Documents - The Methadone Handbook- Fact File

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Swim is adding this to forum because it answered all of her questions about methadone, and she hopes it will make a good accompaniment to the 'what to expect when starting MMT' thread:
http://www.drugs-forum.com/forum/showthread.php?t=90065
The methadone handbook is written for people in the UK, and given as a free resource to those starting treatment or wanting to find out more, but swim hopes alot of the information will still be relevant internationally, except for laws/regulations and such. It includes subsections on detox, overdose, law, withdrawals etc.

The Methadone Handbook

Is methadone worse than heroin?
Methadone is not ‘much more addictive’ than heroin. There are two parts to drug dependence: the physical and the psychological.
Physically there really isn’t a lot in it. If you actually stop (and stay off) heroin the withdrawals will probably be more severe but shorter by several days than if you stop methadone. Psychologically (because it doesn’t give a high like that of heroin) people tend not to crave methadone as much as they crave heroin.
Whichever way you look at it there isn’t much in it. Methadone and heroin are both powerful drugs which are very hard to get off.
There are disadvantages to being in methadone treatment - such as having to pick up your methadone regularly and not being able to go away at short notice. However, prescribed methadone can provide a useful period of getting used to life without heroin before becoming drug-free. Being stable in treatment can be the basis on which people start to build a way of life away from heroin use.
Prescribed methadone mixture also has the advantages of being:

• regular;
• long-acting;
• inexpensive;
• legal;
• non-injectable; and
• accompanied by counselling, medical care and other forms of help.

This means that, on balance, for people who haven’t been able to stop taking heroin and who can switch their dependence to methadone, it is a much safer drug to be dependent on.
If you are thinking about starting methadone treatment, it might be useful to list the pros and cons of switching to methadone and talk them through with a drug worker.

What are the benefits?
Methadone is one of the most researched medical treatments in the world. The studies clearly show that prescribed methadone can help people who are dependent on heroin to:

• stop using heroin (or greatly reduce the amount they take);
• stop injecting (or to inject less often and with less risk of HIV and hepatitis infection);
• improve their physical health and nutrition;
• stop committing crime to get money to buy drugs; and
• have more stable relationships and to get on better with their families.

Which means that while on methadone treatment you have a chance to get things like debts, housing and relationships sorted out, so that you will have fewer pressures to use when you do come off opiates.
How long will it take?
For many people, becoming opiate-free is a long way off and, as long as methadone is helping avoid the risks of illicit drug use, it can be prescribed safely for many years.
It can be hard for people who have been on methadone for a long time. Many wonder if they would have got off opiates sooner if they hadn’t started treatment. However, there is no evidence that people would get off opiates more quickly if they weren’t prescribed methadone.
Often, the reason treatment goes on longer than was first planned is because people find that getting off opiates is much harder than they thought it would be - not because methadone is ‘more addictive’ or ‘harder to get off’ than heroin.
...And carrying on using heroin would have been much more risky than getting into treatment.

The history of methadone
Methadone is a man-made drug. It was invented in Germany during the Second World War by scientists who, having discovered pethidine some years earlier, were developing other similar compounds.
When first invented it was given the name Polamidon. But methadone wasn’t brought into commercial production at all during the war.
After the war, the factory where methadone was invented fell under American control and it was they who began the first clinical trials in 1947.
The American pharmaceutical company Eli-Lilly first coined the name Dolophine - not in honour of Adolf Hitler (as has been said) but probably as a combination of the Latin word dolor (pain) and the French fin (end).
At first doctors thought methadone would be a revolutionary new painkiller, but by the early 1950s it was hardly being used at all.
In 1964, Drs Marie Nyswander and Vincent Dole in New York were looking for drugs to help heroin users when they read about methadone in the medical literature. They found it helped their patients stop using heroin and that tolerance was slow to develop - and methadone maintenance treatment was born.

