Are you or any one you know addicted to opiates?

John! Thank you for your response! I agree with almost all of what you said, particularly the part about self belief and the need for counselling. I am a Pharmacist by profession and deal with Methadone users daily. I posted this question to get a better understanding of peoples experiences on this drug and what kind of counselling they might need from me as a health professional they trust.

Methadone is an opiate as you know but the premise behind it is to encourage people to get off heroin, oxycodone, fentanyl, morphine, etc and get onto this so that the dose can gently be tapered off. Do you agree that Methadone is beneficial if given with the intention that it is short term (i.e. smallest dose possible for the shortest amount of time without feeling cravings, withdrawal or intoxicated)?

Reason I ask this is because a lot of patients take MEthadone and then openly tell me they will take a hit later that day because they are forced by courts to be on the Methadone. This invalidates the purpose of taking Methadone from a health perspective, and substantially increases the risk of overdose. What would resonate with a user in order for them to understand this point and wholeheartedly partake in their treatment regimen?

Thank you once again for your contribution, and congratulations on getting getting clean!

In my opinion...  methadone is used for long term treatment, with counsling.  If users are looking for somthing to detox from, then I believe suboxone would be a better treatment.  Most addicts I know,,including myself, have been through a 3 to 5 day detox many of time, just to find themselves relapsing as soon or shortly after they finish the detox.  Methadone is used as a long term treatment to allow addicts to live a normal life, not be out committing crimes, takes away all need and cravings, so relaps is unlikely.  Methadone is also should be used long term because addiction is a habit with the drug use, people, places and things, and humans are people of habit.  Methadone gives addicts time.. time to become unfamiliar with their habits and to learn new, healthy habits with the help of their counslers.  The role of the counsler is to also teach addicts how to cope with every day stressers of life,  to help get their lives in order, be their for the addict during this difficult learning process and to equipped to addict with all they need to live a clean and sober, happy and healthy life.  Only after the addict feels they are strong enough.. they should then taper off of methadone.  Some may never want to get off methadone.  The way I was taught in the methadone clinic, is that addiction is a disease just as cancer or MS.  People with cancer or Ms or any other disease need treatment to treat the disease.  Well, addiction is a disease and needs to be treated as such.  So, addicts should never think of methadone as a scape goat or just using another drug in place of heroin, oxys, ect.   That we were just taking medicine to treat our disease and that we needed it.. until we were strong enough.  Anyway.. I don't think that methadone would be good for short term use just to detox someone... addiction is a debilitating disease that is almost impossible to control on it's own.  Long term treatment is needed to give time to retrain the addicts brain.  These are just my opinions, I am not in the medical profression, but I am an addict of 15 years with 6 years clean.

Hi hinzalle absolutely I would agree that methadone has it's place in short term reductions and even long term reductions. However as you correctly point out it often results in a dual addiction with clients taking their methadone in the morning (supervised consumption) and then scoring heroin later in the day. I think a lot of users don't take on board the fact that a methadone habit decreases the effect of heroin. Really people get it or they don't and sometimes they get it later after they have reflected on what they have learned. Methadone is given as a damage limitation initiative in the hope that it stops users from criminal activities. Nowadays treatment agencies are less the kind of "script and go" attitude of the past and more focussed on an experiental /educative process that hopefully proves conducive in the long term to real change. In my view the biggest and most valuable tjhing you can give a drug dependent person who experiences prejudice and criticism from nearly everyone on a daily basis , is empathy and non-judgemental acceptance.

Yes... I actually know of many addicts that are in the methadone clinic that actually abuse the treatment program by still getting high on heroin or other drug of choice.   I find it very disturbing.  The program really does work... BUT.. only if the addict wants to get clean.  So for someone who isn't really ready or has been court ordered to take the methadone, the program will not work.  At the clinic that used to go to, they did random urine screenings.  The first "hot" urine you receieved, you were givin a warning and extra counsling.  The second "hot" urine, you were kicked out of the program and rapidly tapered off the methadone.  I'm not sure how other methadone programs work though.  For myself.. I knew I was ready to get clean and the program worked wonders.  I never had an urge to use again.  I have been clean since the day I walked in their doors.  I could only hope that other methadone maintnance programs are such as strict, to prevent addicts from abusing the programs and to also make room for the addicts that really want and need the help.  As the program I was in, had a long waiting list.  So, it's sad that alot of thoses spaces are being taken up by addicts who are not as serious in becoming clean and living a normal life as others may be.

Very sorry to hear of the pain you live with daily, I know it can be debilitating and severely affect the quality of your life. Fentanyl, oxycodone (in percocets) and butrans are all opiates and actually butrans is the weakest of the bunch.

How many percocets are you taking daily and what strength? Also what pain are you suffering from may I ask as I might be able to give you some options to try/discuss with your GP?

