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Hello Everyone !  Welcome to our "Frequently Asked Questions."                  

 Is everyone familiar with the bottle below? I bet so if you have "takehomes". 

Everyone always has questions about their " takehomes" therefore I am going to post them directly from The Federal Register, The following "Rules And Regulations " went into effect on January 17, 2001. They didn't come easy! The National Alliance Of Methadone Advocates spent many hours along with numerous others to make this dream a reality.  It was through their hard work and fervent determination  that we are able to enjoy the fruits of their work.  I would like to take the time to say "Thank You" to everyone who helped bring it to pass.  It is difficult to appreciate the value of "takehomes" unless you are a patient.

       Page 4098  Federal Register    

     (i) Unsupervised or "take-home" use.

To limit the potential for diversion of opioid agonist treatment medications to the illicit market, opioid agonist treatment medications dispensed to patients for unsupervised use shall be subject to the following requirements.

(1) Any patient in comprehensive maintenace treatment may receive a single -home dose for a day that the clinic is closed for business, including Sundays and State and Federal holidays.   

(2) Treatment program decisions on dispensing opioid treatment medications to patients for unsupervised use beyond that set forth in paragraph (i)(1) of this section, shall be determined by the medical director.

     (i)     During the first 90 days of treatment, the takehome supply (beyond that of paragraph (i)(1) of this section) is limited to a single dose each week and the patient shall ingest all other doses under appropriate supervision as provided for under the regulations in this subject.

    (ii)     In the second ninety days of treatment, the takehome supply (beyond that of paragraph (i)(1) of this section) is two doses per week.

   (iii)     In the third 90 days of treatment, the takehome supply (beyond that of paragraph (i)(1) of this section) is three doses per week.

   (iv)     In the remaining months of the first year, a patient may be given a maximum 6-day supply of take-home Medication.

    (v)     After one year of continuous treatment, a patient may be given a maximum 2-week supply of take-home medication.

    (vi)     After 2 years of continuous treatment, a patient may be given a maximum one-month supply of takehome medication, but must make monthly visits.

(4)  No medication shall be dispensed to patients in short-term detoxification treatment or interim maintenance treatment for unsupervised  or take-home use.   

Do the new regulations allow programs to dispense pills? yes, the restriction to dispense only liquid medication has been eliminated. Patients will be allowed to have medication in solid (pill) form. So patients with 31 day takehomes should receive one bottle of pills, per month.

What if my Program does not want to implement these new takehomes schedules and other provisions of the new Federal Regulations? Unfortunately, although these are Federal Regulations, individual states and programs can still have their own, more stringent regulations. But, the new regs clearly state that OTPs that do not substantially conform with the Federal Opioid Treatment standards will risk losing SAMHSA certification. If a program is not SAMHSA certified, it does not operate.  If your state has stricter regulations, contact your State Methadone Authority, and lobby for adoption of the Federal Regulations.

Does CSAT have to be notified if patients on doses higher than 100mg get takehomes?  No., this reporting requirement has been eliminated.  Any patient with a dose over 100mg can have takehomes.  There is no mention of 100mg mentioned in The Federal Regulations. If you are restricting your dose to under 100mg in order to keep your takehomes, this is no longer necessary.  Go to your program and get your dose raised, if necessary.  If your program has a dose cap policy in effect after  May 18, 2001, please contact Georgia Advocates For Recovery With Medicine and report this to us. The proper officials will be notified about the violation.  

Are there any changes in the U/A requirements? No, the same federal requirement of eight random u/a's per year remains.  But, if your program uses "observed u/a's", this will no longer be allowed under the new accreditation guidelines.  The guidelines are very clear that program wide observed u/a's are not necessary.  The Federal Regulations do not require testing for marijuana. For Your Information:  Please check under Drug Tests before exiting our website for more up-to-date information concerning "observed urinalysis."