Physeptone, mixture, linctus, tablets and amps
Methadone can be prepared as a medicine, tablet or in ampoules for injection.
The Department of Health advises doctors treating opiate dependence to prescribe methadone mixture 1 mg/1 ml. For many years this mixture has been made to a standard ‘Drug Tariff Formulary’ (DTF) formulation. Other formulations are available, and although they may vary in taste and colour the effect of the drug is always the same. Since June 1999 the standard green DTF formulation has been available under the brand name Physeptone.
Some clinics dispense a concentrated methadone mixture that has 10 milligrams (mg) of methadone per millilitre (ml) of fluid. This means that people only need to take one-tenth as much liquid to get the same dose. 5 ml of concentrated methadone can be enough to cause overdose in people who aren’t tolerant. People used to ‘ordinary strength’ methadone can easily overdose if they take the same volume of the concentrate.
Although often called linctus, methadone 1 mg/1 ml is 2.5 times stronger than linctus. Methadone linctus shouldn’t be prescribed for opiate dependence and should only be used to treat chronic, painful coughing.
Methadone is also available in 5 mg tablet form and in ampoules. The amps usually contain 10 mg of methadone per ml of fluid, although they can be much more concentrated with up to 50 mg per ml.
The Department of Health has issued strong advice to doctors not to prescribe the tablets or ampoules. This is mainly because of the risk of illicit sales; and because of concerns about the risk of vein damage if the tablets or concentrated forms of the ampoules are injected into a vein. Also, there isn’t any good evidence that people on tablets or amps do better than people on the right dose of methadone mixture 1 mg/1 ml.

What is in methadone 1 mg/1 ml?
Pharmacists may buy different formulations or make methadone mixture on site. They may use a different combination of colourings but whatever the colour of the medicine, the methadone dissolved in it is always the same - and will have the same effect.
The ingredients below are based on the standard DTF/Physeptone methadone mixture.
Methadone is a white crystalline powder. The powder is carefully weighed and then dissolved in one millilitre (ml) of fluid for every milligram (mg) in weight.
Sugar and water - about half (44%) of methadone mixture is sugar. The sugar is mixed with water and added to the methadone. The effect of this on teeth is the same as taking sugar in tea or coffee. If injected, it is the high sugar levels that can cause discomfort and pain (by drawing water from surrounding tissue) and lead to damaged and collapsed veins.
Chloroform is a flavouring (and scent) that has no psychoactive effect. When used as an anaesthetic chloroform can damage the liver and kidneys, but the amount of chloroform used in methadone is very small (below 0.009%) and there is no evidence of it being harmful. Sugar-free methadone does not contain any chloroform at all.
Yellow colourings: Tartrazine or E102 and Sunset Yellow or E110 are common yellow food colourings used in things like chewing gum and fizzy drinks. They are thought by some to be a cause of hyperactivity in children. Problems in adults are rare but in some susceptible people (usually those who react to aspirin and/or have asthma) sensitivity may develop. Symptoms include skin rashes, hay fever, tight chest and blurred vision.
If you think you might be sensitive to these colourings, check all food labels and cut them out of your diet, and talk it over with your prescriber and pharmacist.
Green S or E142 is a green food colouring used in tinned peas etc. It has no known side-effects. The colourings are added so that methadone looks different to other medicines - to stop people mistaking it for something else and taking it by accident.
Preservatives - small amounts of approved food-safe preservatives are added to prevent bacterial growth.

Starting treatment
It is important to remember that you won’t get a heroin-like hit from methadone. Although they are both opiates, the effects of methadone are less intense and come on more slowly. Some people find the change takes some getting used to, others don’t find it a problem at all.
Taking more methadone will only increase the risk of overdosing.
It is possible that you will be prescribed too much methadone. This can make you drowsy. If this happens - especially if it happens with the first dose - you should talk it over with your doctor or drug worker as there is a risk of overdose.
If, on the other hand, your dose doesn’t feel like it’s enough, or if you are finding it difficult to stop injecting, talk to your prescriber or drug worker about it.
If you don’t stop injecting once you are on methadone, make sure you have access to sterile needles and syringes and, to protect yourself from hepatitis B and C, use your own water, filters and spoons. You may want to talk to your drug worker or doctor about what effect it will have on your treatment if you continue to use on top.
Although methadone doesn’t always feel like a powerful drug, it is, and using heroin, alcohol or other sedatives (such as diazepam [Valium]) or sleeping pills (such as temazepam) on top of methadone is dangerous and can easily cause overdose.
The ideal dose at the start of treatment is one that:

• is enough to get you adjusted to taking methadone instead of other opiates;
• stops you suffering from withdrawals; and
• doesn’t over-sedate you.

There are a few rare effects that can occur in the first few days of treatment, such as a swelling of the ankles and feet, painful and swollen joints and a skin rash. Although these usually go within a few days, you should discuss any side-effects with your prescribing doctor.

