Methadone is a rigorously well-tested medication thatis safe and efficacious for the treatment of narcoticwithdrawal and dependence. For more than 30 yearsthis synthetic narcotic has been used to treat opioidaddiction.

Heroin releases an excess of dopamine inthe body and causes users to need an opiate continu-ously occupying the opioid receptor in the brain.Methadone occupies this receptor and is the stabilizingfactor that permits addicts on methadone to changetheir behavior and to discontinue heroin use.

Taken orally once a day, methadone suppresses nar-cotic withdrawal for between 24 and 36 hours. Be-cause methadone is effective in eliminating withdrawalsymptoms, it is used in detoxifying opiate addicts. Itis, however, only effective in cases of addiction toheroin, morphine, and other opioid drugs, and it is notan effective treatment for other drugs of abuse.

Methadone reduces the cravings associated with heroin useand blocks the high from heroin, but it does not pro-vide the euphoric rush. Consequently, methadonepatients do not experience the extreme highs and lowsthat result from the waxing and waning of heroin inblood levels. Ultimately, the patient remains physicallydependent on the opioid, but is freed from the uncon-trolled, compulsive, and disruptive behavior seen inheroin addicts.

Withdrawal from methadone is much slower than thatfrom heroin. As a result, it is possible to maintain anaddict on methadone without harsh side effects. ManyMMT patients require continuous treatment, some-times over a period of years.Methadone maintenance treatment provides theheroin addict with individualized health care andmedically prescribed methadone to relieve withdrawal symptoms, reduces the opiate craving, and bringsabout a biochemical balance in the body.
Important interventions in heroin treatment include comprehensivesocial and rehabilitation services.

• To reduce and if possible ultimately eradicate the use of illicit/street/impure drug use by an individual

• To reduce none prescribed drug use

• To decrease risk behaviours: self harming (including unsafe injecting), misconduct involving third parties (including drug related offences)

• To retain those patients in treatment unready for abstinence-focused interventions

• To improve the general health of drug-users

• To promote a process of change in an individual’s drug and alcohol misuse (rather than solely strive for abstinence)

• To promote stability in lifestyle which should lead to improvement in health

• To promote the use of primary health care services and maintains contact with these services.

• To remove or reduce the need to resort to crime and/or prostitution to support drug addiction

• To improve relationships in the family or living unit

Dosage of Methadone

The right dose, is the one that achieves stability and comfort with no withdrawal symptoms should be used

The methadone prescribed dose must be the equivalent to the amount of heroin or methadone the patient has been using.

The patients usually suggest a dose of methadone they feel they may need to eradicate withdrawals

If the patient has been using heroin, convert this to methadone and give test dose.

• Start with a low dose of methadone and be prepared to move up. Moving a patients’ dose up is almost always easier than down.

• The maintenance dose can range from 10-120 mgs daily, depending on the patient’s needs. Many patients can be stabilised on quite small doses but some need larger amounts.

According to the Drug Misuse and Dependence – Guidelines on Clinical Management (2007), with heavily dependant users, i.e. those who are neuroadapted or tolerant, a first dose can be up to 40mg but it is unwise to exceed this dose. A second dose may follow after at least 4 hours and may be up to 30mg depending on the persisting severity of withdrawal.

Once the patient’s daily dose of methadone is reduced to 30mg/day, his treatment may be switched to buprenorphine if there are plans for detoxification.

Patients will first be titrated (tested) early in the day so his response to the drug could be monitored over the course of the day.
After taking methadone the patients will have to drink a cup of water to prevent the spitting out and subsequent storage of methadone.

All patients will return a fully completed self-assessment form before being presented to any keyworker or doctor. This will include drug and alcohol history, sexual and psychiatric history, social, forensic and financial history and housing status. Any misrepresentation on this form may result in an investigation, which could lead to discharge.

The keyworker or doctor will finish the assessment, set goals and produce a care plan before discussing with the doctor, unless the patient is unwell or distressed.

The keyworker or doctor will formulate a possible treatment plan with the patient. The doctor will then decide on an interim-prescribing plan.

Methadone Mixture (DTF) 1mg/1ml is generally the first choice drug for maintenance prescribing to opiate users because:

• It is taken orally

• It is long acting (24-36 hours) making stability easier to achieve (although some users do find it better to take twice a day).

• It is easy to titrate to get the dose right.

• There is little euphoria; it mainly deals with the withdrawal symptoms.

• It is less likely to be sold than shorter acting drugs and other preparations of methadone.

• It is very unlikely to be injected.

• Being unable to tolerate the mixture is rare and should if possible be confirmed by testing on the patient. Vomiting with mixture is reported but is very infrequent.

• If intolerance is found the pharmacist can be asked to make the mixture up without tartrazine, which may be the main causes of side effects. A sugar-free methadone mixture is also available.