Initially developed as a drug to treat patients suffering from the often extreme elements of opiate withdrawal, methadone has become one of the most widely abused drugs in the world, with related casualties more than quadrupling over the last five years in the United States alone. Methadone is a lab-produced synthetic opiate created by German researchers in the 1930's as an analgesic, and its best-known rehabilitative function is to regulate the body's supply of dopamine, a pleasure-inducing neurotransmitter. Heroin and other opiates attach themselves to dopamine-regulating neurons, thereby allowing huge amounts of the chemical to flood the body directly after consumption. Its production glands exhausted, dopamine then leaves the system very quickly, and its subsequent shortage in the bodies of withdrawing addicts creates the daily cravings that feed physical and psychological dependence. While on methadone, addicts do not receive the same highs from their substance of choice because it blocks the large-scale release of dopamine; it also does not provide the physical euphoria associated with heroin, and one might assume that its users do not stand as great a risk of developing addictions. But the substance can work as a very effective sedative, and it builds in the body's fatty tissue and maintains its presence much longer than any related drugs, so users may underestimate of the increased chances of overdose if they've been on the drug for some time and carry large quantities of it in their systems.

More than 100,000 American drug users (or an estimated 20% of opiate addicts) receive methadone treatment each day, and the substance has unquestionably made significant progress in counteracting the abuse of heroin as well as extremely dangerous synthetic painkillers like OxyContin and Vicodin. Experts warn that the increasing prevalence of the drug, its relative affordability, and the ease with which general practitioners can prescribe it for problems unrelated to drug abuse have all contributed to this growing problem - almost four thousand Americans died of methadone overdose in 2005, an exponential increase from the less than 800 killed by the drug in 1999. Recent highly-publicized deaths in which methadone played at least a supporting role have directed public attention toward this very real problem. The majority of these deaths occur among patients who have been prescribed the drug for pain resulting from serious injury or disease, and doctors have increasingly chosen to give the drug to patients while drug enforcement officials focus on more immediately damaging opiates.

Because of its relatively low cost and availability, an increasing number of street users now buy black marketed methadone as an easier alternative to heroin or OxyContin. While it doesn't provide the same sort of high, it does provide much-needed symptomatic relief. Some take advantage of this situation by selling prescribed methadone at a significantly marked-up price. Casual users may view the drug as a safe buzz, but when used in combination with other conflicting prescriptions or intoxicants like alcohol and barbiturates, it can have dramatic and potentially fatal consequences. The drug's effects are also delayed, so users may increase their dosages while looking for a high and unwittingly suffer from heart failure as the substance builds up in the system. Though methadone is unquestionably a useful and potentially life-saving medication, and many continue to emphasize its positive properties, recent statistics are anything but encouraging. Increased regulation and public awareness seem to be the most obvious solutions to the growing epidemic stemming from the misuse and abuse of methadone. Unfortunately, more public tragedies are likely to unfold before the general populace wakes up to the dangers of this powerful drug.

Deaths related to methadone use — a drug used to treat heroin addiction — are skyrocketing, a Justice Department report found. The drug can be safely used as part of treatment, but has serious health repercussions when mixed with other drugs and alcohol. (ABC News)

Deaths from methadone, a drug used in the treatment of heroin addiction, have risen at an alarming rate in recent years, according to a Justice Department assessment.

As part of treatment, methadone has been used successfully since the 1950s. While it is safe to use when closely monitored under a physician's care, methadone can be deadly when abused by addicts who often take the drug with other drugs and alcohol.

The assessment from the National Drug Intelligence Center found that methadone poisoning increased 390 percent from 1999 to 2004. This accounted for a jump from 786 deaths in 1999 to 3,849 deaths in 2004.

According to the report, "Selected state health department data indicate methadone poisoning deaths increased through 2006."

During the 1999 to 2004 time period, cocaine-related deaths also increased 43 percent, from 3,822 to 5,461.

Theft and division of the drug in recent years have increased, with the report finding that 18,547 doses were stolen in 2004. The number of stolen doses dramatically increased to 67,867 in 2006.

According to the DEA, in 2001 the number of medical practitioners who could distribute methadone was only 6,260, increasing more than 700 percent to 51,046 medical practitioners able to prescribe the drug.

The report noted that the increase in abuse of the pain reliever OxyContin has led to more doctors prescribing methadone. "Many practitioners began to dispense methadone as a pain reliever, following the negative publicity surrounding OxyContin's high potential for addiction and abuse," it said.

The FDA issued a public health advisory about methadone in November 2006, which noted that part of the problem of methadone overdoses occurred because the drug remains in the body for anywhere from 8 to 59 hours.

The advisory stated, "Methadone may build up in the body to a toxic level if it is taken too often, if the amount taken is too high, or it is taken with certain other medications or supplements."

by Nancy R. (Roseville)

I have been on methadone since 1975, straight through to the present. During my first 10 years on methadone (1975 to 1985), I continued to use heroin, then Dilaudids. Before I became addicted, I graduated from high school in 1971 then worked as a secretary for several years. Within one year of using heroin, my life fell apart. I quit my job, sold my car (the last material possession I had left), broke up with my boyfriend of seven years, and moved into the Cass Corridor (for those not familiar with Detroit, in the 1970's, the Cass Corridor was a section in downtown Detroit considered the ghetto, full of street addicts, drugs, poverty, and prostitution. Today, over 20 years later, the area has been considerably "cleaned up"). Anyway, for the next four years, I lived "in the streets". . .staying at cheap hotels and shooting galleries or crashing at friends' apartments, selling myself, cheating and stealing for the next "fix." Yes, I was on methadone during that time, but I was not quite ready to give up the drugs yet (although I believe my use of illicit drugs would have been greater without the methadone). Besides, the city-run methadone clinic I belonged to would only give up to a maximum dose of 30mg. That wasn't enough to keep me from feeling withdrawal symptoms or to take away drug cravings.