The first few days
Methadone binds to cells in the liver, lungs and fat before moving back into the bloodstream to have an effect on you. This process is harmless and doesn’t damage the cells at all.
This means that you won’t get the full benefit of your dose during the first few days of treatment. It takes three or four days for these ‘tissue reservoirs’ to fill up and for the methadone to take full effect.
As you can see from the graph below, you have much more methadone in your system four days into treatment than you do on day one or two. People often feel they haven’t enough methadone to hold them in the early days of treatment. If this happens to you, keep taking the methadone as prescribed and talk to your drug worker or prescribing doctor. The risks of overdose are very high if you use other drugs in the early days of treatment.

Stability is the key
Methadone is more effective in helping people to stop using heroin when it is taken every morning.
If you do this there should only be relatively small changes in the blood levels of methadone. Having ‘heroin days’ and ‘methadone days’ results in very low blood methadone levels. As it then takes three days for things to get back to normal, people who do this feel rough more often, and use more heroin, than those who take methadone every day.
Although there are highs methadone can’t give you, it can give you stability and control - but only if you take it every day.

Effects
Everyone is different. So when someone says ‘methadone makes you sick/tired/itchy’ etc., what they mean is that methadone has that effect on them - it may or may not have a similar effect on you. You may experience only a few, some, or all of the effects listed below. You may experience them mildly or strongly.
There are some effects of methadone which are understood.
Its action on the brain can cause:

• a high/mood change that is less intense but longer lasting than heroin;
• controlling/levelling of emotions;
• drowsiness/sleep;
• nausea - if you vomit after taking methadone it is more likely to be caused by a psychological or medical problem (or, if you drink, by alcohol) than by methadone - get your doctor to check it out;
• Slower, shallower breathing (which is only dangerous in overdose scenarios;
• reduced cough reflex; and
• reduction of any physical pain.

Its action on nerves that control involuntary functions usually causes:

• small pupils;
• constipation;

and can cause:

• dryness of the eyes, nose and mouth;
• reduced blood pressure; and
• difficulty in passing urine.

In some people methadone causes the release of histamine (which is normally only released in allergic reactions) by rupturing the cells that produce and store it. This is not an allergic reaction.
Histamine release can cause:

• sweating;
• itching;
• flushing of the skin; and
• narrowing of the air passages in the lungs.

Methadone may also cause or contribute to:

• absent or reduced menstrual cycle
• reduced libido
• reduced energy;
• a heavy feeling in your arms and legs; and
• a craving for sweet foods.

The mechanisms that cause these effects are not always clear and some (such as no energy, reduced sexual desire and reduced periods) can be caused, or made worse by, other things in life.

The things methadone doesn’t do...
Because it is a long-acting drug, methadone does not give the same sense of a ‘hit’ as heroin: most people can take it once a day without experiencing serious withdrawal symptoms.
In people tolerant to a stable dose, methadone won’t affect:

• co-ordination;
• speech;
• touch;
• vision; and
• hearing.

Long-term effects
Methadone doesn’t damage your:

• bones;
• liver (but see below if you have liver damage);
• brain;
• heart;
• reproductive system; and
• immune system.

Methadone does not damage any part of the body as it passes through.
The liver breaks down (metabolises) methadone into a form which can pass harmlessly through the kidneys into the urine.
However, in people who have a liver that is very seriously damaged (by illnesses such as hepatitis B or C or by alcohol), the extra work for the liver can cause overdose or liver failure. The danger is greatest at the start of treatment, when the dose increases, or if the condition of the liver deteriorates further.
It is true to say that methadone, even if taken for many years, causes no direct physical damage and is usually much healthier than being dependent on illicit opiates. People who are opiate dependent (whether they are on methadone or not) can experience problems such as changes intooth decay, sex drive and constipation.

Tolerance
Tolerance is the way the body adapts in order to cope with the regular presence of some drugs. Once a tolerance has developed it takes bigger doses to achieve the same effect. The tolerance you have built up to other opiates is transferred to the methadone when you start taking it.
If you detox, or don’t take opiates for a few days, tolerance will quickly reduce. After a break it is easy to overdose on an amount that, at one time, might not have seemed to have any effect at all. This is why, if you miss a few doses, you may not get any more methadone until you have seen your prescriber.
One of the reasons why methadone is prescribed is that tolerance to it usually builds up very slowly.
The body builds up tolerance to most of the effects individually and at different rates. So your tolerance to one effect - such as feeling sedated - may have built up while you were taking heroin to the extent that you don’t feel sedated at all when you start the methadone. But another effect - such as a dry mouth - may still be with you after a long time on a script. The effects to which people rarely develop a tolerance are:

• constipation
• sweating;
• itching; and
• small pupils.

