Methadone

An Elephant on MARS

September 4, 2008

original picture by oddsock

The elephant was not on the red planet, but rather on (M)edically (A)ssisted (R)ecovery (S)upport. Taking five times the regular dosage for a human, Xiguang the Asian elephant received daily injections of methadone while in treatment for heroin addiction he developed after being captured by smugglers. This is not the first time I have seen this type of story, apparently the smugglers drug the animals to make them work longer and keep them controlled. Much like human addicts, this system works fine until either the dope or the body gives out.

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Methadone vs Buprenorphine and Suboxone®

August 10, 2008

Methadone vs BuprenorphineAware of my advocacy efforts with methadone and medically assisted recovery for opioid addiction, JamezD of the Island Recovery Centers asked about my stance on Buprenorphine.

There’s certainly some history around this (there always is)
that we’re simply not aware of, but our addiction docs
seem to think that “Bup” is a superior approach to dealing
with opioid dependence… ~ Misleading on Methadone

Both drugs are used in treatment of heroin and pain killer addictions. Methadone and Buprenorphine work in a similar fashion but are usually administered and dosed differently to block opioid receptors in the brain to prevent withdrawal symptoms. Neither of the drugs produces the meteoric euphoric high that accompanies heroin and pain killer opioids and in fact cancel out the high of other opioid drugs taken during treatment. I feel Suboxone® is a superior form of Buprenorphine because of the additive naloxone which prevents misuse and abuse by injection and intranasal ingestion (snorting).

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Misleading on Methadone

August 4, 2008

Misleading on MethadoneContrary to my blogging nom de plume, I am most active in meetings and as a sponsor to opioid addicts. They are patients at a methadone maintenance treatment (MMT) clinic where I hold a weekly recovery class. In fact, tomorrow I will testify in a certificate of need hearing for a proposed MMT center for a nearby county. Other than being prepared to answer the questions presented to me truthfully, I really don’t see the need for any preparation but a post on the subject matter certainly seemed timely.

It was in search of a photo to accompany this entry that I ran across this story from USA Today. Yeah it’s a little dated, but it seemed like a good way to concentrate on a singular issue instead of taking on the comprehensive subject. I’m also too lazy tonight to find something more current and this article really serves as a great example of why MMT is often misunderstood. Read the article, notice in particular that every fact and figure on overdoses given in the text is related to prescription methadone prescribed by doctors for pain management. Yet the big pretty picture of methadone offered along with the story is accompanied by this caption:

A plastic cup holds a dose of methadone at the Southern Indiana Treatment Center in Jeffersonville, Ind. Methadone deaths as a percentage of all drug overdose deaths has increased from 4% in 1999 to 13% in 2004, according to the National Center for Health Statistics.

Not exactly a relevant picture is it? I am not sure if the author was biased or just ignorant of the subject matter, it’s misleading regardless.

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FYI: Carol Sholiton “Live” This Tuesday

February 4, 2008

Carol Sholiton, the founder and director of MethadoneSupport.org and the mirror site MethadoneAnonymous.info will be on the Recovery Talk Network on the evening of February 5th, this Tuesday. I have interviewed Carol myself and know first hand the breadth of her knowledge on medically assisted recovery (MARs) and have a deep respect for her commitment to the recovery community, she is an expert in the field.

When it comes to a subject like this, where most people have very strong opinions based mostly on conjecture and misinformation, I can think of no better person to listen to if you are looking for the straight talk when it comes down to methadone and other MARs related topics. I have seen these programs save lives, and I personally know people that are working their way as we speak toward a goal of complete sobriety, but even if you consider yourself an oponent of MARs based treatment I urge you to listen to Carol speak on the subject.

Just in case I haven’t done it before, here’s a TDA salute to Carol and her caring and helpful organization. Don’t miss her “Live” this Tuesday.

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Meeting about Meetings

January 28, 2008

recovery meetingsA meeting on meetings, yeah sounds kind of crazy doesn’t it? Actually the topic of our recovery meeting this week was why we go and what we get out of our weekly get-together at the methadone clinic. As a recovering alcoholic with a considerable amount of meetings under my belt I had a little more to say on this topic, but I was pleasantly surprised at some of the feedback even from those new to group altogether.

Much like any 12-step or other recovery meetings you have those who say they are there because they have to be, either court or program ordered. A few of the responses including my own hinted at a self-flagellation or atonement, but for the most part that was just good natured banter. A sense of camaraderie and community was mentioned by those more regular to our group. A few even discussed how by listening and watching others it became easier to reflect upon their own actions and thoughts.

