It is harder to come off methadone than heroin, so why prescribe it?

By klaatu · Mar 12, 2006 · ·
  1. klaatu
    Scotland Sunday Herald
    12 March 2006

    DURING First Minister’s Questions last week, Annabel Goldie of the Scottish Tories had three related issues on her mind. How many Scots, she asked the First Minister, are on methadone? How many weeks, months, or years have they been on the drug? How many of them have children?

    The immediate context was as obvious as it was tragic: a two-year-old dead of a methadone overdose in East Lothian after ingesting his parents’ prescribed dose. Goldie, though, was attempting a broader debate. The Tories argue, predictably, that there should be zero tolerance towards narcotics. Simultaneously, and not entirely logically, they claim that efforts to rehabilitate users need to be reformed drastically.

    They are sceptical, too, when it comes to methadone programmes. Their leader believes that far too many people are being “parked” on the drug, their addictions legitimised and concealed. Or as Goldie told parliament: when the well-off have drug problems they pay for residential rehab, while “the masses use methadone”.

    “Masses” isn’t far short of the mark. In a partial answer, McConnell said that according to his (out of date) figures, the drug is being prescribed in 19,200 cases. He conceded, further, that there is “not enough information about the individuals who are prescribed methadone”. The database would be expanded, but surely Goldie was not calling for an end to such treatment programmes?

    She didn’t go that far. In her view, there is a place for methadone. At a rough guess, after all, there may be upwards of 50,000 heroin users in Scotland: no strategy should be dismissed. But Goldie’s insistence, unusual in a Tory, that a “two-tier” drug treatment system exists in Scotland was not disputed seriously by the First Minister. Then, quoting one strand of medical opinion, she said something interesting: people with money choose not to use methadone to end addiction.

    Why not? Isn’t that the purpose of the drug, at least in the public’s mind? If methadone inspires so little faith in those who can afford alternatives, why are at least 19,200 Scots – the 2006 figure is undoubtedly higher – being prescribed an approved alternative to smack?

    The green syrup, as addicts know it, is interesting stuff. It is what is known as an opioid, officially a long-acting synthetic painkiller that mimics heroin. First developed by German scientists during the second world war when morphine was in short supply, it has a structure and actions similar to that drug. It was first used on heroin addicts in New York, in 1964, and since then it has been deployed in programmes around the world.

    But here’s the problem: methadone, like morphine, like heroin, like opium, is a class A drug. It is highly addictive. According to some addicts , freedom from methadone is harder and slower to achieve than freedom from heroin. The former can produce a range of side-effects – confusion, nausea, vomiting, suppression of breathing reflexes – and it can kill. Sometimes death is caused in error, by overdose, sometimes because street methadone has been mixed with other narcotics. Nevertheless, as long ago as 1997, 421 deaths in the UK that year were attributed to a “harm reduction” drug, vastly more than could be attributed to heroin. The figure has continued to increase.

    In the US, methadone-related incidents requiring emergency room treatment increased by 37% between 2000 and 2001. Florida reportedly saw an 80% increase in methadone related deaths in the same period, and in North Carolina fatalities increased eight-fold between 1997 to 2001. These alarming figures may be attributable to illicit use, without medical supervision, but as a report by two doctors from Amsterdam’s Municipal Health Service has put it: “Methadone is not an innocent substance; one man’s methadone maintenance dose is another’s poison.”

    In cases of drug addiction, the green syrup is used in one of two ways: either in a rapid detox programme, or in what is known as a “maintenance or long-term programme”. In the latter case, methadone is rarely, if ever, described as a “cure”, even by its advocates. Instead, it is held to “improve health”, to “stabilise” lives, to reduce the use of contaminated heroin, to remove the risk of hepatitis and HIV from injections, and to cut addiction-driven crime.

    Better than nothing, surely? Where harm to individuals and society is concerned, less is less. But what of the addicts who simply use methadone as a “top-up” for heroin? What of the critics who say that the treatment simply does not address the core problem, and instead simply prolongs drug addiction, with a narcotic that lingers in the body far longer than heroin? And what of the fact, now well-established after 40 years of medical use, that many of those being “treated” with methadone will be state-sponsored addicts for years, possibly for life?