If you need to be prescribed painkillers, your tolerance to opiates can cause problems. If it does, it may help to ask the doctor treating your pain to talk to the doctor treating your drug dependence.

Constipation
Constipation is one of the effects of opiates to which people rarely develop a tolerance, and chronic constipation can cause serious long-term problems.
So, if you will be taking methadone over a long period, it will be really helpful if you can include lots of fruit and vegetables and alcohol-free drinks in your diet every day.
If constipation is a problem, talk it over with your doctor - especially if you are thinking about using laxatives. Some types of laxatives can be very helpful, but those which work on the muscles make things worse in the long term.
Teeth
Like all opiates, methadone is not good for your teeth because it can restrict the production of saliva which is one of the body’s natural defences against plaque - the commonest cause of tooth decay.
If you are prescribed methadone that is not sugar-free, it will be 50% syrup which can cause plaque. However, methadone is no worse for your teeth than eating sweets or taking sugar in tea and coffee! And research has shown that the teeth of opiate users on methadone scripts are no worse than those of opiate users not on a script.
To improve your dental health find a good dentist (your drug agency should be able to put you in touch with one) and visit at least once a year: regular dental care can make a big difference.
It also helps to:

• try and cut out (or reduce the amount of) sugary foods in your diet;
• clean your teeth morning and night and after meals
  (use your own toothbrush as there is a hepatitis C risk from using other people’s);
• use dental floss; and
• chew sugar-free gum.

Sex
Like all opiates, methadone can inhibit or remove the desire to have sex. In men it can affect the ability to get an erection. These effects vary from person to person - and loss of desire to have sex can happen in relationships for a number of other reasons. However, this can be one of the most difficult side-effects of methadone treatment to live with. If it is a problem for you, it may be helpful to talk things through with your drug worker.
If you do have a sexual relationship, using condoms not only helps to prevent pregnancy, but can also protect you and your partner against HIV, hepatitis B and other sexually transmitted diseases.
hepatitis B and HIV and other sexually transmitted diseases live in body fluids: mainly blood, semen and vaginal fluid. They are passed on when the infected body fluids of one person pass into the blood of another person.The skin of the vagina, anus and penis is thin and easily damaged so this can happen when people have penetrative sex without a condom.
This happens even more easily when injecting equipment is shared. Hepatitis C is a virus that can be caught easily through sharing injecting equipment or paraphernalia such as water, filters, spoons, etc. but is not usually transmitted sexually.

Women and methadone
A large proportion of women who use opiates experience reduced or absent periods.
This may be due to opiates reducing the levels of hormones that control menstruation. However, periods can also stop because of stress, poor diet and/or weight loss.
It is important to remember that even if you are not having periods you can still get pregnant.
At any time during your treatment, but especially at the start or during detox (when desire to have sex may increase), you may get pregnant.
Apart from protecting you from hepatitis and HIV and other sexually transmitted diseases, condoms can also stop you getting pregnant - even when you aren’t having periods.
Advice on condoms and other forms of contraception should be available locally from drug agencies, family planning clinics, sexual health services, HIV/AIDS services and GPs.

Pregnancy
If you think you might be pregnant, don’t worry that the methadone may have harmed the baby. There is no evidence to show that there is any additional risk to the development of the baby while you are on a stable dose of methadone.
For the sake of your health and that of the baby, it is important that you tell your GP you are pregnant as soon as you can.
A lot of women decide to come off opiates when they are pregnant. If you decide to detox while you are pregnant this can be done most safely during the last six months of the pregnancy - but your doctor needs to help you plan and monitor any reduction.
Stopping suddenly can be dangerous for you and the baby and should only be done under medical supervision.
Sometimes the stress and pressures of pregnancy make it hard to stop using and you could decide not to detox. If you are physically dependent on opiates, being stable on methadone is better for the baby and you than being unstable on illicit drugs, especially if you are injecting.
When you go into labour it is important to make sure the midwife and doctor caring for you know you have been taking methadone and about any other drugs you have used recently.

