Are Narcotics/opiods Such as Methadone Work for Long Term?
Question by IWantAnswerz: Are narcotics/opiods such as methadone work for long term?
Best answer:
Answer by Jared
For pain management? Opiate addiction?
The sad fact is our brains will adapt to all opiates over time. So you will need to continually raise the dose over the months and years to achieve effect. Methadone is used primarily for opiate addiction/dependence , however it is a great pain killer as well and as such is used for chronic pain as well. Methadone has an incredibly long half life which is a good thing when using it for pain relief .. as you don’t have to continually re-dose. This makes it potent and suitable for many reasons, and not suitable for short term pain relief or ‘detox’.
In general for a long term pain condition, everything should be tried that is NOT “narcotic” or more specifically an opiate. This is due to the undeniable dependency that will occur with long term use of the opiate and the complications and unfortunate stigma that is attached to these medications.
However, there is no better medication for general diffuse or even local pain. The natural poppy plant still beats all of mans best attempts at pain control/relief — so with this in mind it is very often the only humane way to treat chronic pain that cannot be relieved through exhaustive conservative approaches.
IE: – Physical therapy, exercise, diet, de-compression, chiropractic manipulation and so on. I do not know what you need this for, but I am assuming.
So yes it works long term, but not without side effects and consequences all its own — but even though it ‘works’ it should be saved for ‘last’.
Long term opiate therapy should be the last treatment, for chronic pain, before surgery. (Mainly when dealing with spinal pain, generally as a result of nerve compression.)
Answer by Sparrow
Methadone is one of your best options with chronic pain, if used properly- but it is absolutely key you find a physicians who is well versed in it’s pharmacology, and knows how to prescribe it.Contrary to the prior replier’s information,methadone has one pivotal benefit that no other opiates/opioids don’t- it does not develop tolerance. It has become well respected for MMT for opiate addiction & for chronic, severe pain for that, and it’s incredibly long half life- methadone requires only once daily dosing. As patients build a residual supply in their system, many often find that they they do not begin to feel withdrawal for as long as 72 hours. Some shorter; but there is significant study now being done on Fast Metabolizers/Slow metabolizers, and a little reading of Methadone Today’s online newsletter will help satiate any desire for further information on the issue for you. Methadone users do not develop an increasing need for increased doses- meaning once you find the therapeutic dose that works for you, you can stay on it without increasing for years.
A little information of methadone:
Methadone has two main uses:
1) Severe pain: Methadone is used to treat severe, chronic & terminal pain. It works as a pain management drug because it is strong, but also time released- one dose holds you for 24 hours. Once a proper dose is determined, the patient does not develop increasing tolerance the way you would with other opiates, so you stay at the dose, instead of constantly needing higher doses for the same effect. Because it is such a strong medication, it is not used for mild pain easily treated with other narcotics, because it does cause dependency- if however, a patient will likely need pain meds the rest of their life, it makes sense to use methadone instead of other opiate pain killers that also cause dependence, and must be increased frequently & taken several times a day.
2) The second use is for opiate addiction- MMT (Methadone Maintenance Treatment). It is one of the oldest & is the most successful treatment for opiate addiction
I’m assuming you’re familiar, but in case not- opiate addiction, unlike other drugs, causes a physical dependence. If an addict suddenly stops using opiates, they become severely ill. Methadone is an opioid agonist- not an opiate, but a synthetic drug that works on the same receptors in the brain that opiates do, and therefor “tricks” the brain into thinking it’s getting opiates.
There is a lot of science behind it- but the long and short of it is that our bodies produce endorphins- natural pain killers- in small amounts, as needed. Opiates- drugs derived from the poppy plant- (heroin, vicodin, Darvon, oxycontin, morphine, dilaudid, etc.)- when taken, cause an influx of these endorphins. When a person takes opiates on a regular basis, the human body, which is extremely adept at conserving it’s natural resources- recognizes that the person is providing them with more than enough synthetic endorphins through opiates- and the body stops producing it’s small amounts. So when an opiate addict suddenly stops using opiates, the body goes into an endorphin-deficiency, causing the person to become very ill.