    The simple answer is that at least they will be alive, most of them; addicts but still alive and, with luck, functioning. You can find any number of anecdotal accounts from long-term junkies who claim that methadone has transformed their lives. Against that you will find those prepared to state baldly that the drug is “as dangerous and as harmful as heroin”. Smack addicts who have done it the hard way, cold turkey, meanwhile have a tendency, according to some studies, to be dismissive of methadone users. They say harm may have been reduced, but the problem of addiction has not been confronted , far less dealt with.

    To be fair, you would struggle to find a supporter of methadone programmes prepared to say that the drug can ever be fully effective in isolation. Addicts and their families need support in all sorts of ways and they need it before problems run out of control and lives are destroyed. That, nevertheless, does not answer the central question: is it really wise to maintain addicts in their addiction?

    On the other side of the coin sits a reminder of a simple, well-established fact: prosperous junkies, with a reliable supply and a shred of self-awareness, can function perfectly well for decades. Things fall apart when cash becomes scarce, when crime becomes unavoidable, when prostitution seems like the answer, when the smack has been cut, the needle shared and the family unit dismantled. It is no accident that heroin hits our poorest communities hardest: they were the most vulnerable to begin with.

    Goldie may be correct, then, to talk about a two-tier system, but she would be as well employed talking about a two-tier society. It is in the bottom layer that you will find the methadone users, kept afloat only by dint of medical supervision, with luck, and what is allegedly a less-worse drug. The suspicion lingers, nevertheless, that methadone is, as a friend said the other day, the politicians’ panacea. They can call it a weapon in their perennial war on narcotics while keeping the real casualties out of sight, out of mind, and addicted with the state’s blessing. Better that, surely, than the alternatives?

    I’m not so sure. Well into the 1960s, after all, a different policy endured: heroin on prescription. Why not? The chemical difference between smack and methadone is slight. The real demarcation lies in illegality, purity, and modes of use. Yet if it is easier to come off heroin than it is to be rid of methadone, aren’t we offering the wrong treatment?

    Heroin on the NHS? One of the first symptoms to arise from that course of treatment would be mass apoplexy among the political and media classes. The fact that such a policy would steer us closer to common sense would be neither here nor there. The fact that the drugs problem is a function of illegality is a truth, meanwhile, that very few people are prepared to discuss.

    Clean, legal, modestly-priced: what do you achieve by legalisation? A great deal of harm reduction, as it happens, if you are truly worried about crime, health and social welfare. Addicts would still exist, as alcoholics continue to exist, but we would not be mired in the half-answer that is methadone, or trapped in the mythology of the “war on drugs”.

    Prescribe heroin and end the pretence. Prescribe a drug of which the body can be cleansed in weeks, rather than months. Then spend some real money on rehabilitation. If not, the masses will go on queuing, deluded, for their methadone.

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  1. oldman
    because the drug companies will make more off methadone, you won't go back to heroine cause methadone is stronger. you'll be a slave to them and the gov. will be able to more easily tax your habit. they don't care about getting people off h. just getting them on theirs.
  2. Solidly-here
    Klaatu's title: "It is harder to come off methadone than heroin, so why prescribe it?"

    Answer: Because it is difficult (and even illegal) to prescribe Heroin.
  3. Alfa
    Morphine is just as illegal as Heroin. Prescribing drugs is in fact licening a patient to get illegal drugs.
    This article does not come by itself. There are multiple EU governments discussing this. All in all there is a lot of lobby going on about drug reform in the EU. The pressure on the Dutch government to prescribe heroin to hard core addicts, is so large that the trials which they so strongly oppose, will be expanded none the less.
  4. sands of time
    "On the other side of the coin sits a reminder of a simple, well-established fact: prosperous junkies, with a reliable supply and a shred of self-awareness, can function perfectly well for decades. Things fall apart when cash becomes scarce, when crime becomes unavoidable, when prostitution seems like the answer, when the smack has been cut, the needle shared and the family unit dismantled."

    I believe that statement in itself shows why methadone is an appropriate answer for the heroin problem. Opiate addicts (non needle using) are no more a danger to society than any other human... That is until they don't have any opiates left. Methadone solves this problem by giving the addict a drug which will prevent withdrawals for a long period of time. It also takes the needle out of the equation. Dose by dose, methadone is a more effective solution due to it's long half-life.

