Anna Nicole Smith died of Methadone?!

A Common Killer - Methadone

Whatever happened in Anna Nicole Smith's case, methadone has become an increasingly common killer. Overdose deaths from the drug shot up nearly 400 percent between 1999 and 2004.

Robin Debaise's 16-year-old daughter, Sara, died after taking methadone.

"She made one bad mistake, and it cost her her life," Debaise said. "It's been 2½ years, and I still expect her to come walking through the door. Everyone says this can't happen to them, but it's happening to me."

From a Treatment for Addicts to a Prescribed Painkiller

Sara is the new face of methadone. For decades, liquid methadone was given to help heroine addicts ease the agony of withdrawal.

In recent years, doctors have increasingly prescribed methadone pills as painkillers because they're cheaper and less controversial than OxyContin or Vicodin, which have been widely abused.

Dr. Terry Horton, medical director of Phoenix House, a drug and alcohol treatment center, believes methadone can be safe.

"The problem occurs when methadone is used outside of the physician's supervision. Then individuals are misusing it and can find themselves in harm's way," Horton said.

While methadone can be safe under medical supervision, it is considered a tricky drug to prescribe.

There are concerns that doctors who are not sufficiently familiar with methadone can prescribe it in ways that lead to medical complications and even death.

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HeroinHelper.com's Clinic Advice for Methadone Detox

Inside the Clinic

Methadone, whether used for pain or opiate addiction, is considered a medicine. But unlike medicine for, say, a heart condition, methadone is not distributed as a prescription drug (when used for detox). Instead, the methadone patient must come to the clinic every day to ingest his dose. This is done for two reasons. First, addicts are not considered trustworthy and second, the methadone is easily sold on the street.

Patients on maintenance can earn "take home" doses--so they don't have to come into the clinic every day. This is usually done for patients who are "stable" which means drug free. Patients are periodically tested for illegal drugs. If a patient consistently tests negative for illegal drugs, the clinic will usually allow him to take home doses. The maximum number of "take home" doses that clinics will give is six--so the patient is forced to visit the clinic at least once per week.

Outside the Clinic

Many patients who get take home doses sell those doses. Sometimes, this is done just to make ends meet, but mostly it is just the methadone patient converting the 'done into heroin. Whatever the reason, it is not difficult to buy black market methadone.

The easiest way to find a methadone connection (or a heroin connection, for that matter) is to hang out at a clinic. It is easiest to do if one is somehow involved--as a detox patient, for example--but it can be done regardless. It may take a while, but eventually the right people will be met. The fact of the matter is that if a person is looking for methadone to detox, he is already addicted to heroin--he is already in the right subculture to find methadone.

Avoiding the Clinic

The average price of methadone on the street is 50¢ per milligram (mg). Prices vary of course, but it should never be more than a dollar per mg. How much methadone is necessary to detox also varies, but 200 mg should be enough for just about anyone. This means that the cost of street methadone for a detox is about $100. Compare this to the cost of a clinic detox--usually in the $200-$300 range--and a very compelling reason to avoid the clinic is clear.

An even better reason for avoiding the clinics is that they do not give the patient a lot of control over his detox. There is a tendency to think that heroin addicts are always trying to scam people and so the clinics are resistant to make any changes for their patients (even though the "junkie" is also the customer and the guy who is paying the salaries of the people at the clinic).

The best reason of all for avoiding the clinics may be that many clinics are not ethical. Many clinics use their detox programs as a way to funnel addicts into their maintenance programs. Triad in Santa Cruz, for example, gives no support meds to help the patient at the end of their detox. It is hard to justify this practice except as a way to make addicts think that maintenance is the only option.

Doing the Done

With rights come responsibilities. Once the addict has acquired the methadone, he can use it to detox himself in any way deemed fit. But this also means he can screw up the detox--no one is available to help.

In the first article of this series, we recommended people start by doing a methadone detox in a clinic and following the procedure set by the doctor. This gives the addict a baseline against which to compare. It also gives him a good idea of where to start when doing his own detox.

