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----HOW METHADONE WORKS! 

Methadone saved my life.  It gave me a chance to rebuild my life and to live it as a normal person. Yes, it can kill you, just as guns can, if used improperly.  If guns are used correctly, they can be an asset, but if not they can kill you.  It is the same with methadone.

Methadone is only for opiate-tolerant people.  It is a very potent medication.  It is not one to be used lightly. If you are opiate-tolerant then it should be your last resource if used for pain.  Methadone 44mg is equivalent to 440mg morphine. Do you have an idea of its potency now?

We have many who prescribe it too lightly and have not  been educated on the
medication properly. Many patients have died from their ignorance and it has in turn given rise to methadone's bad reputation. 

It has hit the streets and who should we blame?  Until the Oxycontin scare, it rarely was ever prescribed for pain. They used it to maintain heroin addicts and it worked well,but it wasn't until later after they started cracking down on the Oxycontin prescribing, we began to use it for Pain Management.  Many seen it as being comparable to morphine. They didn't understand the unique diverse qualities methadone possessed which was different than most other drugs.

It became very popular with the insurance companies. Why do you think it did? It was a very inexpensive medication to prescribe. You could buy a 150 (10mg) tablets for less than $40.00. Why would they not prefer methadone to any other medication? If you purchased 120 Percocet (Generic) they would cost you ($90) ninety dollars.  Methadone would certainly boost the insurance companies profit margin.

More began to dispense it and were not educated enough on it's properties. The patients began to take it and the more popular it became. It was then the value of it became known and it hit the streets. Just as many prescribing it thought it to be similar to morphine, so did the people who purchased it on the streets.  They did not understand the potency of the medication nor it's unique properties.    

Is the medication to blame for all the deaths?  Should we contribute it to the ignorance of those prescribing the medication or to the greed of the insurance companies?  Maybe we should blame the Drug Enforcement Agency for making too much of the Oxycontin scare?  I'm not sure where we should lay the blame and if is really important - - -what is important is we try to find a solution to  stop the deaths. It should begin with education.

Deborah Shrira, CEO

Dear Family Member or Friend:

This letter will attempt to address some common concerns of those of you who have loved ones on methadone maintenance treatment.

There are many misconceptions and common misunderstandings surrounding this treatment, which education and knowledge about the treatment may help to alleviate.  Methadone, unfortunately, is surrounded by unfair stigma and prejudice based on fears and assumptions, not science and medicine. Family members quite naturally are concerned about their loved one's health and future and want the best for them, and they may have heard some things about methadone maintenance treatment that cause them alarm.

One of the most commonly voiced concerns is that methadone maintenance is "just trading one addiction for another". Many feel that the only way to truly recover from addiction is to abstain from all mood-altering substances. At one time, this was thought by most to be true. However, science has discovered that with long-term opiate addiction (opiates meaning heroin, vicodin, morphine, oxycontin, etc), the brain's natural production of endorphins is shut down.

Endorphins are the chemicals we all have that enable us to feel pleasure and happiness. We all have opiate receptors in our brains to which these chemicals attach. The word "endorphin" comes from "endogenous", meaning coming from within, and "morphine"--i.e., morphine from within. These chemicals are released when we eat delicious food, make love, enjoy a beautiful sunset, exercise (runner's high), or even when we are injured, as natural painkillers. Without this natural chemical, life can be very difficult and painful.

When we flood our systems with exogenous (outside) opiates, our bodies recognize that we have plenty on board and cease to manufacture our own natural endorphins. This results in the patient feeling extremely ill when withdrawing from opiates. They experience depression, irritability, exhaustion, anger, sleeplessness, hopelessness, etc. This happens to all opiate mis-users when they cease taking opiates and is to be expected.

Some patients, especially those with short-term addiction histories, will be able, after a few weeks or months of abstinence, to get their natural endorphins back into good working order again, and will begin gradually to improve. However, for many, the damage done is permanent. This has been demonstrated in many scientific studies involving CT scans of the addicted brain. For these patients, no amount of abstinence, group therapy, meetings, will power, or good intentions will undo the fact that their brains simply will no longer produce endorphins in sufficient quantity to enable them to live a normal, happy life.

