Category Archives: Methadone Benefits

Buprenorphine and Liver Health

methadone-safe-for-liverJana Burson is a North Carolina physician who specializes in the treatment of opioid addiction using medications like buprenorphine and methadone. Dr. Burson is a passionate caregiver and patient advocate with considerable experience in the field of addiction treatment. She maintains an informative blog on the topic of opioid addiction treatment and recently posted her comments and observations on a revealing 2012 study.

The 2012 study by Saxon et al is reported in her blog to have followed more than 700 patients over 24 weeks who were receiving either methadone or buprenorphine (the active ingredient in Suboxone). These patients were checked for specific red flag elevations that would suggest emerging liver damage or liver inflammation. None of the patients receiving methadone or buprenorphine had significant abberations in liver functioning. This led the researchers to conclude that neither medication causes liver damage.

A 2014 follow-up study by Soyka and others (published in the American Journal on Addictions) found the same results in their research of 181 patients on Suboxone (buprenorphine + naloxone).

Studies like these help to dispel misinformation around opioid treatment medications and their safety. Dr. Burson expressed that it was once routine to order liver function tests for patients on buprenorphine therapy, but that this is likely unnecessary given the more recent research validating methadone and buprenorphine’s safety in regard to liver functioning.

There are addiction-related illnesses, like Hepatitis C, that can have highly detrimental effects on the liver. According to Dr. Burson, the Soyka study also showed that buprenorphine was not harmful even in patients diagnosed with Hepatitis C.

Thorough research studies like these are important in further legitimizing the benefits & established safety profile of opioid treatment medications. Having access to safe medications helps hundreds of thousands of people find effective treatment for chronic opioid addiction.

For More On Methadone

Methadone Treatment Services

methadone-treatment-resourcesWhen one thinks of methadone treatment, they usually consider the power of methadone to eliminate opiate withdrawal and the value this has to someone fighting off withdrawal sickness.

Methadone treatment actually consists of more than just the “medication assistance” component. Real treatment always addresses the underlying lifestyle, thinking, and behavioral elements that are a significant part of the addictive process. These areas are specifically addressed through counseling. All opioid treatment programs providing methadone in the United States are required to also offer counseling to their patients in order to help them achieve true and lasting success.

Some patients will need more counseling & emotional support than others. But all patients new to the recovery process will need to receive basic education on addiction as an illness, how to build a personal recovery program, and to have an opportunity to develop new coping and relapse prevention skills.

Methadone clinics in the U.S. vary in the ways that they deliver counseling services. Some programs are heavy on individual counseling while some focus more on a group therapy model. Often, programs will provide a blend of the two with optional family or collateral participation available as needed.

There is another important consideration with methadone treatment pertaining to the need to also treat “co-occurring disorders”. Co-occurring disorders consist of other psychiatric symptoms that merit special interventions and additional care. For example, many individuals dealing with an opioid addiction may also have struggled with chronic depression or anxiety. Unless these disorders are treated effectively, they can become stumbling blocks on the road to recovery, and can undermine a person’s sobriety success.

A number of methadone programs have in-house psychiatric services to address co-occurring disorders and to provide additional medications and/or therapy if required. Opioid treatment programs that do not have psyc services will typically refer a patient out to the local mental health center or a private provider who specializes in psychiatric care.

Methadone treatment has at times been presented as a harm reduction approach to dealing with severe addiction. In other words, reducing a person’s risk of overdose or exposure to other illnesses is a worthwhile goal. However, “harm reduction” alone does not represent all that recovery truly offers. There are many people who have found life long recovery through their introduction to methadone treatment. After becoming drug free, they went on to have families, start businesses, develop new careers, and enjoy a full life in the best sense.

The possibilities are limitless in recovery. Addiction is treatable. Methadone can be an important piece of the recovery journey. For many thousands of patients, it was the new start that they had hoped for.

Methadone Maintenance For Opioid Treatment

methadone-and-opioid-treatmentOpioid Treatment is a category that includes several different interventions or approaches relating to opioid use disorders. People sometimes mistake opioid treatment for “opioid detox” when they are technically two different processes.

Opioid detox refers to the process of helping an opioid addicted individual discontinue their use of opioids and be medically monitored as the body withdraws from them. In a supervised setting, a person is typically assisted through a short-term opioid detox (3-10 days) by the administration of various medications used to manage withdrawal symptoms like clonidine (to guard against high blood pressure), vistaril (to reduce nausea and anxiety), and even buprenorphine (to minimize the severity of the opioid withdrawal process).