    Having said that, methadone is a nasty substance due to it's withdrawals. All in all, there are better solutions such as Subutex. Methadone is going to keep an addicts addicted, but it will stabilize the quality of life and reduce the potential damage to society. Sobutex is an actual solution to addiction because it allows the person to get off all opiates (psychoactive anyways) with less pain, increasing the chances of success.

    In my opinion, heroin does have a legitamate place in modern medicine, just like any other opiate. I'm not sure I think it's any better than methadone for the treatment of addiction though. The doctor would probably say methadone is best since it has the longer half-life. An educated use would probably come to the conclusion that methadone is a bad idea because of the longer addiction.
  5. ***FREAK***
    In the Uk there is a really easy answer to that one, and thats because all drug treatment is shaped by crime reduction, that is the driving force behind it all.
    And people on scripts, legal as they are, dont need to get together as much cash, from illegal activities to fund their gear.
    So straight away our government can say that they are winning the war on drugs because not so many cars got broken into this week!!
    It is also my experience that a lot of heroin users on methadone top up, and some on subbies just stop taking them at the weekend, so they can have some brown.
  6. enquirewithin
    Heroin was prescribed to addicts for many years in the UK, until the UK was pressured into following the useless US-style punitive War on Drugs. I've met junkies who are prescribed methadone who simply re-sell it in order to buy heroin, partly because they know that he withdrawals from it are much worse.

    Heroin addiction is most prevalent in areas with social problems. Generally, only people with 'issues' or with lives which seem hopless to them will tolerate being a heroin addict (it's such a mind-dulling drug).

    Of course, heroin addicts should be prescribed heroin.
  7. Jeff Woad
    Here here.

    Give addicts their heroin the same as you give diabetics their insulin, the good it would do is immense, not just for the so called junkies, but right down to the source- The opium farmers could be payed a reasonable wage by governments and pharmaceutical companies, not have to sell their children to drug-lords when they have a poor season. Our governments could save the millions they're spending in vain, (no pun) to try and eradicate the crops. The police could dedicate their time and resources dealing with real criminals, not people trying to make money the way they are forced to do, for their over-priced, adulterated medication- not to mention the amount of burglaries, robberies and petty crime that would disappear over night...

    But most importantly, the people at the end of the chain, the users, who would no longer have to devote 90% of their lives to finding money and drugs. They could live their lives as they pleased.

    It's not heroin that's evil, it's the stigma attached to it and all the shit one has to go through to get it.
  8. Solidly-here
    Jeff Woad says: "It's not heroin that's evil, it's the stigma attached to it and all the shit one has to go through to get it."

    Truly, this is right. Up until 1912, there were Millions of Heroin users. They quietly (and legally) purchased there Heroin at the neighborhood Pharmacies (and for pennies). There was NO stigma about being a junkie. People lived normal lives (worked, raised kids, played).

    Then, Uncle Sam "decided" that Heroin was Bad. Poof, it's now illegal. The price goes up 100-fold. All of these long-time Heroin users were forced to spend most of their time seeking out enough money to support their (formerly legal) habit.

    Was Heroin (somehow) better in 1911, than it was in 1920? . . . NO.