Do the regulations make any provisions for patient grievances?  The SAMHSA/CSAT Accreditation Guidelines, as well as the accreditation standards developed from them, include provisions for accepting and acting upon patient grievances.  For the first time, patients will have access to a formal grievance procedure, through CARF and JCAHO, the accrediting, and through CSAT, which will be implementing an 800 number soon for patients to call, all across the country. Below you will find these numbers helpful if you have grievance :

CARF Accrediting Agency:  Dial 1-866-510-2273    JCAHO  Dial 1-800-994-6610           CSAT 1-866-463-CSAT    COA  Dial Toll Free 1-866-COA-8088

Do the new regulations address fees that programs can charge?  No, there is no mention of fees.  And there have been reports of programs around the country raising their fees to cover "accreditation."  This area area that needs to be watched carefully.  

Do the new regulations allow any doctor to prescribe methadone treatment to treat opiate addiction?  No. Current regulations enforced by the DEA do not permit DEA Registered Doctors to prescribe narcotic drugs, including methadone and LAAM, for the treatment of opiate addiction. But any Doctor with a narcotics license can prescribe methadone for pain.  This is not changed.  If your private physician is interested in becoming an OFFICE-BASED OPIOID TREATMENT PROVIDER, and treating your opiate addiction, there are resources available. Robert Lubran at CSAT can assist physicians, who want to become OBOT providers.  Mr. Lubran can be reached at 301-443-7745. 

   ANY QUESTIONS YOU NEED ANSWERED             JUST ASK METHADONE_GIRL                  MORE QUESTIONS ANSWERED.   

   1.  WHY DOES METHADONE MAKE ME PUT ON WEIGHT?

There is nothing about methadone or the way it affects the body that would make a person put on weight.  However, this is a very old complaint of patients in methadone maintenance treatment programs .  A survey in 1984 reported that 1 in 10 patients had gained weight, although 1 in 20 lost weight while on methadone.  So, the situation is entirely opposite in different folks, which supports the view that methadone itself is not the cause.

One common explanation for the weight gain is water retention but, in most cases, it is found that the patient is taking other medications  that cause water retention  or there is another reason. Many medications, such as some (but not all) antidepressants, cause weight gain as a side effect.  Furthermore, there is the fact that many persons in methadone maintenance treatment are simply taking better care of themselves, and eating much better, than they did while leading a life of substance addiction.  A more healthy diet (talk to a dietician) and some regular exercisecould go a long way in helping weight problems.   

Some persons have believed that the prepackaged liquid form of methadone is fattening.  This is untrue.For example, Methadose®, cherry oral concentrate does contain sucrose syrup (a natural sugar) to deter potential injection of the product. However, in a 100mg dose there are only about fifteen calories (1.5 calories in each milliliter of Methadose)--about the same calories in one Life Saver candy and ten times less than in a single glass of lemonade or Pepsi.  (This also means that the amount of sugar in  this methadone product would not be harmful for persons with diabetes.) 

2. COULD METHADONE BE CAUSING MY SEXUAL PROBLEMS?

Some surveys have found that as many as 9 out of 10 men and women entering methadone maintenance programs have sexual difficulties of one sort or another.  But such problems are not caused by methadone, and, in almost all cases, these persons can be helped to experience intimate relationships with a partner and enjoy sex.

There are many causes of sexual and reproductive problems in methadone maintenance treatment patients.  Past use of illicit drugs and alcohol could have upset hormonal balance in the body, which often returns to normal over time.  Some prescribed  medications, such as certain antidepressants, may cause impotence (trouble getting an erection) or lack of orgasm a side effect.  Then, there are many psychological issues  that could have left sexual  problems in their way, such as previous sexual abuse or long-lasting anxiety and guilt from a drug-addicted lifestyle.

There are many ways that methadone maintenance clinic staff can help-from changing medications to special counseling. Unfortunately, when it comes to sexual matters, many patients are embarrassed to mention their concerns and suffers in silence.  It is important to overcome this discomfort or shyness and ask for help that is available.

You can find a helpful article in "Sexual Dysfuntion And Addiction Treatment" in the Spring  2000 edition of AT Forum. 

 3. Is there anything I can do if I end up in incarcerated; Will I have a problem obtaining my methadone?     

Beware! It is much better not to end up incarcerated without methadone!


