Basic Treatment Information / Considerations for Clients Seeking Treatment

Severe addiction is a catastrophic disorder which requires intense long-term treatment comparable to any chronic medical-surgical or psychiatric condition. Patients addicted to opiates almost always relapse if rapidly withdrawn (detoxified). Outcomes are much better if treatment includes opioid maintenance for at least eighteen months. The conclusion of treatment would ideally include a slow medical withdrawal, accompanied by intense rehabilitative services, including education and therapy groups, as offered at this clinic.

Starting treatment at this clinic may be one of the most important decisions in your life. Make sure you stay with the treatment.

If you are pregnant, do not withdraw or use opiate medications other than methadone. Methadone treatment is safe during pregnancy. Withdrawal and the use of illicit drugs are much worse for the embryo/fetus than methadone. When pregnant it is particularly important to avoid alcohol, cigarettes or smoking, or the use of any illicit drugs. Our clinic offers education and support for pregnant patients.

Methadone and buprenorphine prevent physical withdrawal and decrease craving, drug abuse behaviors, and relapse. Treatment maintains your physical opioid dependence but alleviates ("cures") the psychological addiction. Abuse thinking may continue but addiction thinking and behaviors cease. Methadone works as a slow-release medication and lasts about three times longer than heroin. It maintains a normal mental state, without "highs" and withdrawal symptoms. If abruptly discontinued, withdrawal starts after 2-3 days, is less intense than heroin withdrawal, and lasts about three weeks (it is safe to miss one or two days of treatment). Buprenorphine is similar to methadone but last even longer. Withdrawal is delayed, less intense and longer lasting. As with alcohol and benzodiazepine withdrawal, clients may experience sleep disturbance for months after withdrawal. Follow-up treatment is provided by this clinic to address the issues arising from slow withdrawal. This problem may be addressed with antidepressant medications.

While on a methadone dosage that is suitable for your present drug tolerance, you will function normally with no loss in motor or mental skills, and you will benefit from psychotherapy and other forms of treatment.

Methadone is taken daily. New patients receive take home dosages for Sundays and holidays. With stability and the appropriate amount of time in treatment, clients may earn regular take-home privileges. Some clients attend the clinic only once or twice a month. After at least three months of continuous treatment, you may qualify for four times weekly attendance; after six months, three times weekly; after nine months, once a week; after a year, twice monthly, after two years, once monthly. Our clinic considers group attendance (i.e., involvement in treatment) to be a critical component in earning take home dose privileges. Take-home dosages must be transported and stored in a lockable metal container, such as a cash box. Regulations about buprenorphine are less strict.

Side effects of methadone and buprenorphine are dose related, so they may stop when the dosage is decreased. If the dosage is too high, you may feel nauseated, sleepy, or "wired". Longer-term side effects include: constipation, sweating, decreased sexual functions, and, rarely, water retention.

Methadone is not toxic. In other words, it does not lead to any tissue damage. It does not hurt bones, teeth or the liver and can safely be taken for decades.

As with all opiate/opioid medications, women on methadone may not have menses but can still become pregnant.

Patients who have developed an opiate addiction cannot safely use alcohol, tranquilizers and other potentially addicting medications. (However, abrupt discontinuation of opioids, alcohol tranquilizers or sleeping pills is dangerous.) Alcohol use while on methadone reduces the effectiveness of methadone. Methadone seems to decrease alcohol craving, and during treatment, clients may have a false sense that they can easily control their alcohol consumption. During and after medical withdrawal, any alcohol use readily leads to alcoholism or relapse.

Many patients have both chronic pain and an addiction to morphine, Dilaudid, Vicodin, Percodan, Oxycontin, or other opiate pain-relieving pills. Abuse and addiction often develop when patients receive pain medications which they also use for pleasant feelings such as relaxation, stress relief, and intoxication. In therapeutic opiate use, the medication helps the patient function and has minimal or no negative effects. In contrast, in addiction the drug seeking and the drug effects interfere with normal functioning. This clinic deals with the pain issues of our opiate addicted patients, and we often consult with other specialists as part of our services.

Many opiate addicts have anxiety, depressed mood, sleep disturbance, or other psychological issues. Such problems need attention along with chemical abuse treatment. As part of our program services, we treat psychological problems with counseling, appropriate medications, and by teaching self-help skills in groups. Appointments with the psychiatrist for evaluation and prescription of appropriate medications are also included.

Some medications interact with methadone and buprenorphine. Patients should inform treatment staff of any prescription, over-the-counter and herbal medications they use and any treatment received for medical, dental, surgical and psychological conditions. Patients are advised to inform their pharmacist that they are prescribed methadone or buprenorphine, as well as any other medications they are on. They should inform their physician(s) that, while on methadone or buprenorphine, they cannot take pain medications such as Talwin, Stadol, Nubain, Suboxone/buprenex (for methadone patients) because these lead to withdrawal symptoms and worsen pain. Buprenorphine patients cannot take any narcotic medications. They may possibly increase buprenorphine dose to the maximum effective level. Increased methadone and i.m. Toradol are optimal medications for severe pain while on methadone. Morphine, Dilaudid and other high potency opiates/opioids are less effective. Demerol seems a poor choice. Patients must never use theantagonist naltrexone (Revea, formerly called Trexan). Naltrexone is sometimes used for alcoholism.