Starting Dose

The first thing the addict must decide is at what methadone dose to start the detox. A good rule of thumb is that if an addict is doing a gram of heroin per day, he should start his detox at about 30 mg per day. The relationship between former heroin use and beginning methadone dose should be linear. The table below shows this. The first column is the amount of heroin the addict was using each day before he started the detox. The second column is the amount of methadone the addict should take the first day of his detox.

heroin use	methadone dose
0.25 g	10 mg
0.50 g	15 mg
0.75 g	22 mg
1.00 g	30 mg
1.50 g	45 mg
2.00 g	60 mg
3.00 g	90 mg

Course of the Detox

There are basically two ways to handle the methadone dose during the course of the detox. The first is simply to use the same dose each day. Although this is the easiest way to divide up and administer the methadone, it has a few problems. The first is that the same dose every day will not translate into the same amount in the body everyday. This can be seen in the graph below where a dose of 20 mg is given each day. The other problem is that the body will not respond to the abrupt change in dosage and the withdrawing addict will be less comfortable.

The other option is to decrease the methadone dose each day. There are various ways to do this but each is just about as good as the other. In this case, it is best to simply have the dose decrease the same amount each day. So an addict would decrease the dose each day by the starting dose divided by the length of the detox in days. So if the starting dose is 35 mg and the length of the detox is 7 days, the dose would be decreased by 35 ÷ 7 = 5. Thus the dose each day would be: 35, 30, 25, 20, 15, 10, and 5.

Length of the Detox

The last thing the addict must decide is how long to detox. This issue was dealt with in the last article. It doesn't matter whether the detox is being done at a clinic or not: between five and ten days. It is best not to go over seven days, in fact.

Conclusion

Detoxing alone has many advantages. The only real drawback is that doing so is illegal. This is an important drawback, however. While it is true that cops and courts are more likely to go lightly on an addict who is trying to get clean, possession of methadone without a prescription is just as illegal as possession of heroin and can send one to jail for years. Any person going outside the clinics to detox should be very careful and aware of potential hazards.

Another important issue to keep in mind with methadone is that it is dangerous. Children are often attracted to methadone because it is normally distributed as a brightly colored liquid. Each year, children OD on methadone because they mistake it for something like Kool-Aid^TM. Keep methadone away from kids! And the addict must not forget to be careful when dosing himself.