4. DEFINE DELIBERATE INDIFFERENCE. 

1983 Deliberate Indifference is the conscious or reckless disregard of the consequences of one's acts or omissions.  

There is an objective and subjective case for deliberate indifference.  The objective focuses on whether the medical need is serious while the subjective focuses on the prison official's state of mind.  If the official displays deliberate indifference and the objective test is met, a constitutional violation has occurred!

The comments to the Eighth Circuit's Jury Instructions define a serious medical need as "one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person could easily recognize the neccesity for a doctor's attention.

The next two requirements, taken together, constitute the subjective element, the state of mind of the state actor; the defendant was aware of the plaintiff's need for such medical treatment, and the defendant , with deliberate indifference, failed to provide medical care, direct that such care be provided, or allow the plaintiff to obtain such relief.  The Eight Amendment does not prohibit all pain and suffering  when a government  .official is deliberately indifferent to the prisoner's medical condition.  If the official had no knowledge of the problem, then there is no guilty state of mind  and no violation of the Constitution.  

The fourth requirement if that the plaintiff was damaged.  This is similar to the "serious medical need" requirement, in that plaintiff must show that the indifference of the official had the effect of seriously damaging the prisoner, establishing the objective element of the claim.  .  

The final requirement according to the Eighth Circuit's Model Jury Instructions is that the defendant was acting under color of state law.  In the custodial context, this is not a seriously disputed element, as prison officials are obviously acting under color of their authority granted them by the state. 

 For a more in depth answer, 
 please see the section labeled
 "Legal Issues" located on the
 left Sidebar.              
 


5. IS METHADONE BAD FOR THE HEART?

Used appropriately as part of an Methadone Maintenance Treatment Program, methadone does not appear to cause any heart problems, even at quite high doses.  There were some concerns during 2001 when LAAM (a long-acting cousin of methadone) was associated with disturbances of normal heartbeat, called cardiac arrhythmias .  LAAM was taken off the market in Europe  and American doctors were advised to first test patients for any existing arrhythmias before prescribing or continuing LAAM therapy.

To some extent, all opioids, including methadone, have an influence over heart function. Some of these effects are helpful.  For example, persons having heart attacks are sometimes given morphine.  Other effects, which have been demonstrated mostly in animals or test tube experiments,  are less certain to be helpful or harmful.  However, methadone has not been found to be harmful to heart health in actual patients.  . 

A panel of Methadone Maintenance Treatment Medical Directors, collectively representing 117 years of experience in treating more than 29,000 persons with methadone, noted that they had not seen a single heart problem that they would directly attribute to methadone.  Similarly, a small study of patients receiving very high doses of methadone -from 500 to 1400mg per day--did not find any methadone -related heart problems. .   

This is not to say that Methadone Maintenance Treatment  patients do not experience heart problems just like other persons. However,  the health risks, heart--related  and otherwise, for opioid --addicted individuals not in treatment are great and death rates are high.  The Methadone Maintenance Treatment Program, of which methadone is a central part, provides a total healthcare environment potentially contributing to better heart health.         Methadone And Heart Health 2001 Edition AT Forum


6.  Does Methadone cause problems with teeth?

Dental decay is often noted in methadone patients and the great
majority of the deterioration occurs long before treatment. However there is a theoretical reason that an opioid in a sugar based solution might add to dental problems so rinsing with waterafter dosing is essential. Some physicians believe that methadone
can slow salivary flow. Regular check-ups are advisable for all patients on methadone (or anyone else for that matter!).

7.  "Does methadone get into the bones?" "Are there other effects?"

There is no evidence I know from the research literature that methadone
affects the bones directly. I believe that this is an old 'howler' which seems to follow the rule that 'if you say something often enough then people will believe you'! Heroin use may theoretically lead to bone problems - mostly through injuries sustained in the quest for the illicit drug. Methadone treatment will reduce risk-taking behaviors and improve nutrition generally. Thus it probably aids with appropriate bone mineralization, growth and strength at the appropriate ages.

8. Does Methadone cause fluid retention?

Some patients can develop fluid retention on methadone and this is dose
related. It is exceedingly rare, occurring in less than 1% of cases.
It can be addressed by reducing the dose or using diuretics (fluid
tablets).