There are also variations on an opioid detox referred to as a taper. A taper often occurs on an outpatient basis and involves a more gradual reduction in dosage of either methadone or buprenorphine (suboxone) over time. This taper may take as long as 90 days and allows the individual to adjust more comfortably due to the slower, milder reduction in dosage that occurs over a coarse of weeks or months.

Maintenance is the term which refers to maintaining an individual for a significant period of time on either methadone or buprenorphine (suboxone) to allow for stabilization on the opioid replacement medication. Since opioid addiction introduces dramatic brain chemistry changes in conjunction with strong physical dependency and cravings for opiates, many people find that they need a substantial period of stabilization on methadone in order to have a realistic chance at building a personal recovery. Numerous individuals have decided that they will utilize methadone for only a few weeks with the intention of tapering off of it very quickly. This strategy is prone to failure and tends to end in dramatic relapses back to heroin and other illicit opioids.

Methadone maintenance for most opioid-addicted persons involves receiving methadone for a year or more. This length of time dramatically raises the probability of successful physical stabilization and necessary thinking, behavior, and lifestyle changes which lead to long-term drug abstinence and sustained, productive living. Put very simply, when people attempt to rush through the process of stabilization & recovery, they sabotage their chance of experiencing real success. For that reason, maintenance is a therapeutic process which should be regarded as a one year commitment or longer, and tapering off of methadone or buprenorphine should not be rushed. Bear in mind that not all individual situations are exactly the same and there are unique exceptions.

There are many different factors that play into how long a person needs to remain on methadone or suboxone maintenance. This is highly individualized depending on the length and severity of one’s opioid abuse history, one’s present medical status and general state of health, the availability of social & emotional supports, and the presence of any co-occurring psychiatric disorders like depression.

There is considerable misinformation about methadone tapering and a bit of fear-mongering that often occurs around the topic. People that generally taper successfully off of methadone or suboxone are individuals that have invested time in counseling and personal recovery growth, and who have developed a good working relationship with their doctor or treatment staff. These individuals approach tapering as a gradual goal and are allowed to halt or slow down their taper as needed. This allows their body time to adapt to the somewhat lower dosage. It also allows them to proceed slowly and carefully such that any anxiety or fears can be successfully identified and managed.

Choosing The Right Direction: Detox – Methadone – Suboxone

Methadone and Treatment Are Valuable Resources

action-methadone-assistanceSince the launch of Methadone.US, hundreds of thousands of visitors have searched the site and located important treatment resources to help them deal with a chronic opioid addiction. The city pages on Methadone.US list both methadone clinics and local buprenorphine (suboxone) physicians.

While the federal government maintains a similar database of medication-assistance providers, we focus on making this site convenient and easy-to-use for patients, families, medical professionals, and anyone interested in finding help for addiction problems.

We have some recent clinic additions to Methadone.US in the cities of Salt Lake City, Dallas, and Cincinnati. There are an increasing number of clinics around the country, and in larger metropolitan areas there are often numerous facilities available to serve the much larger population. To highlight local treatment programs, we offer Featured Clinic Listings for those methadone treatment providers who wish to profile their services to a larger number of prospective patients who are visiting their city’s page on Methadone.US.

A very exciting aspect of opiate-specific recovery is the growing recognition among medical professionals nationwide that opioid addiction is an actual illness and that it can be successfully treated with medication-assistance. For too many years, there has been a rush to judgment when it came to opioid addicted people who would present sick and in need of care. Recently, the problem with opiates has become so widespread that those in society who thought they could never be affected by it have come to realize that addition is an equal opportunity disease.

The “story” is in the real recovery of people who begin medication-assisted therapy and who then go on to change their lives, resume work, get ahead financially, reconnect with their family, and live a better, high quality life that is not compromised by constant medication seeking.

Methadone and treatment have value because they change lives and save lives. It’s not a hard concept to grasp and not controversial when evaluated from a factual, objective point of view. More good news is that opioid replacement therapy is not going away. It is an effective, proven intervention that is based on actual science and extensive research, and it has been deemed a best practice by the U.S. Substance Abuse & Mental Health Services Administration. That is quite an endorsement. Methadone and treatment … valuable resources that make a lasting difference in the lives of many people.

Advocating For Addiction Treatment

recovery-journeyTreatment for addiction is one path which may be taken to help rebuild a person’s life when alcohol or drugs have become a problem. There is a compelling documentary recovery film recently out entitled The Anonymous People. The film is an interesting retrospective on the recovery movement in the United States and how it evolved, beginning with AA in the 1930′s, until present day.