HEROIN HELPER

Faq(s) about Methadone

FAQ About Methadone

Q.) What is methadone?
A.) Methadone is a long-acting opioid (narcotic) medication. It is used as a substitute for heroin or other narcotics that are being abused.
Q.) What is the history of methadone?
A.) Methadone is a synthetic opioid receptor agonist that was developed more than 50 years ago. The circumstances surrounding its development have been, and perhaps still are, associated with an interesting myth. Methadone was said to have been developed in response to an order by Hitler to develop an alternative to morphine, which was in short supply at the end of World War II. The trade name Dolophine was said to have been derived from Hitler’s first name Adolph. The truth is that methadone was discovered at I.G. Farbendustrie at Hoechst-am-Main in Germany, in the course of work on spasmolytic compounds during World War II. Because it lacked any resemblance to known compounds, its narcotic analgesic properties were not expected. Despite the morphine shortage, methadone was not used as an analgesic until the post-war period. It is believed that Germany’s failure to realize methadone’s value as an analgesic was because initial doses were too high and intolerable opioid side effects resulted. Concerning nomenclature, the more likely etymology is that Dolophine was derived from dolor for pain and fin for end.
Q.) How is methadone used?
A.) Methadone is usually available as a liquid - linctus or methadone mixture - which is swallowed. Tablets and injectable ampules are sometimes prescribed. Like many other medicines some of these prescribed drugs are diverted and become available illegally.
Q.) What are the effects of methadone?
A.) Methadone's effects are less powerful than heroin. However, Methadone offers a similar, less intense, absence of pain combined with euphoric qualities. The combined methadone effects are a sense of well being, feeling warm, content, drowsy, and untroubled. Physically, the pupils of the eye become smaller, body temperature drops, and blood pressure and pulse slow down. Methadone may also affect a persons ability to drive a car or operate heavy machinery.
Research has demonstrated that when methadone is given in regular doses by a physician, it has the ability to block the euphoria caused by heroin if the individual does try to take heroin. Despite methadone's role in the treatment of heroin addiction, it has addictive properties and also a high potential for abuse on the street.
Q.) What are the side effects of methadone?
A.) Patients on methadone maintenance report a wide range of methadone effects. A long list of methadone's effects has be compiled and is presented below. Some of these methadone effects are easily mistaken as withdrawal symptoms or as other medical conditions.
Methadone side effects include but are not limited to:
drowsiness
lightheadedness
weakness
euphoria
dry mouth
urinary retention
constipation
slow or troubled breathing
Methadone side effects that are more rare include but are not limited to:
allergic reactions
skin rash
hives
itching
headache
dizziness
impaired concentration
sensation of drunkenness
confusion
depression
blurred or double vision
facial flushing
sweating
heart palpitation
nausea
vomiting
Methadone side effects that are more uncommon include but are not limited to:
anaphylactic reactions
hypertension causing weakness and fainting
disorientation
hallucinations
unstable gait
tremor
muscle twitching
myasthenia gravis
kidney failure
seizures
Q.) Is methadone addictive?
A.) Many people go from being addicted to heroin to acquiring a methadone addiction. They continue with this "treatment" for years, fearing the withdrawal that will occur when they stop. Methadone does not have to be the way of life for former heroin addicts. Gradual cessation followed by a drug-free program of rehabilitation may be the answer for many sufferers.
Addiction to methadone can take several forms:
conning a doctor into prescribing a higher dosage than is required
taking more than the recommended dosage
taking methadone in combination with other drugs, including alcohol
using methadone as a 'top up' drug while continuing to take heroin
selling prescribed methadone in order to buy heroin
Q.) What are the symptoms of methadone withdrawal?
A.) Many former heroin users have claimed that the horrors of heroin withdrawal were far less painful and difficult than withdrawal from methadone.
Methadone withdrawal symptoms include but are not limited to:
sneezing
yawning
tearing of eyes
runny nose
excessive perspiration
fever
dilated pupils
abdominal cramps
nausea
body aches
tremors
irritability
After several days of stabilizing a patient with methadone, the amount can be gradually decreased. The rate at which it is decreased is dependent on the reaction of the individual . . . keeping Methadone Withdrawal symptoms at a tolerable level is the goal.
Q.) What are the symptoms of an overdose of methadone?
A.) A methadone overdose is a serious medical emergency. In the event of suspected overdose call an ambulance. If the person is losing consciousness lie them on their side in the recovery position so that they will not choke if they vomit. Inducing people to vomit is not recommended because of the risk of rapid onset of CNS depression/unconsciousness which could lead to choking.
Symptoms of an overdose from methadone include but are not limited to the following:
muscle spasticity
difficulty breathing
slow, shallow and labored breathing
stopped breathing (sometimes fatal within 2-4 hours)
pinpoint pupils
bluish skin
bluish fingernails and lips
spasms of the stomach and/or intestinal tract
constipation
weak pulse
low blood pressure
drowsiness
disorientation
coma
death
Q.) Why was methadone maintenance treatment created?