9. Does Methadone affect the muscles?

I have never heard of methadone affecting the muscles and I do not know
of any research reports on the subject. Of course withdrawals often
start with muscle pains or cramps and this may be an indication of inadequate
methadone dosage.

Inflammatory arthritis, tendonitis and synovitis may also occur rarely in methadone patients and the cause is unknown. It may be coincidental
as there are no research reports on the subject as far as I know. We should remember that one of the commonest causes of musculo-skeletal pain in methadone patients is inadequate dose levels. These can be addressed by a trial of a higher dose, with a blood methadone estimation if there is any doubt. There is no arbitrary maximum dose for methadone since patients' metabolism of the drug is so variable.

10.  Is there normally any adjustment of methadone dose with bodyweight? (ie lower dose for those with lower bodyweight)?

A: While I imagine there are physicians who take into consideration the body weight of patients in prescribing methadone dosage, this generally is not the practice. There are a great many variables that determine the degree of dependence and tolerance to opioids : type of opiate used, route of administration, purity, frequency, etc. With so many variables, most of which are impossible to quantify with any degree of reliability, the best approach seems to be a pragmatic one.

Specifically, the PRIMARY consideration must be patient safety, and the SECONDARY concern is to minimize the severity of any withdrawal symptoms associated with transition from the illicit drug use to prescribed methadone. These two considerations make a starting dose of 30 or at most 40mg the most commonly advised.

Having said this, I also agree that this is a complex issue, and the ultimate decision must be that of the prescribing physician. It is never possible to make pronouncements regarding what is best in the care of a patient one has never seen, examined or interviewed.

11. What is the optimal maintenance dose of methadone?

As with all other medications, there is absolutely no place for moral judgements that particular dosages are inherently "good" or "bad." There are general guidelines, based on empirical and scientific evidence as reported in the professional literature, regarding the dosage range associated with optimal results in most patients. For methadone, this range is approximately 80-100mg per day. However, as with all other medications, the ultimate decision as to dosage must reflect the physician's assessment of the individual patient's response, and some will be found to require a higher dosage, and others lower. (NOTE: "maintenance" dosage must be distinguished from the amount of medication to be prescribed at the outset of treatment. Here, as with all other medications, one must follow the admonition: primum non nocere. We know that dosages above 40mg can lead to fatal outcome in non-tolerant individuals, and thus - to rule out even a remote chance of risk to the patient - one should give no more than 30-40 mg. initially and raise the dosage in increments no greater than 10mg twice a week).

12.  What effect does methadone have on the liver?

Numerous studies have demonstrated that methadone is not hepatotoxic (toxic to the liver) and is well tolerated even by patients with significant liver disease. Indeed, to paraphrase a doctor who has long studied the medication, the greatest side effect of methadone maintenance is a clear improvement in the health of the patient being maintained.

The effects of the liver on methadone, on the other hand, are a little more complicated. Methadone is primarily metabolized by a system in the liver call the "cytochrome P450 system". Various substances may "speed up" or "slow down" this system and thus affect the metabolism of methadone. It is also possible that methadone may influence how the liver metabolizes some other medications. If you have concerns about how your other medications are mixing with your methadone, speak with your doctor.

It should be noted that liver disease - specifically, hepatitis - is extremely common among former users of heroin, including methadone-maintained patients. This liver disease, in turn, makes individuals very susceptible to further damage as a result of alcohol intake. Thus, all former heroin users, whether
receiving methadone treatment or not, should be extremely cautious in their intake of alcohol.
 

13.   What happens to a patient who stops taking the methadone?  Could there be a need for hospitalization?

 Methadone, like heroin, is an "opioid agonist". All such drugs produce physical dependence in those who take them steadily for a sufficient period of time. What this means is that someone who takes methadone or heroin for long enough will find that his or her body has adapted to the drug and that without it (or another opioid agonist) he or she will get sick, or suffer a "withdrawal syndrome."

Opioid withdrawal can range from mild to severe depending on factors including the opioid in question, the amount used, the length of time dependent, underlying medical and emotional issues, and environment. The syndrome is frequently compared to a combined respiratory and gastrointestinal flu with psychiatric symptoms coloring the experience. Symptoms may include watery eyes, running nose, gooseflesh, yawning, muscle cramps, nausea, vomiting, diarrhea, fever, depression, anxiety, insomnia, and confusion.