Babies
Many babies have been born to mothers using methadone, and large studies have shown that methadone does not damage the unborn child. But the baby may experience withdrawals, which may not start immediately after the birth.
The baby can be detoxed in a few days - under medical supervision - without any long-lasting effects. If the baby is withdrawing, make sure the doctors know. Allow the baby to rest as peacefully as possible between regular feeds and avoid bright lights, which may irritate him/her.
You must not try and detox the baby yourself, or ever give methadone to a child - you could easily kill it!
Children of opiate-using mothers are not automatically taken into foster care. If social services do have concerns, being in methadone treatment may help as it shows you are doing something positive about your drug use.
By law, children can only be taken into care if they are at serious risk and every effort has been made to keep them at home.
Breastfeeding
There are many benefits to breastfeeding and you can breastfeed while on methadone. Small amounts of methadone in breast milk can pass to the baby, but opinion varies as to how much the mother has to take before this happens. If this does happen it will reduce or prevent withdrawals in the baby after birth.
If you do breastfeed, it is important not to use drugs erratically. When you come to wean your baby, it is better to do it gradually to remove the remote possibility of withdrawals.

Children
If you can take your methadone home, make sure children can’t get to it - as they have no tolerance even very small amounts can kill them.
This is because methadone can make them:

• stop breathing;
• vomit; and
• choke on their saliva or vomit because they can’t swallow while unconscious.

To help prevent such accidents, you should keep methadone in bottles with a child-resistant cap. These caps can save lives but they are not enough on their own - even very young children can sometimes get them open.
If you take methadone home and you have children, you should:

• make sure your pharmacist gives you bottles with a child-resistant cap (but remember even small children can open them!);
• keep it in a locked cupboard (sometimes wardrobes have locks already fitted) or somewhere high, out of sight, that can’t be reached by climbing; and
• talk to your children about the dangers of all medicines.

And make sure methadone is never kept:

• in a fridge;
• under the bed; and
• in a car glove box.

The myth of the 'registered addict'
In the past, doctors were required to notify the Chief Medical Officer at the Home Office if they saw people addicted to certain controlled drugs, including heroin and methadone. The Chief Medical Officer kept details of those people who had been notified on what was known as the Addicts Index. People who had been notified to the Addicts Index often called themselves ‘registered addicts.’
The Addicts Index now no longer exists. It was a victim of government spending cuts in 1997.
The Addicts Index was confidential and no information from it was ever given to the police, other countries, employers or anyone else. Now that the Addicts Index has gone, the information has been stored securely.
Information about how many people are asking for help with drug problems is now collected regionally. This information is held in strict confidence too. Usually the only personal information that is put on the forms that go from your GP or drug service to the ‘regional database’ is your initials, date of birth and general area where you live.
Sometimes local police forces find out who has scripts. This is not because there has been a breach of confidentiality but because most police forces have a Pharmacy Inspection Officer who checks the controlled drug registers of the pharmacies on their patch from time to time. They do this to make sure everything is in order but it means that they can see who is being prescribed methadone too.

Supervised consumption
Most of the research that has demonstrated the effectiveness of methadone prescribing was carried out in services where all the clients had to go into the drug service every day and take their methadone in front of a member of staff. This is known as ‘supervised consumption.’
In recent years supervised consumption has become more widespread in the UK, especially since the development of ‘low threshold’ methadone prescribing programmes and the involvement of community pharmacists in supervised consumption schemes.
Although it can be a bind, supervised consumption can really help methadone be more effective by making people take the same amount every day. Without it, people who have had difficulty controlling their drug use often try and take more some days and less on others - which makes them much less stable.
Supervised consumption schemes have also increased the number of treatment places available because doctors who would otherwise be unwilling to prescribe have been persuaded by the fact that they know that the methadone they prescribe can’t be sold on the illicit market.

Chemist shops and pharmacists
This section may not apply to you as many prescribing agencies dispense their own methadone, and some have collecting from a local pharmacy as a second stage of the programme. So read, skip or save this section, depending on how you are going to pick up your methadone.
There are lots of grapevine tales about pharmacy staff with attitude problems - but remember, they have probably heard about (or had experience of) drug users with what they see as attitude problems too!
It is no good being at war with your pharmacist - there are problems that they can help you solve. It will pay off if you can find one of the many pharmacists who want to get to know and help you.
The information on the next two pages should help you to understand what the world looks like from their side of the counter and give you a realistic idea about what you can and can’t expect from them - which will help you to avoid most of the arguments that people with scripts and pharmacists can get into.

