain barrier. The blood-brain barrier is an actual physical barrier, made up of tightly interspaced blood vessels that protect the brain from substances that might be harmful. The more effective a substance is at getting through the blood-brain barrier, the greater the effect it has on the person’s mental status. Methadone and other opiates cross the blood-brain barrier quite easily.
Most users of methadone, especially new users, report feelings of well being and tranquility after taking the drug. How methadone produces these feelings is still being researched. Some scientists think that methadone and other opiates cause these effects by acting on a part of the brain known as the locus cerulus. This area of the brain is known to play a major role in feelings of pain, panic, fear, and anxiety. It is thought that by dampening the action of the locus cerulus, methadone and other opiates cause thoughts and feelings of tranquility and ease.
Methadone and opiates were first used for pain relief, and are still chiefly used in that area of medicine. It is important to remember that methadone and other opiates do not exert their pain control by altering a person’s sensitivity to pain. Rather, methadone and other opiates interfere with the transmission of pain impulses from the nervous system to the brain. They accomplish this by a variety of methods. First, they decrease the transmission of nerve signals that conduct pain messages from various parts of the body to the spine. Secondly, they prevent production of neurochemicals that transfer this pain information to the spine. Finally, they mimic the actions of endorphins, which are the body’s own pain-controlling chemicals. While methadone and other opiates work quite well to control pain, they do not affect touch, vision, or hearing.
Methadone also produces clouding of thoughts, drowsiness, and sleep in people who use it. It is thought that psychological effects seen in people who use methadone, including the inability to concentrate, apathy, and lethargy are related to methadone’s pro-drowsiness effects, although researchers have yet to pinpoint the way in which methadone causes these effects. Methadone is often used by clinicians who specialize in addictive disorders to help heroin addicts resume a normal sleep cycle, since it is a powerful trigger at inducing sleep.
There are some reports by users that methadone use may cause hallucinations. While it is well known that heroin users often describe a dream-like mental state when using heroin, this effect is rarely seen in people who use methadone. The reason behind this is probably due to methadone’s slower onset of action and reduced level of intensity. Likewise, while users of heroin and other harder narcotics sometimes report feelings of acute anxiety, especially when first using the drug, users of methadone rarely report these psychological effects.

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