In general, at pharmacologically equivalent dosages, studies have shown methadone to produce a withdrawal syndrome that is less intense but longer lasting than that of heroin. However most people who have experienced both tend to rate the methadone withdrawal as more severe. The most likely reason for this is the difference in the duration of each withdrawal syndrome. Heroin withdrawal usually peaks within 3 days and is essentially finished within a week to ten days. Methadone withdrawal, however, may not peak for 7-10 days and may last for several weeks.

In general, opioid withdrawal is not life threatening in and of itself. However it can be extremely uncomfortable and may exacerbate pre-existing medical or psychiatric conditions. Anyone considering withdrawing from any opioid agonist would be well advised to consult a physician in order to consider the potential complications and investigate "tapers" (gradual dose reduction) and other treatment options.

14.  How long does it usually take a person that is on methadone to be detoxed he has been on the drug for five years and taking 100 mg a day ?

The usual rule of thumb in detoxifying someone who has been maintained on methadone is no more rapidly than 10mg decrease twice each week. By this rule, a patient on 100mg would be detoxed in about 5 weeks. BUT the other rule  of thumb is that the slower the better. The real problem is that at around 30-40 mg per day, the craving for opioid drugs very commonly recurs, and that craving leads to significant distress for most patients - especially those who have done well during treat-ment. So . . . if someone WANTS to detoxify, despite the fact that there is always  a risk of relapse associated with detox in even trhe most successful patients, then the slower the better, and both patient and doctor/staff should be ready at any time to re-verse or delay the process if craving does recur. We know that there's always a likeli-hood of relapse after ANY treatment, methadone or drug free. That being the case, if the patient has no side effects from the methadone, and very few patients do, then the more conservative and the safer course is to continue the treatment.

The amount of time the individual has been receiving methadone treatment is not a critical factor.

15.  Do methadone and heroin come up the same on a drug test or is one able to distinguish the difference on a drug test?

Most "drug tests" are really "drug screens". That is, they only show that there is a probability that a substance similar to a particular drug is present in a sample. However, even though methadone and heroin are both "opioids" and have similar effects, their chemical structures are very different. For this reason, methadone does not react with the drug screens used to look for heroin. Therefore treatment programs use separate screens for methadone and heroin-type opioids (such as morphine and codeine).

16.   What are the effects of injecting methadone?

Methadone injecting poses a number of special risks. The possibility of a fatal overdose is higher when injecting any opiate than it is when one ingests it orally. There are risks of infection-local as well as systemic (liver, heart, etc).

 -  More -
Questions 
Pertaining  
    To
   Drug
 Screens

                                                                                                                            17.  How long can methadone be detected in the body after someone has stopped taking it?

It depends on the type of drug "test" or "screen" used. If the patient's urine is analyzed, then methadone can generally be detected for a maximum of 5 days after the last dose. If hair is analyzed though, then even use from months past may be detected if the patient's hair is long enough. Blood is rarely used for drug testing purposes but if screened would show evidence of methadone use for a shorter period of time than if urine was screened.

18.   Does methadone show up as an "opiate" on drug tests? 

Methadone does not cross react with the standard opiate drug screen. It must be specifically screened for.

19.   Opiates and Drug Testing: What is an opiate? What could cause a false-positive for opiate use on a drug test?

Opium is a black, gooey extract of the opium poppy (papaver somniferum). The main active ingredients in opium are the drugs morphine and codeine. These and other drugs found in or manufactured from opium are called "opiates". Heroin is made from morphine so it is also an opiate.

There are also drugs with effects like those of morphine but which are manufactured entirely in a laboratory. Methadone is an example of such a man-made drug. The term "opioid" is used to describe all these synthetic drugs as well as the 'natural' opiates. In other words, morphine, codeine, heroin, and methadone are all "opioids", but only morphine, codeine, and heroin are "opiates."