Picking up your methadone
If your pharmacist seems to take ages to dispense your methadone or serves other people while you are waiting, it isn’t necessarily because they hate you and think that you deserve to suffer.
It is probably because:

• they make up prescriptions in the order they are given in. Quite often people drop off a prescription and go and do their shopping; so just because the shop is empty it doesn’t mean the pharmacist isn’t busy;
• methadone is a ‘controlled drug’ so there are strict regulations about how it should be measured out, recorded and dispensed. One thing that does take time is the filling in of the ‘controlled drugs register’ which has to be done at the same time the prescription is handed out;

or because:

• they are preparing a batch of methadone from the different ingredients - which can take quite a while to do.

There are things you can do to make sure that you can pick up your methadone when you need it:

• get the agency writing your script to recommend a sympathetic, local pharmacist who stocks methadone (as not all do) and, if possible, to introduce you personally. If they can’t do this then someone should ring the pharmacy to tell them to expect you;
• pick up your own methadone. If you do want someone else to pick it up, ask the pharmacist (who is entitled to say no) and introduce them to the person who will collect it. If that seems like a pain in the neck, imagine how you’d feel if you turned up for your methadone to find it had been stolen by someone who had said they were collecting it for you...;
• write down the opening hours of your pharmacy (there is space at the back of this book). If they’ve closed when you arrive for your script there is nothing that can be done;
• agree with your pharmacist a time for collecting your methadone that is convenient for you both; then they can try to have it ready for you to collect without a wait; and
• carry some ID with you when you pick up your methadone in case your usual pharmacist is off.

Going away
If you are thinking of going away, don’t forget to sort out your script as soon as possible. The more notice you give, the less chance there is that you will have to cancel your plans because you can’t get your methadone while you are away.
Your pharmacist can’t dispense a day early because you are going away, nor can they give you methadone that should have been collected yesterday - legally they have to dispense according to the prescription.
Going abroad
To take over 500 mg and/or more than 15 days’ supply of methadone abroad, a Home Office licence is required. You should apply for this at least seven working days before you travel. You must enclose a Ietter from your prescribing doctor, giving your name and address together with the strength, form and amount of methadone you will be taking with you, the daily rate prescribed and your intended dates of departure and return. A Home Office licence is not necessary for amounts under 500mg, although it is advisable to carry a ‘to whom it may concern’ letter from your prescribing doctor, confirming that you are in possession of the drug for legitimate medical purposes.
Although following these guidelines will enable you to take methadone out of this country and bring any surplus back in, it is important to remember that it doesn’t mean you have the right to take it into the country/countries you are visiting. You should check with the embassy or consulate before departure to ensure that the country/countries to be visited will allow you in with your methadone. This may take a long time.

The law
If you have any legal problems at all with methadone, or any other drug, the best people to speak to for advice, help and information are your solicitor, doctor or drug worker.
When it comes to deciding the penalty for certain offences, methadone is in the same class as heroin under the Misuse of Drugs Act 1971. As a Class A drug, charges of both unlawful possession and supplying methadone (this includes giving or sharing as well as selling it) are likely to be referred to Crown Court where the maximum penalty for unlawful possession is seven years plus an unlimited fine, and for supply - ‘trafficking’ - the maximum penalty is life imprisonment plus an unlimited fine.
Selling, sharing or giving away your methadone can easily jeopardise your script, overdose a non-tolerant person and cause serious legal problems...
Custody
Police surgeons don’t have to continue treatment prescribed by another doctor. Although opiate withdrawals can be horrible, they’re not physically dangerous and there have been methadone overdoses in custody. Because of this, police surgeons are sometimes reluctant to prescribe methadone.
If the police confiscate your methadone on arrest, they should give it back on release.
Prison guidelines do allow for longer-term prescribing and it does happen in some progressive prisons. If you tell the prison medical service at the reception interview that you are on methadone, they may continue the treatment. You should at least get a seven-day detox, but, if you are pregnant, seriously ill or are on a maintenance prescription and are likely to be released soon, you should receive methadone as you would in the community.

Driving
The Road Traffic Act requires licence holders or applicants to tell the DVLA of ‘any disability likely to affect safe driving.’ They consider drug use to be a ‘disability’ in this context.
Once informed they make you have a short, independent, medical examination which includes a urine screen for illicit drugs. If there is only prescribed oral methadone in the urine they will normally issue you with a licence for one year, but if you are on injectable methadone they will withdraw your licence (because it is more sedating). You will be called back for another medical when it needs renewing (or when you reapply) and every year until three years after your script has stopped.
If the test is cannabis positive they withdraw the licence for six months. Regular users of cannabis will test positive for up to a month from last use. If other illicit drugs are found they remove the licence for one year. There is another medical on reapplication for the licence, and every year for three years, once it has been returned.
It is an offence to be in charge of a vehicle when ‘unfit to drive through drink or drugs’ - this includes prescribed ones. If you do carry on driving on a script, take care and don’t drive if you feel sedated or if you have had any alcohol.
If you are involved in an accident and your insurance company finds out that you are on methadone, they might be able to claim that it invalidates your insurance.