Shooting heroin ruined my health very quickly; I had seizures, caught Hepatitis B, and got several abscesses. Then, someone introduced Dilaudids to me. Dilaudid pills could be crushed, added to water, then injected, and they worked like heroin. With Dilaudid, at least addicts knew what they were getting; in other words, the pills could not be "cut" with who-knows-what, like heroin is. But, buying Dilaudid illegally on the street was extremely expensive, just like buying heroin. I finally got tired of chasing money, chasing drugs, shooting up, taking a chance of getting arrested, and of "living the life."

Luckily, I found a privately-owned clinic where doses were individualized. I was able to go as high in dose as I needed (150mg) in order to feel comfortable and end any drug cravings. So, since January 1985, I have never again used an illicit drug, but I continued taking methadone at the methadone clinic. My life turned around dramatically! I went back to work full-time as a secretary and enrolled in college part-time in the evenings. I worked nine years at a local hospital, eventually getting promoted to Executive Secretary to the Medical Director. I am halfway through my junior year at Wayne State University, working toward a bachelors degree. I got married, and we bought a house in Detroit. Yes, METHADONE SAVED MY LIFE!

A little over a year ago, I was laid off from the hospital. I had started attending Narcotic Anonymous (N.A.) meetings the previous year. When I lost my job, I decided to take advantage of the break from my grueling schedule of work and school to see if I could possibly detox from methadone. A little background history here: Since 1985, I had been taking between 100mg and 150mg of methadone daily (some of you may remember reading my previous articles in Methadone Today--"Take Home Med Policies, What is Fair?" in the August 1995 issue and "Narcotics Anonymous" in the February 1996 issue). I felt most comfortable at 150mg but would try periodically to detox down to 100mg in order to get once-a-week take homes. I would achieve this then find I just couldn't function as well and go back up in dose to 150mg (but then have to go to the clinic every day).

I began my detox: From October 1995 to March 1996, I dropped from 150mg to 130mg. Then, within three months (April to June 1996), I detoxed from 130mg to 45mg! Well, it sounds great, but the physical withdrawal symptoms suddenly hit me as if I had run into a brick wall. I had bad stomach cramping, nausea, diarrhea, sleep disturbances, aches and pains, and worst of all was that jittery, internal restlessness where you can't stand being in your own body--you just want to shake your arms and legs right off. I didn't expect detoxing to be a breeze, especially after taking methadone for over 21 years and at high doses, but it was hard to persevere day after day with severe withdrawals. The clinic doctor pointed out that I had dropped much too fast and suggested stopping or slowing down the detox, or even going back up in dose slightly until my body had time to readjust, then continuing the detox at a much slower pace. I followed his advice. I backed up to 65mg for a few weeks (I felt much better), and now I have just begun my detox again, only going down a few milligrams a week. For those interested, I will write again to keep you updated on my progress!

I must add this: I am strongly in favor of Methadone Maintenance Treatment (MMT). I understand many of us patients may need to take methadone for the rest of our lives, and we need not feel guilty about this! It has to do with brain chemistry (in fact, if you are interested, contact Beth Francisco, Editor of this newsletter, and she will be happy to pass on articles on brain chemistry and addiction. An excellent article appears in the Ombudsman, Fall/Winter 1994 issue, by Joycelyn Woods, Executive Vice President of the National Alliance of Methadone Advocates [NAMA], called "A Matter of Degree", which explains in medical and biological terms about how long-term use of opiates can cause damage to our brain chemistry, sometimes permanently).

I decided to try to detox after the past 11 years of successful MMT for several reasons. First, I am 43 years old, and I thought, "If I don't at least try to see if I can detox now, the older I get, the harder it will be to do it." Secondly, I am scared! It really scares me how the government is treating addicts in general, and methadone patients in particular--as criminals, rather than persons with a disease. Last year, the DEA raided a Detroit methadone clinic as if it were a "dope house", going in with guns drawn! Appalling! Addiction is considered a disease, and MMT is recognized as a viable treatment option by medical professionals. But, for persons with an addiction, Medicaid funding is in danger of being cut, SSI has been cut, and the government is considering making all methadone clinics 7-day-a-week operations (in other words, No take homes for anyone regardless of your personal history!).

A third reason I am trying to detox is that I would like to see if I can live life methadone-free. Narcotics Anonymous gave me many tools for learning how to cope with life and be happy without drugs. NA has helped put me on a path of personal and spiritual growth. Plus, I have met many people in NA who have successfully detoxed from long-term methadone treatment. They gave me hope. I want to see if I can do it!

One last note: "Total abstinence" does not have to be the only definition of "successful recovery." To paraphrase something our editor said recently--to only count complete abstinence as successful treatment dooms many addicts to total failure! MMT is success for many addicts when you consider "success" to mean an addict who turns his or her life around, stopping illicit drug use and stopping criminal activity, going back to work, paying taxes, raising families, and voting--just like everyone else!