This is, in fact, very similar to the way in which diabetics require supplemental insulin because their pancreas no longer manufactures insulin. In addition, there are some patients who have never had a normally functioning endorphin system, who have struggled since birth with crippling depression, and who became addicts in an effort to relieve their constant emotional and mental misery. For them, too, abstinent recovery works poorly or not at all. This is where methadone maintenance comes in.

Methadone is a synthetic (man made) opioid drug, used to treat pain and addiction. It has some unusual properties that make it well suited to addiction treatment. It is a long acting drug, remaining active in the tissues for up to 72 hours after ingestion. It does not cause the high or euphoria caused by other, short acting opiates because it is taken up gradually by the brain, not suddenly and sharply. In fact, many overdoses involving this drug are due to people seeking the high they have come to expect with other opiates and not getting it, so they take more and more.

A stable methadone patient who is not mixing the medication with other drugs--particularly benzodiazepines, which can sometimes be a very dangerous mixture-- and who are on a medically appropriate dose will not be "high" or sedated. These patients are able to work, operate a vehicle, care for children, and do anything else a normal person can do. Their minds are not "clouded". Some of these rumors may come from observing patients who are misusing other drugs, or are taking more than prescribed.

Methadone, properly administered and taken, balances the chemicals in the brain so that the patient feels normal. Unfortunately, standard antidepressants generally do not work well for those with dysfunctional endorphin systems because they target serotonin, not endorphins.

Methadone is also unique in that it does not attach to all the opiate receptors in the brain, leaving some open to encourage production of natural endorphins if possible. This may contribute to the healing of the addicted brain. Methadone is commonly referred to as "replacement" or "substitution" therapy, and most think that this means it is replacing the heroin, etc that the patient was abusing, when in fact, it is replacing the natural endorphins no longer being manufactured by the patient's brain, in the same way synthetic insulin substitutes for that not being made by the diabetic's own organs.

Methadone treatment enables the patient to return to a normal, productive, law-abiding life in a great many cases, and even when the patient continues mis-using other drugs, etc, it may lower their chances of contracting a disease by reducing their drug use, and enables them to see a medical professional for assistance and referrals on a daily basis.

However, for many (not all) methadone maintenance patients, long-term therapy --even life long--may be needed to maintain recovery.  Addiction is a chronic, incurable disease. We do not tell diabetics, blood pressure patients, and epilep-tics to discontinue their medications because we know that if they do, the active disease will return.

Why, then, do we encourage recovering, thriving methadone maintenance patients to do so, when the relapse rates for those discontinuing methadone maintenace treatment is greater than ninety percent?

Methadone is the most effective modality of treatment for opiate addiction available today--far more effective than traditional rehabs and 12 step groups alone. By no means is it the treatment of choice for every opiate addict--however, if abstinence based methods have failed many times over, there is little point in continuing to try the same thing expecting different results "this time".

Most experts recommend that a patient remain in methadone maintenance treatment a MINIMUM of 3 years after they cease illicit drug use. At that time, if, and only if, the PATIENT themselves wishes to begin a taper program, one can be attempted. Tapering must be done on a slow and gradual basis--no more than 10% of the dose every two weeks to a month. If the person begins experiencing severe cravings or withdrawals, they should stop and return to an adequate dose until symptoms subside.

If the person relapses, this should not be seen as failure or weakness, but only as evidence that he or she may require ongoing therapy to control their symp-toms. Family support is ESSENTIAL to the patient's successful recovery on MMT, and continued questions of "When are you going to get off that stuff? It's just a crutch!", etc undermine treatment efforts and sabotage recovery, leaving the patient confused, sad and frustrated instead of feeling proud and happy at the improvements in their lives.

Addiction is a deadly disease and there are few effective treatments for it so please support your loved one's recovery efforts and praise them when you see improvements. There is nothing positive to be gained by forcing them off treatment before they are ready.

Reference : http://www.tota-texas.org/LetterfromKerry.htm

Editor: Deborah Shrira,CEO                               Dated: February 2009      

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