    Uncle Sam destroyed the lives of countless people, turned them into criminals (just for taking their medicine), and provided Billions of dollars for the Mafia . . . All in one fell swoop. A pity.
  9. sunyata
    Not to mention that overdoses wouldn't occur so frequently with known purity.
  10. deji
    Its harm reduction, thats it. You don't get well, you actually end up with a much higher addiction. Works out for the addict at first too, some like it and will stay for life, some hate it and end up having a hell of a time getting off. Works for the clinics as they get rich, reduces crime and disease. Thats why its prescribed.
  11. sunyata
    Prescribed heroin would also reduce crime since the addicts wouldn't need to steal to get money for it. It's relatively cheap to produce too, so it wouldn't be an economic burden on society
    It's also not very toxic and disease is only a problem when using dirty needles.
  12. rocco_blitz
    Swim thinks that dolophine a.k.a. (methadone) is a magical drug. Swim is not a h user but has tried it a couple of times a few years ago.Swim has been prescribed lortab-10 for almost 9 years now,Yes I know swim tab habbit is not as dramatic as h, but swim as and is using anything he can get his hans on such as oxy,40 to 80 mg min.But when swim runs out of the above he tries to obtain methadone off the street b-cause here it is a hastle to get doans prescribed.Most people go to the clinic to obtain which is cheaper for the drug it-self.But swims problem is that the clinic in his area is over 90 miles away,with gas being 2.78 a gallon and not to mention that swim has a job that begins a 7:00 A.M. and the clinic doesnt open till 5:00 A.M. and there is a huge line to obtain ur medicane.But anyway swim says that methadone when he has it is great,and the doctors should not have to be a so called pain management doc. to prescribe said drug.The thing is>>>that like others have mentioned it is easier to obtain methadone frome h- users cause most or all of them here sell the methadone to get more dog food(h).So swim is a firm believer in methadone and does not withdrawl so far from not having methadone, right now swim just did his last duragesic patch and hopes the tab 10's will get him through till his next script of duragesic.
  13. VincentVan
    Good God, what a confusion!
    Heroin and morphine(to a certain extent) are recreational drugs, methadone is not, or at least should not be. Obviously you can use almost anything as a recreational drug: from glue to gasoline to your cat pisspot and certainly methadone too but that´s not what is meant for. If used in the proper way methadone really is a wonder drug . Thanks to this lovely compound ( and it´s availability on the black market)I just got rid of of a truly monstruos H addiction. Methadone alouds you to regularly and constantly reduce your intake until 0.0 mg ; with Heroine, morphine and opium you can´t do that, I say it because I´ve tried all of the above more times that I care to remember and it just does not work.
    I´m not saying that with meth it´s easy, it is´nt, and I admit that in the last 10 years I stopped taking opiates (always with meth ´s help) about twice a year; but without it I really think it would´nt have been possible, at least not while keeping a regular job and having a (more or less) normal family life.
    Of course I would never ever dream of taking methadone for fun.
    If you want to have a taste of the perverse and all consuming charms of opium and its derivates then try opium , Heroin or maybe even morphine but leave methadone for when you will want to get away from your habit (and sooner or later you will, no matter what).
    It´s true that to suddenly stop taking mathadone it´s probably harder than to stop taking heroin but what kind of idiot would do that ? Methadone is like antibiotics : once you start a treatment you´ve gotta finish it and specially you must use it properly, i.e.: keep reducing your daily intake and specially never mix it with dope or you will end up with a double addiction.

    Of course everyone is entitled to his own opinion but I would beg people who do not have first person experience of what they are talking about to refrain from giving advice to folks who surely don´t need to get more confused than they already are.

    Methadone (properly used) definetly is the easiest way to get rid of opiate addiction. The problem maybe is that after you tried how easy it could be you would feel like to start again . That´s probably the reason why I relapsed so many times,( or at least that´s what I like to think)

    "I never thought you´d be a junkie because heroin is so passé"
    (The Dandy Warhols- If you were the last junkie on hearth-)
  14. VincentVan
    Oh one more thing
    Solidly-here is misinformed about USA´s heroin and more generally drug policy prior or post 1912 ( the illegal drug act by the way is from 1909).There is a beautiful book I would suggest to him and to anyone intrested in how and why drugs started to be demonized written by a non ideological anti-prohibitionist it´s called:
    The pursuit of oblivion- A social history of drugs. by Richard Davenport-Hines
    (Phoenix Press - Orion books Ldt)

    More strictly about opiates I recomand also :
    Opium - A History. by Martin Booth (Simon & Shuster Ldt)
  15. Sklander
  16. bigrod4144
    I will be a drug addict for life i guess i relapsed many times and methadone lets me use my drug without many problems the day to day hunt when i was using other drugs was alot worse than being able to live worry free without hunting all the time, if u want to quit i say cold turkey is the only way off heroin methadone would be alot longer and worse in my eyes. like swaping a monkey for a gorillia on your back. but thats me i think i should be able to buy what i want when i want at any time its my life not the gov.
  17. Nicaine
    Because it's (supposedly) easier/safer to *stay on* methadone than to *stay on* heroin, of which users are assumed to want to be high on it all the time... or at least not getting 'sick'.

    Frankly SWIM thinks Buprenorphine probably has longer-term validity, given the rash-inducing horror stories SWIM has heard about methadone maintenance patients jailed & such, with access suddenly cut off. Bupe for "treatment" of opioid dependence is still in its infancy tho; SWIM hears the systems in place are not very good so far.
  18. jmarsala
    SWIM has mixed emotions about this topic. SWIM was an Oxycontin 80mg x 10 a day or 3g or 30% black tar a day addcit. SWIM loves to insuff but being on the westcoast (the bestcoast) its basically all we got. With 80mg OC being xxxx per & 1 gram of 30% smack being xxxxxxxxx gofig.