I understand how frustrating it can be to just mask the pain or to essentially deal with the symptoms and not the root cause of the problem. Have you tried any natural alternatives? Some of them have been found to be as effective as NSAIDs in dealing with pain.

Subutex is a shorter course for some but in my experience, I have seen patients be on that long term, only to be transferred onto Methadone after due to it not being so successful.

I wholeheartedly agree with you that counselling and therapy should be provided to ensure that the users remain clean from a lifestyle perspective. With regards to your comment about it being addictive, yes it absolutely is, but once the patient is on a treatment plan the dr can cut the dosage by minute amounts (usually mls) to gradually wean the patient off. This is really where its success lies.

I'm really asking this question so I can better counsel my patients and also because I would like to ensure that loved ones who may be searching for answers about Methadone or opiate addiction treatment options can get a feel for what the individual may be going through on a daily basis, so I write articles addressing this (and other health) issues online.

Thank you for your input!

Thank you for your caring response Melissa. Firstly let me say that you are doing a brilliant job, not only because you are successfully off other opiates, but also because you are consciously trying to reduce your dosage and get off the Suboxone completely too. It is commendable that you are not trying to remain on it for life, because I know how addictive it can be.

Secondly, I think I should have made it clearer in my question - I am not an addict, have never used opiates, I am actually a Pharmacist and deal with Methadone, Subutex and opiate dependent patients daily. My aim in asking this question was to understand the problem points Methadone/Subutex patients might feel so that I could better counsel them and also my own patients.

You make an interesting point about the Methadone being harder than the Subutex to come off of. Many find that the Methadone is easier as it can be so minutely reduced in dosage, so its hard overall, but a little more manageable than the subutex.

What kind of withdrawal are you experiencing when you try to cut the suboxone dosage? and what amount of mg are you trying to cut down by and every how many weeks?

I should have read your respons to me firt before replying on someone elses..lol.  I thought you were asking if methadone should be just used for short term, more of a detox.  Anyway.. im my experience, as I mention some above, counseling should include in retraining the addict brain. Addicts lived in a life were they didn't have to deal with life or their problems, so they need to be taught how to make life choices, how to deal with their problems, mentally and physically.  They need to relearn how to live the "normal" way all over again.  They most likely will have either depression, anxiety or both, so they will need to learn to how to handle these and the healthy way to treat them.  They will need help and guidance in changing their people, places and things.  This a big one.  I have learned the hard way, many times, that you shouldn't walk past the house you used to get drugs from.. take the long way, and you also have to find new friends.  An addict cannot hang out with people they used to use with and expect they are strong enought to not use too.  Like I mentioned above.. humans are people of habit, so they must learn good habits to replace the old habits.  It's next ti impossible to just get rid of bad habits and not replace something in their place.  For example... an addict lives their life to get money, get drugs, get money, get drugs, so this pattern needs to be replaced with healthy hobbies.   A counsler maybe can help the addict decide what kind of job that would be good for them, maybe if the addict is a spiritual person, the counsler can help encourage them in growing spritually.  That was a big one for me.. I replaced my bad habits of thinking of drugs and that old life with God.  I now think about God just as much as I thought about drugs.  God is my new drug..  My counsler is amazing, she helps me make up life goals, small and large and encourages me to accomplish them and helps guide me with ways to accomplish them.  I believe it's all in retraining the brain.  Also, to find something to replace the drug use with.  I know for me, after times that I have tried to get clean, I would come home from rehab and find that I was bored.  I didn't know what to do with myself.  Addicts are so use to that fast life, that when that stimulation is stopped suddenly, they find themselves bored and confused.  For an addict to become clean and stay clean, they literally need to relearn how to live.. mentally and physically and a cousler can help give the addict guidance and clairity.  Anyway.. I wish you luck as a counsler.  Be patient with addicts that are just becoming accustommed to the clean life.. they are just like baby's.. needing to be retaught everything.   Best way I could put it...lol.

Oh.. and about your question on tapering off the subutex.. I was on the subutex for 1 and half years now.  I had to go on subutex because of bad side effect of the nalaxone in the suboxone.   I started on 3 8mg pills a day and am down to 1 8mg a day.  To taper off.. I'm not actually cutting the pill and measuring..lol.  Though I should.  I just break a little piece off the pill for the day and only take the rest.  I do this for a while and break more and more off of the pill.  When I start to feel bad.. I stop before I go any lower.  Somtimes I actually feel too bad and have to go up a little before I can go low.  This works for me.  Symptoms I have when I just go too low are, clammy feeling, slight neausea, insomnia and fautigue.  I believe the trick to tappering off, for me anyway, is to just go slow.  Like I said.. sometimes I actually have to go up a little for a couple days before I start to go even lower again.  I hope I was able to share at least some valuable information with you.  Best wishes to you!