Category Archives: Opiate Withdrawal

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.

Zubsolv For Treating Opioid Dependence

zubsolve-methadoneDr. Jana Burson made a recent post about the newly FDA-approved medication for treating opioid dependence called Zubsolv. Zubsolv is manufactured by a Swedish pharmaceutical company, Orexo.

Zubsolv is a new sublingual (tablet dissolved under the tongue) formulation of buprenorphine and naloxone that is taken once daily to eliminate opioid withdrawal symptoms. As an alternative to suboxone or methadone, Zubsolv was approved in July 2013 as a medication which may be prescribed by physicians for the maintenance treatment of dependency on opioids.

The medication is meant to be taken in conjunction with counseling so as to help the patient learn the necessary skills for avoiding opioid relapse. The sublingual tablet is designed to dissolve in about 5 minutes when held under the tongue.

New products such as Zubsolv bring additional choices to those suffering with opioid addiction. As new products enter the market, there is an improved chance that once costly opioid replacement medications may come down in price and become more readily available to individuals who could not afford them.

The primary ingredients in Zubsolv are buprenorphine and naloxone so it is similar to a Suboxone formulation although promoted by the manufacturer as having a better taste, being a smaller tablet, and dissolving more quickly. Note that suboxone is now offered in a thin film formulation that also dissolves more rapidly than the original suboxone tablets.

Repairing Life After Opioid Addiction

methadone-recovery-1Addiction is an uphill battle. We have heard this said many times before. Many who found themselves in the midst of a personal opioid addiction were swept along on a nightmarish roller coaster ride with seemingly no brake pedal within reach.

Fortunately, addiction recovery is real, and people do get off of the roller coaster ride to hell. This is accomplished in a variety of ways with one method sometimes being the decision to try opioid replacement therapy such as methadone or suboxone.

Once off the roller coaster, individuals have an opportunity to survey their surroundings, to reflect on what has happened in their lives, and to begin moving along a better, safer path. Inevitably, facing the consequences of one's past becomes part of this gradual recovery process as does repairing the damage that occurred.

It is important to remember that change does not happen overnight, and repairing one's life happens step-by-step a little each day. There is a popular saying in recovery circles that is profound in its wisdom. It's "progress, not perfection". What this means is that no one is perfect, and that chasing perfection is perhaps an unrealistic goal. The goal should be "progress". This … is achievable. In repairing one's life and in living a new life of recovery, pursuing "progress" is enough.

Another insightful saying is this … "A journey of a 1000 miles begins with the first step". Once you have committed to sobriety and living your life in a better way, you have already taken several steps in the right direction on your new journey. You do not have to reach your destination in 24 hours. The journey itself is a huge part of your personal healing & personal growth.

Repairing one's life after opioid addiction will require several things of you. One is to cultivate patience with the world. The world often moves at a different speed than we do, and it is in our best interest to adjust to that rather than to try and control the speed of the world around us. This will require patience. Patience can grow. We can develop patience through mindfulness, prayer, therapy, and in other ways.

Also important to repairing one's life is trying to live with a sense of purpose. We must be committed to something, or someone, in order to live with a sense of purpose. In active addiction, the daily purpose was to get by without becoming sick, and that defined many addicts' focus day after day. Life loses its purpose when one is reduced to chasing drugs to avoid being dope sick.

Recovery offers so much more in terms having a new and improved life purpose. I can't tell you what that should be. But for some, it's being a good son or daughter, or a good spouse or parent. Or regaining a renewed sense of pride in their job, or "giving it away" and helping another addict or person in need, or volunteering to help a child learn to read, or mowing the yard of an elderly neighbor who can't do for themselves as well anymore.

Your purpose may not be known yet. But you can certainly discover what is really important to you once you get off the roller coaster ride of opioid addiction. As always, recovery is a choice. No one can force it on you. But it is there, available to you … when you are ready. Call your local clinic today. Ask a friend to help you find local resources. Choose to take your first step.

Opioid Craving Similar to Food Hunger

Clients tell me that their loved one does not understand why stopping opiate use is so hard. Most non-users think that it is simply a matter of "willpower". While determination is very important in overcoming active addiction, "willpower" alone is usually not enough to overcome one's physical opioid dependence once it has taken hold.