A.) When methadone treatment originated it was to be a 20 day process to help ease the pain of withdrawal from opiate addiction. Today methadone treatment facilities are run based on their financial success. They base their success on profit from their customers. Think about it this way, if a methadone treatment center is licensed to treat 200 individuals and they are currently only treating 199, you are not going to get off methadone. This is due to the fact that they need you as a customer. Their twisted outlook on helping fight the battle of drug addiction is atrocious. How can one possibly conceive that the trading of opiate addiction for methadone addiction is a step in the right direction. Methadone treatment clinics claim that they help in reducing the spread of HIV and Hepatitis due to the fact that their customers receive their "treatment" orally. This is a very naive philosophy, having done an extended amount of research it is know that many of these individuals not only inject the methadone they receive, but abuse other drugs as well.
Q.) What is methadone treatment like?
A.) Methadone Program Falls Short Of User Expectations
Research that investigated the expectations and experiences of heroin addicts on the Methadone Maintenance Program has revealed a mixed bag of positive and negative responses to the program.
The results of the study, funded by the Alcohol and Drug Foundation - Queensland, were released at a Statewide videoconference to community alcohol and drug agencies today.
The study carried out by Dr Gayre Christie and Richard Hil of QUT and commissioned by the Alcohol and Drug Foundation - Queensland, has placed major emphasis on the perceptions of clients of the program, examining their motivations to take part in the program, their goals, and desired outcomes.
The research conducted in depth interviews with clients and staff of a Methadone Maintenance Program. While the study is not able to generalise the results across the State, the outcomes are strong indicators of the need for a review that extends the research to a larger sample of clinical staff and users in Queensland.
The reasons that people chose to participate in the program included the cost of heroin, their fear of going "cold turkey" to detox from heroin, their desire to break from their criminal activity to support their habit, and to obtain relief from pain. Their health and relationship issues also influenced their decision to participate.
Methadone was seen as the only realistic option available.
Their expectations were that methadone would eliminate the perceived stigma associated with being an addict, that they would receive support, help, and guidance from the clinical staff, and that their level of dependence would be reduced.
These expectations were only partly met. The expectation that was fulfilled was the high standard of professional help from clinical staff. They also reported the positive effects of having more money to meet the costs of food and rent, and the reduction in the health risks from needle usage.
However, their main areas of disappointment were the new health problems from the side effects of methadone, their increased dependence on a more addictive drug, the stigmatisation and privacy violations of regular attendance at clinics and pharmacies to obtain their dosage. They also reported that this resulted in depression and anxiety.
The need to obtain their daily doses of methadone also restricted their ability to obtain and maintain full time employment.
Their hopes for a drug free lifestyle were not realised with most expecting to be on the Methadone Maintenance Program for at least 12 months and some for life.
Q.) Why is methadone detox necessary?
A.) Methadone detox is invaluable to those who have tried to discontinue using opiates with methadone maintenance. Individuals are as physically dependent on methadone as they were to heroin or other opiates; this is not recovery from drug addiction. Detox from Methadone may be more difficult than other substances, but the end result is a body clean from drug polluting toxins. Methadone detox delivered at Narconon is one of the most thorough and successful detoxification procedures available.
Our methadone detox method is designed to cover all the parts of an individual's methadone detox. The removal of methadone residues is a key point in methadone detox. Without this process, methadone residues can remain in ones body and cause cravings for years after methadone abuse has ceased. A vital step in a successful methadone detox is flushing out the accumulated toxic residues, so that the individual no longer experiences unwanted adverse effects from the methadone they have taken. Narconon's success rate of 76% is higher than other drug detox and rehabilitation program because we developed a complete drug detox program that works for the entire individual: mind, body, and soul.
Q.) Is methadone sold on the streets?
A.) Some addicts manage to resell the methadone they receive in order to buy heroin This and other illegal diversion have resulted in methadone joining the group of addictive drugs sold on the street.
Is methadone more likely to kill you than heroin?
-By Dr. Marcel Buster & Giel van Brussel, MD (Municipal Health Service Amsterdam)
Based on literature and analysis of mortality figures, Dr. Russell Newcombe concluded that methadone programs as a form of harm-reduction possibly cause more victims than they prevent. We have doubts whether the conclusion about methadone is fully justified. Looking at the mentioned literature gives a one-sided view at the problem. Moreover, the conclusions drawn are beyond those justified by the results of the analyses. Several points of debate come to mind:
Methadone is not an innocent substance; one's methadone maintenance dose is another's poison. (2). A regular user of opiates develops a certain tolerance. Therefore, it is possible that a tolerant person can function normally with dosages which can be fatal to a non-tolerant person. Also, methadone dosage in the case of first entry to the program has to be evaluated carefully. It is wise to begin with a low dosage that has to be increased slowly in the course of weeks or even months. At entry to the program, it has to be carefully evaluated whether a patient has a clear and unambiguous heroin dependence. In methadone maintenance programs, methadone is dispensed to tolerant persons, moreover, this tolerance remains high because of daily use of methadone. Therefore, it is not surprising that deaths at the King's College Hospital caused by methadone were not those of participants in a methadone maintenance program but were those of 'recreational' users of illicit methadone. In cases where more than one drug is used, the drug responsible for death due to overdose is difficult to establish. Moreover, the same drug prescribed by physicians can also be bought on the street. In seventy percent of the deaths due to overdose studied in Glasgow and Edinburgh a combination of different drugs was found. (3). Prescribed drugs such as temazepam were often encountered in deaths in Glasgow. However, among only 14 of the 34 persons who died in 1992 and where temazepam was found, this was prescribed by their physician. Because of the presence of other drugs, it is not clear whether temazepam really caused the death of these people.The combination of these different drugs was probably fatal to them. This was also the case with the methadone deaths in Edinburgh.
However, in Edinburgh, the authors could not determine whether methadone was prescribed or not. Both Hammersley and Obafunwa report that heroin/morphine deaths seldom occur in Edinburgh (4). 'The fall of the deaths due to overdose in the Lothian and Borders Region of Scotland (LBRS) after 1984 reflects in part the strict policing that took place, in particular in the Edinburgh area. The increase of methadone deaths is probably due to the introduction of a street trend to use this agent as a substitute to heroin. The author suggests that methadone deaths are mainly caused by the use of illicit methadone.
Wrong quotes: Dr. Newcombe assumes that the drug related deaths among participants of a methadone program studied by Oppenheimer et al., were methadone related deaths (5). The correct quote should have been 18 of the 28 deaths were caused by overdose, an opiate as a primary overdose drug was mentioned in only 22% of the cases. Methadone is not mentioned as the cause of death of these persons. The suggestion that methadone would be the cause of death ('invariably methadone') is not based on the findings of Oppenheimer. Also, the suggestion by Godse et al. that deaths due to medically prescribed drugs were caused by methadone ('invariably methadone') is not completely true (6). The most frequently encountered drugs as main cause of death were barbiturates (287 of the 745 cases where the used drugs were known). However, the number of deaths where methadone was implicated was high; 107 cases. Dr. Newcombe is quoting Harvey with "up to 1977 methadone accounted for the majority of drug deaths attributed to strong analgesics." However, he did not quote the next sentence which says "in 1979 the position has been reversed with 11 heroin/morphine deaths to 2 methadone, possibly indicating a greater availability of heroin." (7). Interpretation: For estimating the death rates, Dr. Newcombe uses cumulative figures of drug users (only deceased persons are subtracted) from the Home Office. Drug users have been registered since 1968. He assumes that two thirds of this group still uses heroin. He multiplies this number by five and calculates an annual death rate of 6 per 10,000 heroin users, which is a very low mortality figure that is unlikely to be true. The low figure is probably caused by a considerable overestimation of the actual number of active heroin users. The calculated mortality figures on deaths caused by methadone are higher. Based on the calculation of the death rates caused by methadone, Dr. Newcombe accuses physicians of prescribing a deadly drug. He concludes that clients of methadone programs are at high risk of death due to an overdose. To draw conclusions like this he should restrict his study to clients of methadone programs. Dr. Marks already made an effort in this direction but he divided all methadone deaths by the officially registered methadone clients and found an astonishingly high mortality rate. (8). If he would have limited himself to those occurring within the population of methadone clients this mortality figure would have been much lower. There are studies were drug users in methadone maintenance programs are compared with drug users on a waiting list for methadone programs or drug users who left treatment. Grönbladh et al. for example, report mortality among clients of methadone programs to be 1.4 % per year; among the drug users on a waiting list mortality was 7.2% per year (9). Significantly, mortality due to heroin overdose in this group was high (4.8% per year). Also Davoli et al. report that the risk of overdose is lower during methadone maintenance. 'A high risk of overdose death occurred among subjects who left treatment compared with those still in treatment (odds ratio 3.55, 95% confidence interval 1.82-6.90)' (10).
Therefore, these figures suggest that participants of methadone programs are at lower risk of death due to overdose. However, this does not mean that methadone is an innocent substance. The high and increasing number of methadone deaths in Britain is alarming and certainly needs more attention. The first priority should be to establish whether the methadone causing death has been prescribed within a methadone program or bought on the street. It also should be evaluated at what point during the course of the methadone program death takes place. Further instruction for doctors prescribing methadone could be necessary. The use of non-prescribed methadone without medical supervision can lead to high risks, especially when it is used as a substitute for heroin in order to get a 'high' instead of to prevent withdrawal symptoms. Physicians have to be aware of this danger and they should make sure that the prescribed methadone (as well as other psycho-active drugs) does not end up in the "grey market."
In our opinion heroin users can get great benefit from participation in a well-implemented methadone program. Denigration of methadone programs before a profound study of the real causes of the observed methadone deaths has been performed carries the risk that the baby will be thrown out with the bath water.