Hepatitis
The hepatitis viruses live in blood and other cells and can damage the human liver. Hepatitis is a medical term that means ‘inflamed liver.’ All the hepatitis viruses can cause damage and swelling of the liver.
Many members of the hepatitis family have been identified and named with letters of the alphabet.
The two main types transmitted by sharing injecting equipment and paraphernalia are hepatitis B and C. In some areas, 8 out of 10 injecting drug users have hepatitis C! This is because even tiny amounts of blood can cause infection. Both can be carried (and passed on) for years without people being aware that they have the virus.
The symptoms of liver disease caused by hepatitis include:

• depression;
• exhaustion; and
• jaundice.

Jaundice is a ‘turning yellow’ of the skin and whites of the eyes. In white people, when jaundice starts the skin usually begins to change colour as if the person were getting a tan, but the colour is slightly more yellow than brown. In people of all skin colours, the yellow colouring is most easily seen in the whites of the eyes and under the tongue.
If you have hepatitis, alcohol and paracetamol can accelerate liver damage.
There is a vaccination that can stop you catching hepatitis B. It is a course of three or four injections. Your GP or drug service should arrange vaccination for you: if they haven’t done it yet - ask. Even if you are immune to the hepatitis B virus, you still have to protect yourself from hepatitis C and HIV.
If you are hepatitis C positive and are going to be prescribed methadone, you should make sure the prescribing doctor knows about your diagnosis. Your doctor should be able to tell you about the monitoring and treatment options that might be available to you.
HIV
Studies have shown that for people with HIV, methadone is much better than illicit opiate use. This is especially true for injectors because injecting can accelerate the progression of HlV-related illness by affecting general health and introducing bacteria directly into the bloodstream.
If you are on methadone, the doctors managing your HIV need to know because methadone interacts with some anti-viral treatments.
If you are HIV positive, you can discuss your treatment with your:

• GP and/or prescribing doctor;
• drug worker;
• local HIV/AIDS service; and
• pharmacist.

Methadone and other drugs
Although methadone doesn’t react with or affect most other prescribed drugs, always check with a pharmacist if you get a prescription for something else or are buying over-the-counter medicines.
If you go to the dentist or a doctor other than your prescribing doctor for treatment, tell them you are prescribed methadone.
This is especially important if you need treatment for:

• pain;
• epilepsy;
• TB;
• depression;
• HIV; and
• anxiety or poor sleep.

If you take buprenorphine (Temgesic/Subutex) while on methadone, you may go straight into withdrawals because it is a different type of opiate and it will expel methadone from the opiate receptors.
You will also go straight into withdrawals if you take the drug naltrexone - which is sometimes prescribed to help people stay off opiates.
Methadone blocks the receptors in your brain that heroin and other opiates have to fit into in order to have an effect. So, if you have any methadone in your system, heroin may have a reduced effect or none at all. If you try to take enough to get a hit, you run the risk of overdosing.
Taking any sedatives in conjunction with methadone can be dangerous as they make each other more effective and increase the risk of OD. Particularly risky are the tranquillisers like diazepam (Valium) and temazepam which, as well as being an overdose risk, stop people thinking clearly and so increase the chances of sharing used injecting equipment or paraphernalia.

Alcohol
Methadone and alcohol boost each other’s effect.
So if you overdo either or both, you are much more likely to overdose. And as they can both knock you out and make you throw up, you don’t have to take a lethal dose to end up choking to death on your vomit while too sedated to wake up.
If you find that methadone doesn’t seem to be enough for you, talk to your doctor or drug worker about it rather than drinking more alcohol. The effects of alcohol are not altogether different from methadone and sometimes when people feel like they need more drugs they use alcohol.
The trouble is that dependent or dangerous levels of drinking can creep up (especially during and after a detox) and can do you more harm than opiates.
If you drink alcohol regularly it is important to discuss your levels of drinking with your doctor or drug worker. If you think it might become a problem, recording how many units you drink and setting yourself limits may help you keep things under control.