There were two main reasons I pressed this topic and they really apply to anyone seeking or already in recovery. First, meetings are a positive step, direct action, on the road to personal recovery. No more crouching in the blocks waiting for the starter’s pistol, regardless if you get anything out of the meeting at all you are moving forward and this can be rewarding both in self esteem and accomplishment. Secondly, it’s about the only place where anyone will have truly have a clue about what you feel or experience. Friends, family, counselors and doctors may lend a sympathetic ear or even earnestly try to understand addiction; however it has been my experience that only an addict or alcoholic will ever truly “get it”. Not to take anything away from these well intentioned people, but they have about as much of chance relating to my story as I do to someone who wakes up to voices in his head telling him to sacrifice amphibians- the context just isn’t there.

Strangely enough, when asked I usually say I’m not a big fan of group meetings… but I host one weekly, strongly recommend them to others, and almost always get something positive out of them. I guess that sounds about as crazy as a meeting about meetings.

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Permanent Parking Space

January 27, 2008

methadoneWhile being a very strong advocate for medically assisted recovery, especially methadone maintenance treatment, I still realize there are some major shortcomings in the way these programs are set up. I ran across a term this morning in an article from Ireland about the problems they are facing with their methadone program that describes one of my reservations about the program perfectly: parking.

"There are approximately 9,200 people on methadone maintenance programmes in Dublin city alone and only 23 residential detoxification beds are available in the entire country for those who want to get off drugs completely." Merchant's Quay has voiced concern that too many people are now "parked" on methadone, with no resources available to develop their recovery any further.~ Independent.ie

The methadone programs in Europe tend be more publicly funded as I understand them, but the problem remains the same here. Once in a methadone program, the patient usually shows immediate improvement both in health and lifestyle, but from this point on they are for the most part parked in this position with nowhere else to go with their recovery. Much like the picture of the automated parking garage (cool, click the pic to see it on Gizmodo), there are no stairs or an elevator to get out of the garage and continue the journey… for some people it’s a permanent parking spot. Even worse, many patients become disenchanted with their lack of progress and fall back into their old habits.

By taking heed of the problems other countries are having with their programs we can improve ours. In the States, I see more concern on possible diversion of methadone from the treatment programs. While this does happen, it is considerably minor compared to the diversion of prescription drugs in general. In my humble opinion, we should be emphasizing the role of complete recovery in both the operation and regulation of our methadone programs.

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Keep Coming Back, but Plan on Staying Away

November 7, 2007

You can’t go to an AA meeting without hearing it, “keep coming back.” It’s a fundamental concept of the program, the more you go the better chances you have of staying sober. The same can be said to be true for those in methadone maintenance treatment (MMT). Building a routine of going to the clinic, attending meetings and counseling sessions, and being exposed to a recovery centered environment helps break the habitual patterns of an addictive lifestyle, but there is a big difference as compared to a traditional 12 step program like AA.

Those that attend AA meetings concentrate on taking life one day at a time, while recovering addicts in MMT, because of the nature of their treatment, have this part covered in a matter of weeks. The real problem with MMT once a patient levels out (healthy, clean, and positive), it is difficult for them to risk losing this new found life by considering tapering off the very substance that brought them back to the real world. Making the task even more difficult, is the fact that those that provide MMT services will play the odds by advising their patients there is no set time limit on how long they can stay in treatment. This practice leads to opponents of MMT to say that the clinics are protecting their investment, but unfortunately they are just being realistic. Those that stay in MMT, usually stay out of trouble, those that don’t fall back into their old habits. Same goes for AA, why else would they say keep coming back?

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Mistaken Methadone Methodology?

November 3, 2007

Even a cursory glance through the my many posts here at TDA blog should give you a fair idea that I am a rather strong advocate of methadone maintenance treatment (MMT) and medically assisted recovery. I feel that for the many addicted to opioids such as painkillers and heroin the program presents a feasible alternative to living the life of an addict. MMT offers the chance to straighten one’s life out so that full recovery becomes an option. Yes I still think that totally sobriety should be the ultimate goal, but for many the journey will start here or it will not start at all.