A special focus in the film is highlighting the message that people do recover from addiction, that there is a solution to this disease – and that solution is the decision to choose recovery. Recovery is a process that changes lives and takes individuals to a new destination in their life. Recovery is the journey that saves & enhances lives. To that end, recovery from addiction is of incomparable value.

In life, bad choices are made every day. As human beings, we learn to make better choices – often through the mistakes we endure as we travel through life one day at a time.

In reviewing the variety of recovery “paths”, there exist several routes by which an addicted person can find hope and direction in learning to live a drug free life. Some find their answers in church-based recovery programs. Churches recognize the reality of substance addictions and many have developed their own spiritual programs for dealing with drug addiction and offering hope for a better future.

12 Step Programs have been in widespread use for a long time and many lost in addiction have found the support, fellowship, and help needed in the rooms of AA, NA and other 12 step based programs. Some people in recovery from opioid addiction may find that their decision to take methadone or buprenorphine (suboxone) is not well-received in 12 step programs. This can make it difficult to feel accepted or supported there. However, not all NA or AA meetings are the same. NA and AA have themselves evolved over time, and some NA and AA members welcome all people suffering from addiction regardless of their drug of choice.

Addiction treatment is yet another path that leads toward recovery and the possibility of positive change. Treatment, like 12 step meetings, can vary considerably from one program to the next. Opioid treatment in particular often uses medication assistance as an additional tool to help people in their recovery journey. While medication assistance is scientifically proven to be beneficial to opioid addicted persons, it has endured some controversy through the years as those on the outside looking in chose judgment & criticism over compassion and understanding. Methadone and suboxone are proven, effective tools for alleviating the suffering that comes from opioid withdrawal.

In The Anonymous People documentary, there is a strong message that addicted people deserve love & support. Addicted people are from all walks of life. If treatment works, then advocating and supporting treatment is just and worthwhile. The film makes a persuasive argument that better advocacy is needed for the funding of addiction treatment services across the country. Addiction treatment advocacy has not been as effective as advocacy for other critical health conditions like HIV/AIDS or cancer.

As more families struggle with addiction and more voices are ultimately heard in their plea for treatment funding & support, we will hopefully see a shift in society whereby recovery is embraced as the answer to addiction.

Methadone Dosage Increases

methadone-increaseWhen a new client joins a methadone program, they go through a process called induction. Induction is the initial delivery of a methadone dose and the subsequent increases in dosage over the next 1 to 2 months as the medical team help get the client stabilized & comfortable on a dose of methadone that effectively eliminates their painful opioid withdrawal symptoms.

Induction is historically a high risk span of time since there is an increased risk of accidental overdose with methadone. It is extremely rare that overdose occurs during induction especially if clients are abstaining from other illicit substances during the induction process.

Therein lies the dilemma. Some clients become impatient with the process of methadone induction and will supplement their methadone dose with other unapproved opiates or benzodiazepines. This is dangerous and actually undermines the benefit of what methadone can achieve for the patient.

To help the treatment team determine the level of methadone increase to provide a patient, they use the Clinical Opiate Withdrawal Scale, or COW Scale. This is a withdrawal assessment tool that helps the clinical or medical team determine the prevalence and severity of opioid withdrawal symptoms. The scale produces a score based on the client’s reported symptoms and the team’s observation of withdrawal symptoms. The higher the COW scale score, the more severe the symptomology and thus a greater justification for allowing a higher dosage increase.

Some clinics are known to take clients up 10 mg at a time. Many physicians consider this high risk and too rapid of an increase. Note that methadone is a slow acting, long lasting opioid agonist with a much longer half life than heroin and most other prescription opioids. What this means is that methadone stays in the system much longer and builds cumulatively over time. So the actual effect of a dosage increase is not immediately felt and may take 1-3 days before the full effect of that dosage increase is realized.

With an impatient client, they may receive a dosage increase but not feel the immediate relief they were hoping for. Consequently, they may use additional unapproved opiates that then mix with the methadone increase that is still being absorbed into their system. This puts the client at risk of overdose.

Many clinics use 5 mg increases every few days while some clinics adjust each requested increase in accordance with the COW Scale score. For example, a client may receive several 5 mg increases because they have moderately severe withdrawal symptoms, but then receive a 3 mg increase days later and possibly a 2 mg increase days after that as the symptom severity begins to diminish. This more cautious approach reduces the risk of overdose while still addressing the client’s unresolved physical discomfort.

A well-managed methadone induction is tailored to the individual client’s needs, and the client’s safety is always the chief concern. Methadone dosage increases are provided only to alleviate measurable physical withdrawal symptoms or closely associated anxiety, restlessness, or psychological distress from withdrawal.