Withdrawals
When your body has developed a tolerance to methadone (see page 13), it may react
or withdraw when the amount of methadone in your system drops below a certain level.
Every part of you that is affected by the methadone learns to cope with the drug inside
you, so if you stop taking methadone your body takes time to adjust to not having it
there. During that time you may suffer withdrawal symptoms such as:

• a high temperature but feeling cold, with goosebumps alternating with
• sweating;
• restlessness;
• feelings of anger and/or anxiety;
• jerking arms and legs;
• disturbed sleep;
• diarrhoea;
• feeling or being sick;
• running eyes and nose;
• pains in muscles, bones and joints; and
• yawning and sneezing.

Most physical withdrawal symptoms are probably caused by the body continuing to
overproduce a chemical called noradrenaline. Noradrenaline is responsible for
controlling many automatic body functions - such as digestion. The overproduction
is caused by the body taking time to realise that its noradrenaline receptors are no
longer blocked by opiates.
Opiates may also reduce the secretion of the body’s natural opiates called endorphins.
This may partly explain why people still feel anxious, cold and/or have difficulty
sleeping for a long time after coming off opiates.
Because methadone is a longer-acting drug, most people find the withdrawals
longer-lasting than with heroin. But there isn’t much in it and the mechanisms
of readjustment are essentially the same whether you’ve stopped methadone
or any other opiate.
The problems associated with coming off opiates are not all physical and, in the
long term, looking for non-drug solutions is important if you want to stay drug-free.

Detoxing
Coming off and staying off opiates can be very difficult and complex: there is
another handbook in this series - The Detox Handbook - which looks in detail
at the whole issue of getting off opiates.
How and why you want to detox and what you expect at the end are things well worth
talking over, at length, with your drug worker and/or doctor.
During a slow detox most people find it takes about four days to get over the worst
of the withdrawals when they first drop to a lower dose, but it can take up to 14 days.
It will probably help to talk to your drug worker about how you can best cope with this.
If you use heroin during a detox your chances of staying drug-free afterwards
are reduced. If you want to get off heroin, stop using at the start of the script or detox
- if that isn’t the right time, it will be hard to find a better one.
Each time you take a drop in dose on a long detox or throughout a quick one,
there are several things you can do to help make the adjustment easier:

• if you can, plan to take it easy for a few days after each drop;
• keep things as stress-free as you can;
• look after yourself - stay warm, eat well and drink plenty of alcohol-free
• fluids
• to be sure you are getting an accurate dose when
• you need to measure small amounts, ask your pharmacist for an
• oral syringe; and
• don’t keep an emergency supply because if you do you’ll only
• find emergencies! (apologies for this formatting)

Detoxing isn’t just about withdrawals. You will probably be wondering what life will be
like without methadone. There will be changes - methadone tends to flatten out highs
and lows in life so you will probably find that feelings are more intense
than you’ve been used to. It can feel strange not having it there as things
crop up and you will probably find yourself wondering how you’ll cope.
But people rarely end a detox as a completely different person - it is still the same
you underneath! Great changes are possible but they involve more than stopping
taking methadone.
Detoxing isn’t the end either: staying off is harder than getting off.

Overdose
Being on methadone treatment reduces the risks of overdose.
Some of the things that increase the risk of overdose are:

• mixing methadone with alcohol/tranquillisers;
• persuading prescribers to give bigger
• starting doses; and
• taking methadone if you have serious liver damage.

People who are not tolerant to methadone can easily overdose.
It is important that opiate users remember that:

• as little as 10mg can kill a small child;
• a mouthful can kill a teenager;
• less than 50mg can kill a non-tolerant adult (and that could include you!
• - see below);
• using tranquillisers and/or alcohol at the same time as opiates makes
• overdose much more likely; and
• most of the people who die from methadone overdose have been
• sold it by someone who has got a script. (sorry about formatting)

If you detox, or stop using opiates for a while, your tolerance will reduce.
So, if you do use on top of a low dose, or go back to heroin after a break,
you could easily overdose on the amount you used to take.
If you ever suspect someone has overdosed on methadone, lie them on their side in
the recovery position (see picture below) and get someone to call an ambulance.
In most places the police do not attend when an ambulance is called to an overdose.
An injection of naloxone can be given to reverse the effects of opiates, but only if a
paramedic or doctor gets there in time.

The Methadone Handbook, Sixth Edition.
Written by: Andrew Preston.

Reputation Comments on this post:

Hey, good Work!

[adzket]

this thread may help swiy's it is methadone safety sheet info as printed by drug company as these are rarly given out with the drug.

http://www.drugs-forum.com/forum/sho...354#post487354