This is not necessarily true for one segment of opioid addicts, prisoners. They need not ask for time off from work or need large sums of money for rehab, supporting the family is not really an issue at this junction, and the stigma of admitting an addiction… well the orange jumpsuits kind of trump that problem. More than anything else, prisoners are going to be forced into sobriety through the harshest recovery program of all, incarceration. So I am a little confused as to why MMT clinical trials are being conducted on heroin addicts with over a year of clean time right before they are released.

Yes it does make sense that once they have been placed on MMT they may choose to stay on it rather than fall back into their old patterns, but wouldn’t a non-medically assisted recovery program be a better choice for those have already conquered the physical dependency aspect of their disease? I understand that considering it just a matter of statistics that maybe this methodology may prove sound, but for those that already have considerable clean time I think this type of pre-emptive methodology is unfair because they may could have stayed that way.

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Know Your Enemy

October 20, 2007

Kim Johnson recently stepped down after 7 ½ years as director of Maine’s Office of Substance Abuse. She was widely known as progressive and untiring advocate for the recovery community. In an article that was outwardly praiseful of Mrs. Johnson, I ran across this passage that exemplifies how utterly confused the media and the general public are about medically assisted recovery programs such as methadone maintenance.

But her tenure has been marked by a shocking increase in the abuse of prescription drugs in Maine as well as by the proliferation of controversial methadone maintenance clinics for the treatment of opioid addiction.~Bangor News

Obviously the writer of this article has confused methadone maintenance treatment (MMT) as a problem in the community that is to be equated with drug abuse. A little closer to home, in one of my local papers this weekend I read a quote about the recent battle to stop a methadone clinic from opening up in the county.

Clanton residents could not be happier, “we do not need anything like that in Clanton” says one long-time resident.~The Beacon

Both in Maine and here in Alabama, prescription drug abuse has risen exponentially over the last five years. Opioid based pain killer use has doubled and in some areas, oxycodone use has risen by over 1000 percent! The sad fact that there is a correlating number of people becoming addicted to these drugs and many communities are desperately trying to avoid the truth. The recovery community and organizations are neither qualified or have the capacity to handle this wave of addicts and methadone clinics are needed badly to provide help to those seeking a return to normalcy. As long as politicians and other scare mongers demonize these clinics, more people will turn to illicit drugs and crime because they can no longer support their habit with prescription pain pills.

Sun Tzu in The Art of War said to know one’s enemy so that they may defeated. Unfortunately, our communities have the barbarians at the gate and they are intent on destroying their only ally in the fight.

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Methadone Maintenance Treatment Q & A

October 3, 2007

I have a special treat tonight, an interview with Carol Sholiton, the founder and director of MethadoneSupport.org and the mirror site MethadoneAnonymous.info. Carol is a superhero in the world of methadone advocacy and a friend to all of us in recovery. Please take the time to visit her site, it has an amazing amount of information available and a great forum on medically assisted recovery. If you are interested how a recovering alcoholic like myself became a methadone advocate look at the posts here, here, here, and here.

Now, to the interview with my friend Carol Sholiton:

I can understand the animosity the general public shows to MMT because of misinformation and the fear mongering by politicians, but what is your view of the animosity that comes from traditional recovery programs such as AA and NA?

My organization is one of the only resources for Methadone Anonymous (MA). Unfortunately, many MMT patients are treated with a less than a polite welcome when entering other 12 step groups… AA… NA, etc. They are told that they may sit and listen to the meeting… but are not allowed to participate as anyone on MMT is not “clean”, sigh. This is one of the main reasons that MA came into existance. It really is a shame, TDA. I could never imagine turning ANYONE away from a meeting that is looking for help/support… but I have heard nightmare story after nightmare story about this from MMT patients. MA came into existence for this reason.

While I am not against people staying on MMT because addiction is a chronic disease with relapse in most cases almost a certainty, but I wish there was more emphasis placed on the medically supervised tapering off of MMT. Are you aware of any programs that promote this?

As you know, lol… this is a very controversial topic… but one we answer at least daily. Most methadone clinics do not “push” the patient to taper off of MMT. First of all… opiate addicts do NOT have a good track record of staying “clean”. Lots of us have what is called, “Endorphin Deficiency”. What that means is that we’ve used opiates for so long that our brains no longer function as they once did. Their brain no longer supplies the endorphins that people depend on to feel good… and tapering will most times end in relapse. That said… I am NOT saying that no MMT patient is capable of tapering… it depends on the person… the length of time they’re been using opiates… and so much more. We have a wonderful detox/taper forum that is full of good info… wise and wonderful people… and some much needed support!

