Methadone is a strong opioid analgesic which was one among the first synthesized substitutes for morphine. It has all morphine-like effects and high habit-forming potential. The modern approach recommends its oral administration only for the strong and intense pains and exclusively to the patients with cancer of different localization and the degree of dissemination. According to the opinion of WHO experts it is justifiable to use as late as stage III of this illness, when the pain still persists despite administration of non-opiate analgesic. The major undesirable effects of heptanon are respiratory and circulatory depression, respiration arrest, shock and cardial arrest. Heptanon was used in the treatment of opiate addiction for heroin withdrawal, not more than 15-21 days. Otherwise, the use of Methadon had produced a new type of a legal, iatrogenic addiction lasting for several months or even for several years. The licit use of this drug as a substitute for the illicit use of heroin has only deepened the already formed dependence. Long-term administration within the Methadon-maintenance programs has turned the addicts into lifelong drug abusers who continued their drug practice with a new opiate addiction. The medicine, and the practice too, have demonstrated that the treatment of Methadon iatrogenic addiction is not any easier than that of the morphine or heroin addiction; there are many who believe that it is even more difficult. For those who still believe in Methadon as a drug of choice for the treatment of drug dependence, there is a question: is the narcotic given by a physician within the treatment program effective enough to help the addict restore to normal living?
Dear Milorad
I want to contrbute different empirical reseaches to your question. Especially Reingardiene et al. (2009), demonstrated in a review article, benefits and dangers: they discussed pharmacokinetic and pharmacodynamic properties of methadone, clinical symptoms of its overdose, dosage problems, detection of methadone in biological samples, treatment, and causes of methadone overdose-related deaths.
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greetings
Egon
Dear Egon,
Thank you very much for your quick response and participation in the debate on the question I asked. Very helpful suggestions that you have placed I will be carefully considered and studied.
With a friendly greeting, Milorad.
Answer: yes for some patients, no for others. There is no standard patient and so there is no "one size fits all" treatment. Some patients would need more than methadone. Methadone is the gold standard, but this is mainly due to political reasons. As a substitution medication any opioid could serve (incl. diacetyl-morphine = heroin, as the publications on heroin-assisted treatment show).
I can add to the previous answers that those drugs that got authorized in the therapy of opiate dependence are characterized by "slow" pharmacokinetics, in terms of adsorption and elimination (of course based on the standard way of administration, which is oral for methadone and sublingual for buprenorphine).
Both methadone and buprenorphine effects rise slowly, decay slowly, and after multiple administration tend to stabilize. This is opposite to the general behavior of abused opioids like heroin, which give a sensations rush and wane quickly.
Thank you Robert and Ernesto on quality suggestions and additions for which I am convinced that it will benefit everyone who are involved in the treatment of complex problems, withdrawal from opiate addiction.
The choice is NOT between methadone and abstinence - if it were, the answer would be easy. While the data on use of extended-release naltrexone are not in, the issue is retention. Long-term non-agonist treatment results in between 5-15% of patients remaining in treatment. The mortaility of those not in treatment approaches 8% per year; for those in treatment it is 1.7% per year. That is really the issue. People not on agonist therapy leave treatment in high numbers, those on agonist therapy remain in treatment in high numbers. Those in treatment survive, large numbers of those out of treatment don't. So the question isn't whether they can return to a "normal" life (although large numbers do), the question is keeping them alive.
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