Methadone Detox

Methadone is most often prescribed to manage chronic pain or to help a patient control addiction to opiates such as heroin and opioid-based prescriptions. In this case, it is considered methadone treatment and unless that treatment falls under the category of methadone maintenance in which long-term methadone use is part of the treatment plan, then methadone detox is imminent.

More Methadone Detox Articles

Methadone Abuse Methadone Addiction Methadone Alternative Methadone Overdose Methadone Rehab Methadone Treatment Methadone Withdrawal

What is Methadone Detox?

Methadone is physically addictive. This means that if you should abruptly cease or significantly decrease your dose, you will experience withdrawal symptoms. These withdrawal symptoms can be debilitating and, in some cases, fatal. Unfortunately, even when taken exactly as prescribed, regular use of methadone can be uncomfortable with many patients complaining of excessive sweating and intense fatigue. The risk of feeling 'sick' may often seem worth the risks.

At Meditox, we don't think you should have to endure symptoms related to methadone maintenance or withdrawal. Our outpatient treatment program is designed to provide you with a manageable methadone detox with a minimum of withdrawal symptoms.

What Are Common Methadone Withdrawal Symptoms?

Withdrawal from methadone can mean a number of physical symptoms that include:

• Bone and muscle pain
• Nausea and vomiting
• Insomnia and restlessness
• Irritability and panic
• Constipation or diarrhea

To help you avoid these withdrawal symptoms, Meditox provides you with a prescription for buprenorphine in the form of either Subutex or Suboxone. Both of these drugs are FDA-approved for office-based drug detox as opposed to methadone, which is subject to rigorous restrictions under the Controlled Substances Act. Buprenorphine allows your body to break its addiction to methadone and then slowly taper off your use of opioid-based prescription drugs completely. After just one appointment, many of our patients leave with their prescription and a treatment plan that will leave them drug-free in fewer than six weeks.

How Does Meditox Work?

Meditox is an outpatient treatment program for people who are trying to break a physical dependency to opiates and opioid-based prescription drugs like OxyContin, Codeine, Percodan and Percocet. Unlike most drug addiction treatment facilities, we do not require an inpatient stay of 30 days to six months. Nor are we a traditional outpatient program, which requires patients to attend daily classes, group meetings and counseling. Though Meditox heartily encourages our patients to attend 12-step meetings on their own and/or counseling with a therapist of their choice, they are not obligatory for our program.

Rather, what makes Meditox unique is the freedom we provide our patients to detox in the privacy of their own homes with the support of friends and family. Without the constraints of a drug rehabilitation facility, you are free to uphold your commitments to your career and your family without allowing the drug to intrude any further upon your life. If you think Meditox could be the answer to your issues with methadone addiction or opiate addiction, call us at 888-MEDITOX today.

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