Until the last decade, addiction was not recognized as a disease. Since then, the medical community has found evidence of “addictive” genes, in the form of THIQ- a chemical produced from opiates & alcohol by certain people thought to contain the addictive gene. Those without the Addictive gene don’t process the opiates or alcohol the same way, and therefore, do not turn any portion of them into THIQ, the way a person with the addictive gene does. THIQ is believed to be part of the reason that an addictive-prone person develops such strong cravings & is unable to stop using, compared to the non-addictive prone.
Methadone, when used to treat opiate addiction, and taken in the prescribed, stabilization dose, does NOT impair cognitive ability, motor function, or logic. The very basis of why methadone has been successful in treating opiate addicts is because it works in a time released capacity- rendering it incapable of producing feelings of euphoria or, in laymen’s terms, unable to get you high.
Now- someone who has never taken methadone before, who takes a large enough dose, may experience marked drowsiness- but that’s why Methadone Maintenance Clinics (MMT) follow strict regulations that entail starting every new patient/opiate addict off at the very low dose of 20-30mg, regardless of their height, weight, or tolerance level to opiates. From there, each patient is seen by the clinic physician on a weekly basis, and given the small increase of 2 -5 mg once a week, until they are “stabilized”- meaning they’re feeling normal- not in acute physical withdrawal from the sudden lack of opiates in their system. From that point on, there is a blood test called a peak and trough, that measures the serum levels of the methadone in the patient, to ensure their dose is of a therapeutic level, and not so high as to cause drowsiness. It varies by patient, but anywhere from 65mg-300mg is average.
There has been a lot of propaganda in the press lately about the dangers of Methadone- the bulk of which is directly related to a few celebrity deaths that were caused by the mixing of methadone and alcohol, or methadone & other medications. What is not so well known is that NONE- ZERO- of those cases involved opiate addicts taking methadone in a methadone maintenance program. All of them were the result of a personal physician prescribing methadone for pain, to patients who abused the medication by taking it with other drugs, creating a lethal reaction.
The Harrison Drug Act made it illegal for physicians- general practitioners- to prescribe methadone to patients for opiate addiction. Only MMT clinics, which are strictly regulated, may prescribe it for addiction. MMT clinics require frequent, SUPERVISED, random drug screens (so anyone on methadone for opiate addiction cannot be abusing other meds, or they would be kicked off the program); as well as one on one counseling, group treatments, state required classes, state required physicals and blood tests, as well as anything else the individual’s counselor feels they need. They must complete treatment plans and goals on a monthly basis, demonstrating they are moving forward with employment, housing, etc., and they are not permitted to take many medications, even when prescribed by a physician, if there is any chance of an interaction. For example, benzodiazepines are well known for their ability to interact with methadone in a way that induced euphoria- (i.e., a buzz)- and are a major no-no. The MMT clinic will prescribe another medication that will not interact, if necessary, but using the benzo’s will result in being kicked off the program. A general practitioner, on the other hand, can prescribe methadone to whomever he sees fit for pain management, and there are no other regulations.
Hope this helps- if you have any other questions and can’t find the answers in the resources below, feel free to email me- i run a website & group for MMT based advocacy and client rights and we have a strong group of RN’s,Physicians, Counselors,and MMT users/methadone for chronic pain users that will be happy to help. best of luck to you-
Some other helpful sources:
* http://www.methadone.org/ (NAMA_ National Alliance for Medication Assisted Recovery , is one of the leading sources of information and education on methadone for MMT)
*http://www.drugtext.org/library/books/me… (The Methadone Briefing is an excellent resource that breaks down the myths and stigmas regarding methadone).
*http://www.whitehousedrugpolicy.gov/publ… (ONDCP- a factsheet on methadone from the Office of National Drug Control policy).
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