There is a page here on Methadone.US that is dedicated to explaining opioid addiction and the overwhelming compulsion that addicted people feel to keep using these drugs. If you are suffering with an opioid addiction, I recommend that you have your family or friends read this page. It helps to explain (using easily relatable examples) how and why addicted people have such a hard time avoiding opioid use when their withdrawal symptoms and cravings begin to build.

Opioid addicted people are no more able to "just not use" than most people are able to "just not eat". The need to satisfy hunger and the need to avoid opioid withdrawal are similar physiological drives. Both are powerful needs that a person cannot ignore.

Opioid addiction causes profound biochemical changes in the brain. The potential for becoming addicted is always present. Thus, this risk of addiction is something that all physicians should discuss with their patients when they prescribe them opiates for whatever reason.

Methadone Used With Newborn Babies

methadone-babyThere is a fascinating article in The New York Times which explores the use of methadone and buprenorphine in treating babies born addicted to opioids. While this is often an emotionally-charged subject, it is a very important topic and points to the benefit of methadone in relieving suffering and in stabilizing one’s health through the elimination of painful opioid withdrawal.

The article explains the dilemma that hospitals face when an opioid addicted woman is pregnant. Depending on the type and length of her opioid use, her baby may be born with an opioid dependence. And the newborn could begin experiencing painful withdrawal symptoms within 1 to 5 days.

The Times article addresses the use of methadone (or buprenorphine) in alleviating a baby’s suffering. Prior to birth, methadone has also been used to reduce the chance of miscarriage and the probability of in utero seizures. Many doctors have little to no experience with this type of treatment, and are consequently apprehensive about taking on the risk of treating an opioid addicted mother-to-be.

As of yet, there is no single universal protocol which has been established for treating newborns with methadone. However, several medical centers have been working in this area using a combination of medications such as methadone, phenobarbital, clonidine, and buprenorphine.

Early indications suggest that it is hard to predict which infants will need opioid replacement medication. To determine which babies may be experiencing withdrawal, nurses use a checklist of symptoms and assess each baby every few hours … if the baby has been identified as “at risk” due to the mother’s opioid addiction.

The Times article goes on to speak about the growing opioid addiction in America and the need for medical professionals to further educate themselves on available treatment options. We all need to remain solution-oriented, and to address this problem straight on in a constructive fashion. Thankfully, opioid addiction is a treatable illness, and opioid replacement therapy is a viable option for coping with this growing epidemic.

Methadone and buprenorphine are the best interventions we have at present for treating opioid addiction. Without them, many addicted persons would remain lost in their addiction for years on end. And babies born to addicted mothers would needlessly suffer. With time and good public education on opioid replacement, more people will find their way into a life of recovery.

Texas Methadone and Opioid Treatment Programs

texas-methadoneTexas is America’s second largest state by size and second in total population figures with just over 25 million people. Adding to Texas’ impressive statistics is the fact that Texas has five of the country’s top 20 largest cities: Houston, San Antonio, Dallas, Austin, and Fort Worth.

The U.S. database of opioid treatment clinics currently lists 81 separate methadone clinics in operation throughout Texas. Many of these methadone program clinics also offer suboxone. This number does not include the individual suboxone-approved physicians in private practice. That number is many times larger. For example, there are 132 suboxone doctors in Houston alone. These numbers offer some indication of the magnitude of America’s opioid abuse problem as well as the ever increasing availability of treatment professionals ready to help.

The diversity of opioid treatment programs is somewhat revealing too with many being private clinics, and others being state-funded or affiliated with area mental health centers or general substance abuse programs. More clinics are based out of the (VA) Veterans Administration Hospital system while some are supported through the research or medical school division of the State University system.

Opioid addiction is a subject of considerable interest to addiction researchers as well as private pharmaceutical companies. That addiction is recognized as a legitimate medical condition lends serious examination, and commitment, to discovering causes of addiction as well as potential treatments.

Texas is a state that has a very well-developed medical research network and general above-average health care delivery system. These characteristics can only help to advance opioid addiction treatment, either directly or indirectly, and perhaps lead more people into medication-assisted addiction recovery.

To browse the Methadone.US Texas page, visit: Texas Methadone Clinics