The "drug tests" used in most maintenance programs in the U.S. are really "drug screens." A drug screen doesn't prove that a particular drug is present in a sample, only that a substance with some chemical similarities to the target drug may be present. If you believe that a the results of a "drug test" are wrong, the first thing you need to find out is whether the "test" was confirmed with a procedure that actually identifies the substance(s) present in a sample. If a confirmatory test like GC/MS was not done, a positive drug screen should only be considered an indication that a particular drug may have been used.

When a drug screen incorrectly reports that a particular drug is present in a sample the result is called a "false positive." False positive results can be caused by a defect in the drug screen, a mistake in performing the drug screen, or through the presence in the sample of some other substance with a chemical similarity to the target drug. Many substances have been reported to cause false positives for opiates on drug screens and it's possible that some of them do, but only a few have been studied in the laboratory. Researchers have reported that the following drugs and classes of drugs may produce false-positive results on opiate screens:



¨ Rifampacin - An antibiotic used to treat tuberculosis.
¨ Quinolones - A class of antibiotics including such drugs as Ciprofloxacin.
¨ Doxylamine - An antihistamine used in sleep aids like Unisom and in some cold remedies.
¨ Hordenine - A substance produced from grains. Present in beer made from barley.
¨ Perazine - A phenothiazine-type psychiatric medication - Not used in the U
.S.

Apart from true "false-positive" results, it is also possible for an opiate screen to return an accurate result of "positive" even when the person being screened has not knowingly used any opiate drugs. This happens when the person in question has inadvertently taken medications or food that contain opiates. In some U.S. states and many foreign countries for example, it is possible to buy "over-the-counter" medications containing low doses of codeine or other opiates. Another common culprit is food containing poppy seeds. The common poppy seed used on bagels and rolls is in fact from the opium poppy and contains morphine and other opiates. The amount of these drugs in poppy seed is very low, so it is not common for people to come up opiate positive after eating a bagel or a roll, but it is possible. A positive result becomes much more likely if foods with large amounts of poppy seeds - such as poppy seed cake- are eaten.

20.   Should there be treatment options available to physicians and patients when the condition involved is opiate addiction?

With respect to virtually all questions regarding opiate-agonist treatment, the reasonable answer will generally be found by applying the approach: What would be the response if this issue were raised in the case of any other medical condition, and any other treatment? The answer to this particular question readily becomes apparent: yes, of course there should be as broad an array of treatment options as possible.

Illnesses vary in how they affect individual patients, and this in turn makes it inevitable that specific therapeutic approaches will vary in acceptability to patients, and in side effects and degrees of effectiveness. Accordingly, as with other illnesses, the spectrum of therapeutic interventions - medication-based and other - should be as broad as possible. This is reflected in the fact that there are literally dozens of options when the condition is hypertension, depression, pain, etc. It seems self-evident that the same should be true of addiction, as well.

Sadly, in most countries of the world there is a severe restriction in the medications available to the physician and to the patient when it comes to managing opiate addiction. We look forward to the time when that situation changes.

21.   What are the symptoms of opioid withdrawal?

Opioid withdrawal syndrome is characterized by sympathetic hyperactivity, anxiety, agitation, pain and intense craving for opioids. These symptoms are extremely distressing. Reduction of the symptoms is usually accomplished through slow tapering of opiates, substitution of another opiate of an equivalent level, or use of blocking agents. Administration of opioid antagonists -- such as naloxone or naltrexone -- during the withdrawal period, reduces the duration of withdrawal, but significantly increases withdrawal intensity.

22. MEMORY AND METHADONE?

There have been relatively few studies published that investigate the impact of methadone maintenance treatment on memory – and those that have appeared have reached conflicting conclusions.

Most recently, Curran and colleagues (London, UK) wrote in Psychopharmacologia (vol. 154, March 2001) that “A single dose of methadone can induce episodic memory impairment in patients who have a history of heroin use averaging more than 10 years.” However, they go on to note that “Such impairment can be avoided by giving methadone in divided dosage.”

On the other hand, two studies almost a quarter-century ago from different academic centers found that memory among methadone patients was NOT impaired. (Kelley et al, Int. Journal of the Addictions, vol. 13, Oct. 1978; and Grevert and colleagues, Archives of General Psychiatry, vol. 34, Jul. 1977).