Usually… if a patient wants to be tapered/detoxed… after discussing it with their counselor, the Dr. etc… they are put on a very slow taper. The rule of thumb with methadone taper is… THE SLOWER THE BETTER… and the lower the dose gets… the slower it needs to go.

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Recovery is Not a Meeting

July 19, 2007

It was about two years ago when my city newspaper asked me to write a story about a methadone clinic that had opened up in our area. They did not know I was a recovering alcoholic or that I had any familiarity with addictions, I was just a cheap (free) writer they could depend on for local coverage. They were probably kind of surprised when I told them I wasn’t interested in doing a “hit” piece on the clinic, there had been plenty enough of negative news already gleefully distributed by the mainstream media.

I guess I already had a rudimentary understanding of methadone maintenance treatment (MMT), although in hindsight I realize most of my knowledge came from the con side of the argument. I expected at least a guarded interview from the program director but instead was giving a (chaperoned) free pass to the facility and its employees during dosing operations. The openness both surprised and impressed me; needless to say that I came away that day with a positive story that much to my surprise was actually put to print. Since then I have found that there are definitely clinics out there that are less than reputable, but the clinic I now call mine has never let me down in their professionalism and their sincerity to help those suffering from opioid addictions.

I call it mine because I hold a once a week recovery meeting there that we currently do on Saturday mornings. It’s not an AA, NA, MA, or even a twelve step program, it’s just an open topic meeting where we talk about our addictions and learn about recovery. Recovery is hard to define for anyone, but for those in MMT it can be a very elusive concept.

I have discovered, ergo my name, that recovery for me is a process of continuous improvement, gathering of knowledge, and exploration. Recovery for me is not only reining in my disease, but throwing a saddle on its back and riding that beast into the future for all it is worth. The lessons that we learn to recover from our addiction become the very tools that allow us to effectively handle stressful situations, try new things, and make us successful in life.

But for many in MMT, recovery is something for addicts and alcoholics that have kicked their substances all together and not for those that are just “maintaining”. Many have tried support groups like AA and NA but have either actively or passively been made to feel unwelcome once it is known they are in MMT. Some have not even been properly introduced to the concept; they have accepted that MMT is successful as long as they don’t fall back to illicit drug use. There are those that think of recovery as a meeting with their counselor.

So in our meeting we talk about how recovery is not just a twelve step process or only total abstinence from drugs and alcohol. It is instead a continuous process that can also include MMT as a critical stage in one’s development. Recovery is way of improving one’s life and that of our loved ones. It is learning new confidence and self respect, and it is planning for the future. It may include the twelve steps, counselors and groups, or a more personal program as I follow, but recovery is definitely not just a meeting

There is no set schedule for weaning off MMT just as there is no set schedule for progression through the twelve steps. Many balk at the thought of life without methadone just as newcomers do in AA thinking the end goal is beyond them, but by working through the steps they find the power to make it happen. It is no different for those in MMT, in the beginning it may be hard to imagine a drug free life but by following a graduated path of recovery one can eventually discover the power to succeed.

How do you define recovery?

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Trading One Drug for Another

June 11, 2007

Some say methadone maintenance treatment (MMT) is just trading one drug for another including some very high profile critics like Presidential hopeful Senator John McCain. You know what? I agree with him. Sounds funny coming from a guy that leads a weekly recovery group at a local methadone clinic, but first for those that aren’t familiar with these programs take a look at the Wikipedia link below and then I’ll explain myself.

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Meet Your Minister of Misinformation for Addiction, Recovery, and Treatment

May 23, 2007

Meet Your Minister of Misinformation for Addiction, Recovery, and TreatmentToday I had the opportunity to listen in on a large group of medical professionals and administrators from different methadone maintenance treatment centers and regulatory agencies who had met to discuss different issues and complaints in their field. I will address some of the things I learned in the meeting in later blogs, but first I wanted to share an epiphany I had during the discussion.

One of the issues they were addressing was how to better educate the patients, other doctors, and the general public of the true nature of methadone maintenance treatment (MMT) programs. Many of the patients and their significant others in MMT often experience confusion on the difference between MMT and a total recovery program. Many health care professionals are not familiar enough with MMT programs to properly prescribe medications for their patients who are in the programs. And of course John Q. Public often finds it hard to distinguish the difference between a backwoods,single-wide crystal meth lab and a fully certified and professionally operated MMT center. So why are so many people confused, why not ask the guy in the picture above?

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