Treatment
Is methadone maintenance treatment or suboxone maintenance treatment for you?
If you’ve been using opioid drugs such as heroin, OxyContin, codeine, Dilaudid, Percocet and others, and you’ve come to a point where you know you can’t go on using, but you can’t seem to stop either, methadone maintenance treatment (MMT)/subxone maintenance treatment (SMT) may be right for you.- If you’re pregnant, and you’re using heroin, seek MMT right away. Methadone prevents opioid withdrawal, which can threaten the life of your baby.
- Users who are HIV or hepatitis C positive are strongly urged to begin methadone/suboxone treatment immediately. Treatment helps to stabilize your health, and it lets you focus on getting the best possible care.
- You may be ready for MMT/SMT if you’ve been using for a year or more, and you’ve tried to stop. You’ve been through withdrawal, you’ve seen a counsellor, perhaps you’ve gone through a residential treatment program. If you can’t seem to stop using for more than a few hours, days, weeks or months at a time, and you know you want to stop, think about going on MMT/SMT.
- You’re ready for MMT/SMT when you’re still using and all it’s doing for you is keeping you “normal.” If there’s any high at all, it isn’t worth it anymore. You’re scared of being sick and all you want is to feel well and be free of the craving that nags you to keep on using. You want to be more in control of your life, your work, your home. You want to feel better about yourself; you want to be able to offer more to the people you care about.
If you think you’re ready for MMT/SMT, read through this site to find out what it is, how it works, what to expect and where to go. Pass along this website to your family and friends to help them understand and be able to offer you the support you need.
Help is available.
“I wish I had kept a diary from just before I started methadone, then every time I am having a difficult time, I could re-read my thoughts and know that I do not want to return to that place.” — Adam, 20, on methadone three months.
The benefits of MMT
For people who are dependent on opioids, methadone has a number of benefits over other opioids. These are:- The effects of methadone can last 24 to 36 hours. For most people, as long as you take your one dose a day at the same time every day, you won’t get sick with opioid withdrawal.
- You drink your dose of methadone, usually in a mixture with orange juice. Taking an oral dose is much safer than injecting, snorting or smoking.
- Drinking methadone won’t get you high, but it can help to keep away the physical drug cravings, or the feeling that you need to get high. Some people experience no cravings at all once they’re on methadone. Others may continue to struggle with the “conditioned” cravings, or those that are triggered by something or someone you associate with drug use. The counselling you can get with MMT can help make it easier to cope with cravings.
- When prescribed by a doctor and dispensed by a pharmacist, methadone is legal. The source is reliable and safe, and there’s no fear of arrest.
- Methadone is made using strict manufacturing guidelines. The exact potency is known, and it’s never cut with unknown substances. You know what you’re getting.
- The cost of methadone is less than $10 a day. If you have an Ontario Drug Benefit Card, or are covered by a prescription drug plan at your work, or through a member of your family, methadone costs you nothing. You may also qualify for financial assistance through the Trillium Drug Plan. (For more information on help with the cost.
- Some illicit-drug users participate in a lifestyle that involves crime and other risky activities to support their need for drugs. Methadone replaces this need with a substance that is legal and cheap. Methadone treatment can result in less crime, fewer people in jail and a safer community.
- People on methadone are less likely to use or share needles. If you’re not using needles, the risk of becoming infected with HIV or hepatitis C is reduced. And since methadone lets you think straight and use your head, you’ll be more likely to practice all you know about safe sex.
- Methadone blocks the euphoric effect of other opioid drugs. For example, if you take a hit of heroin when you’re on methadone, you may not feel it. Methadone’s opioid-blocking effect can be a benefit because it takes away the main reasons why you might continue to use other opioids. If you can’t get high, and you won’t get sick if you don’t use, why waste your money?
- Going on methadone treatment can put you in touch with people who understand where you’re at, and can help you get where you want to go.
- Once you’ve been on methadone for a while, you should feel more energetic and clear-headed. This lets you focus your life on things like work, school and family.
- Of all treatments for opioid dependence, MMT has the best record for keeping clients off other opioid drugs.
“My reward has been the chance to enjoy my family, to find employment, to have good health in my mind and body, and to be in control, for once, of my own happiness. I’ve learned a lot about myself. I’m friendlier and more helpful to others. I love me now, and I love life!” — Margaret, 41, on methadone 11 years.
The Drawbacks of MMT
- Methadone is not a cure for opioid dependence; it is a treatment. For it to work, you’ve got to want it to work. Success requires motivation and determination.
- Methadone treatment replaces opioids such as heroin, OxyContin and codeine with another opioid, methadone. You are still opioid dependent, and if you miss more than one dose, you will experience flu-like withdrawal symptoms.
- Methadone clients may be branded as “still addicted” by some members of the community. Many people don’t understand methadone treatment, even some people who work in the addiction and health professions. Some drug treatment programs and self-help groups like Narcotics Anonymous (NA) are abstinence-based, and may not accept methadone clients. Some doctors and pharmacists are reluctant to work with methadone clients, perhaps fearing they will be pressured to supply prescription drugs. Some employers may not react kindly if they discover that you’re a methadone client. It’s probably fair to say that most people regard methadone treatment as a positive step, but there will be exceptions, and you should be prepared for that.
- While methadone detox is sometimes used to withdraw opioid users by reducing their opioid dose gradually over a short term, methadone maintenance is a long-term treatment. You can expect to be on it for at least a year or two. Some stay on for as long as 20 years or more. In general, the longer you’ve been dependent on opioids, the longer you’ll likely stay on methadone. Other factors include how long you want to stay on methadone, and how things are with your family, home and work life.
- As it stands now, methadone treatment guidelines say that for the first few months of treatment you have to go to the clinic or pharmacy every day to get your dose. Even after a year of treatment, you still have to go at least once a week. Expect to make a lot of visits to your doctor too.
- You will be asked to produce samples of your urine for drug testing frequently. It’s often required that these samples be produced “under observation,” meaning someone will be watching you to be sure that the urine is yours, and that you haven’t done anything to change it.
- Methadone can have some unpleasant side-effects. These are likely to be more pronounced at the beginning of treatment — during the two- to six-week dose stabilization phase when you may experience withdrawal symptoms. The most frequently reported side-effects include drowsiness and light-headedness, nausea and vomiting, excessive sweating, constipation and change in sex drive. Other complaints include insomnia and agitation, joint pain and swelling, ankle swelling, skin rash, dry mouth and weakness. Often an adjustment to your dose will help to reduce side-effects. Always report side-effects to your doctor and pharmacist.
- Even though methadone blocks the opioid high, some people do continue to use other opioids on occasion when they start methadone treatment. Seeking out the opioid high when you’re on methadone can be dangerous. Methadone is a strong opioid drug, and if you take more opioids, you might not feel high, but you’ll be at risk of overdose. Talk to your doctor about using other opioids. If you feel the need to take additional opioids it may mean that your methadone dose should be adjusted.
“Methadone is not a lifelong hell! And it’s not a ball and chain – unless you make it that way. If you get your shit together and it’s in your fridge, you can go about your life the same as anyone else. You wake up in the morning and you take it, just like you brush your teeth and you drink your coffee.” — Richard, 45, on methadone three years.
Weighing your options
Methadone maintenance has the best record in terms of keeping clients in treatment and off opioid drugs for the longest period of time. On the other hand, it does carry some side-effects that may be unpleasant, and it does require a long-term commitment. If you have tried one or more of the other treatment options listed, and you are still using, and you know you want to stop, methadone may be your best choice.