Certainly, every patient’s complaints should be reviewed and responded to on an individual basis. However, based on the above, a very general approach might be to consider other sources of memory loss where it exists (especially, the possibility of consequences of long-term heroin use and the problems associated with it), but it’s also reasonable to consider early on a splitting of the methadone dose.

Pain & Chemical Dependency

Q: If I take Methadone or other narcotics for pain relief won’t I become addicted
A: Many individuals worry that if they take strong pain medications, particularly narcotics, they will become addicted. This worry is so prevalent that a landmark study identified fear of addiction as the most frequently mentioned barrier to adequate cancer pain management. In fact, however the likelihood of addiction as a result of medically prescribed pain medication is extremely low, less than one tenth of one percent.

Q: If I take a narcotic medication for pain relief after surgery, will I become addicted to it?
A: Pain associated with surgery is most often described as ACUTE PAIN. It has a well defined onset; is related to the tissue, nerve or bone damage associated with the surgical procedure, and is expected to decline over a short period of time.

Pain after surgery can interfere with activities that promote recovery. After most operations, it is important to mobilize, and it is always important to breathe deeply. If pain prevents this, it is not adequately controlled. The goal of pain management after surgery is to enhance comfort and to enable participation in activities associated with recovery. Whether pain medication is given by mouth or by injection during the postoperative period, there is an extremely low risk of addiction.

Q: Will I experience side effects from taking narcotics for pain management?


A: Virtually all medications have associated side effects. Before taking any medication, it is important to ask your doctor or nurse to explain the side effects you might experience, and to discuss how side effects, if they occur, should be addressed.

The side-effects most frequently encountered when taking narcotic pain relievers include sleepiness, nausea, vomiting, itching, mental clouding and constipation. Many of these side-effects can be relieved by decreasing the dose of medication taken. Generally, side effects decrease as the body becomes accustomed to the medication

Q: How does methadone treatment differ when used for pain management versus addiction treatment?

A: Methadone is a synthetic opiate (narcotic) that is widely used in the treatment of addiction, but it is also useful as a pain medication. There are several distinctions between the use of methadone for addiction treatment and its use in pain management. When methadone is used for addiction treatment, it is most often given once a day. When it is used for pain management, it commonly is given more frequently (two to four times a day). When methadone is used for addiction management, it is used to control the cravings associated with chronic drug use, without producing the effects of sleepiness, euphoria, etc.; this is possible because consistent daily dosage causes the body to become tolerant – or resistant – to the effects of the medication. The purpose in pain management, on the other hand, is to provide the pain-killing effects of the medication with minimal side effects.

Q: Can patients who've had substance abuse problems be treated with opioid drugs for pain?

A: Yes. Controlling pain is an essential part of everyone's medical treatment. Unfortunately, patients with past or current substance abuse problems are frequently under-treated for their pain (as indeed are all patients in most countries). Some doctors don't realize that their patients need more medication, some are afraid that patients will abuse or sell the pain killers they are given, and some are just prejudiced against drug users.

Q: Don't methadone maintained patients already get pain relief?

A: No. Patients maintained on an appropriate constant dose of methadone feel as much pain as anyone else, for the simple reason that they are tolerant to the analgesic effect of the medication.

Q: How can methadone maintenance patients best be treated for pain?

A: The International Center for Advancement of Addiction Treatment advisory board member and pain management specialist Dr. Russell Portenoy suggests a number of principles for managing the pain of patients maintained on methadone. These include:

-First continue the original maintenance dose of methadone. The maintenance methadone is separate from any other opioids prescribed for alleviation of pain.

-Ask the patient how much pain he or she is in. As a general rule, the patient is the best judge of his/her pain.

-Short-acting opioids (like oxycodone or morphine) are usually the most effective and practical for acute pain, in methadone-maintained patients as in all others.

-Avoid mixed antagonist/agonist medications. Drugs such as Ultram(Tramadol) and Pentazocine (Talwin) may produce severe opiate withdrawal symptoms in the methadone-maintained patient.       

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Modified: March 18, 2005

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