Methadone

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Methadone is an opiate that was first introduced after World War II as an alternative to morphine. Methadone was originally thought to be less addictive because of its extremely long half life. Today, methadone is used as an analgesic for pain management and more popularly as replacement therapy for heroin and other opiate addictions. According to Wikipedia 2006, “methadone is chemically unlike morphine or heroin, methadone also acts on the opioid receptors and thus produces many of the same effects…methadone has a slow metabolism and very high lipid solubility, making it longer lasting than morphine-based drugs.” Methadone is also one of the cheapest of the opiates landing it as a preferred drug for insurance companies consequently making doctors more apt to prescribe it to patients. Methadone is fat soluble and is primarily stored in the liver and secondarily in other body tissues such as lungs, kidney, and spleen. Methadone is difficult to detect in blood because it’s mainly stored in these organs and the transfer between body organs and blood is slower according to Australian Government Department of Health and Ageing (2003). The elimination half-life of methadone ranges from 24-36 hours but may deviate from 4 to 91 hours depending on how it metabolizes in the individual body chemistry of each patient and due to the fact of other drug interactions that may be taking place. The Center for Substance Abuse Treatment, Methadone-Associated Mortality: Background Briefing Report (2004) states that “because of the long half-life, achieving steady-state serum methadone levels (SML’s) - in which drug elimination is in balance with the amount of drug remaining in the body - requires, on average, from 4 to 5 days, although it can take much longer in some individuals… After each dose, the SML, typically reaches a peak in 3 to 4 hours (with a range of 1 to 5 hours), although individual physiologic responses differ for a variety of reasons.” Methadone has many uses but only recently has become more popular for pain management and recreation. Methadone was initially created as an opiate analgesic but became accepted as an agonist agent in heroin addicts. Its effectiveness is in replacement of heroin in the opioid receptors in the brain of the addict to eliminate painful withdrawals and reduce cravings. Methadone essentially replaces an illegal short acting drug (heroin) with a legal long acting drug (methadone) to help reduce crime, and decrease spread of blood borne diseases associated with illicit drug use while enabling the individual to pursue a healthy lifestyle and contribute as a productive member of society. In an article from George Mason University Maia Szalavitz (2006) attributes the recent rise in Methadone being prescribed for pain management to the deaths and addiction potential of OxyContin. Pressure from the DEA along with media forced physicians to look for a safer but effective alternative to OxyContin therefore resulting in prescriptions for the widely used Methadone. Methadone has been primarily successful in its treatment of heroin addiction. Methadone has been extensively researched and is believed to less addictive because of its longer half-life duration then other opiates used to treat pain. Opiates have historically been used for recreation to achieve the “high” associated with the release of endorphins creating a euphoric sensation. This feeling of euphoria has led many people to abuse opiates by not taking them as prescribed resulting in continued use and consequently dependence and finally addiction. Methadone seems to be an appropriate substitution of other more popular opiates that are abused because of its delayed narcotic effect and lack of the typical “high”. The Charleston Gazette (2006) states that “researchers found that opioid painkillers caused 91 percent more deaths in 2002 than four years before – far more than heroin or cocaine, according to death certificates”. With those astounding statistics it stands to reason why medical professionals are looking for a safer approach at treating chronic pain. Since methadone has been more recently used for non-addicts; methadone sales (not including methadone for drug treatment) have risen 175 percent, more than any other opioid sold according to The Charleston Gazette (2006). In addition to methadone increasing its sales it has also increased mortality rate. The Charleston Gazette (2006) reports that a new analysis done by the Centers for Disease Control and Prevention found that the number of Americans who have died from overdoses of methadone increased 213 percent between 1999 and 2002. Methadone advocates and pharmaceutical companies attribute this increase to illegally obtained and diverted methadone pills almost exclusively from pain management recipients and not methadone clinics. Surprisingly the research will show that the majority of deaths take place during the induction phase of methadone to persons with prescriptions or beginning a maintenance program. Induction to methadone poses the most significant risks to patients because often methadone doses are increased rapidly and many patients have not yet achieved the levels of tolerance to physiologically combat fatal respiratory depression. Karch and Stephens (2000) state that most deaths occur during the first few weeks of treatment and describe this phenomenon as being related to:This log is on behalf of the victims and those yet to be victims of methadone. We are the concerned citizens, family members, and friends of those who have died at the hands of uninformed doctors, hospitals, and methadone. Do you know of anyone who died from methadone?It would be interesting to see the respones on this topic.