    With that being said SWIM has tried Cold-Turkey, Methadone and Suboxone/Bupe/Subutex.

    In SWIMS opninion:
    1. Cold-Turkey:
    Is the best possible way. Most Opiate addicts are babies and want to use the first sign of un pleasentness. In most cases this is the best way to get off because it a. not only creates a rememberence (5 days of hell and 5 days of maliase, is it worth it to just take this one hit? b. Gets it out of your body quickest for fastest recovery. Cop'ed with NA or some kind of out patient rehab, its purly the best way.

    2. Bupe/Subs/Tex:
    If you have a good insurance converage this one is for you and also all the people who 'phear c0ld turk3y'. The doc will usually want you on this drug for atl;east 3-6months which is not a bad thing. It gets you out of the habit of cop'ing, talking to dealers it also blocks the addiction and though of wanting to get high. I would recomend this to the middle american type budget. At mdone clinics (at least in Santa Rosa, California - its around $700 thats half doc/meds if recomended dose is 3 8mg's a day.) If you really cannot do cold turkey which is highly sugested (look up: thomas reciept for cold turkey UTFSE) then SWIM would strongly recomend obtaining these weather its illicitly/legaly. Note: You do not HAVE to stay on it for 6mo. If the person is smart they can do it with 1-3 8mg subs. Subs have an extremly long half life being 24-60hrs. They are also not a full opoide but mearly a half opoide so kicking it after last dose is simular or even less then if you got no sleep for a few days and your malaised. Its expensive but a wonderdrug. The only draw back in SWIMS humbal opinion is for a person wanting to use while taking suboxone (Bupeanorphine Half-Opoide/Naltrexone Antagonist (blocks effects of euphoria is user decides to use plus also blocks the users craving))
    Its all in the hands of the person. If he/she really wants to quit they will successuflly with this drug. If the person really really wants to use the euphoria is very limited and should wait at leats a day. This creates a situation where the person is being perscribed subs 90-120 a mo. If the user is not in the mental state of mind of wanting sobrity he/she will use this drug only in the sense of a backbone. I.E. SWIY wants to get hizzy, that person is able to do whatever whenever with no comedown consaqunce. I would suggest if the world was run right and uncle sam was not so kurrupt.. To have bupe be orally admin'ed. The reason SWIM says this is because he used to do this and no feels he took advantage wrongly of this most helpfull drug.

    3. Methadone:
    I think this is by far the most humilating pos (IMO) thing out there. Basically SWIM feels they are just exchanging one drug for another which only takes about a good xxxxxxxx bones a mo. It is very true, because Methadone being a full opoide and having the same (not quite sure) antagonist which will also block the effects of the high. They say it kills craving but SWIM thinks that this is untrue but then again SWIM did not do the ever so popular Im_hard_core_so_i_need_120mg_200mg_of_mdone_for_the_nod_effect
    Also the half-life of Mdone is roughly 24 and 36 hours. Thats 3 days roughly vs 1 1/2 roughly. You do the math. In SWIMS opinion, Mdone/MMT may regulate lives and keep needles from arms but is it worth knowing that SWIY is fully dedendent and mmust burden there day just to get your immataion fix? I say if your going the Mdone route, fuck it just snort an 80 or do some h. Because we all know that people who go to mdone clinics are just funding our govenrment (even though they say non prof). And using it as a back bone so when they cannot afford H/opiates they have a fall back.

    SWIM was not here to knock anyone. If Mdone works for you then thats awesome. To each there own. SWIM just personaly does not believe in it and never will from first hand experience.

    SWIM is currious to here others input. Feel free to discus.

  19. jmarsala
    SWIM also forgot to mention, that most mdone clinics have dealers around who try to make a sale and/or get take home and sell it. Its just corrupt. Infact to prove SWIMS accusations, When SWIM did mdone, he saw Guy #1 hand Guy #2 a few 40s mg ocs. WTG guys. Shoot shoot shoot them up what murdah murdah murdah kill kill kill!
  20. Nicaine
    Hey jmarsala... good posts, but please delete the references to prices of substances in message #19 (not allowed on drugs-forum). Or if a mod gets there first...
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