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Re: Methadone DianeD

Posted by Elizabeth on May 24, 2001, at 21:43:26

In reply to Methadone to all interested, posted by DianeD on May 24, 2001, at 13:24:17

> > > Elizabeth > You can't assume that the principles that apply to MMT will also be true of the use of methadone (or other opioid agonists) for depression.
> I don't see why not.

People who take methadone as part of treatment for an addiction are completely tolerant to the dose they are on. It doesn't elevate their mood; its only purpose is to prevent the protracted opioid withdrawal syndrome. If you're taking it for depression, you are trying to get an effect (not just to maintain homeostasis), and it's quite possible, though not certain, that you could become tolerant to this effect.

> After so many days/weeks my system is clean of heroin so I don't see where I would then differ from a straight AD patient or anyone else.

I don't recall how long you used heroin (did you mention it?). There are long-term changes (the protracted abstinence syndrome that I mentioned above) that have been documented in long-term opioid users.

If you're suffering from protracted abstinence syndrome, you'll probably know it. My guess is that you are, since you've been in MMT. Have you ever been free of all opioids for a year or more, and if so, did you still feel a continuous lingering discomfort? That's the best I can describe it. Like I said, if you've experienced it, you'll probably know.

> I am not suggesting by any stretch that Methadone is right for everyone or that it will have the same effect. But I figure if it worked miracles for me that it just might work for others.

It has -- no doubt about that. But some do find that, at the doses they require, it is sedating or concentration-impairing. And some people do abuse it -- it is possible to get high on methadone (although it doesn't cause a "rush," the high is supposed to last all day). You're right that it doesn't get people high who are in MMT and are taking it as directed.

> Water is probably the only thing one could safely say is right for everyone.

< g >

> Methadone has been around for what, 50+ years? Death and/or illness from Methadone is rare.

Yes. OTOH, its potential lethality in overdose is a disadvantage of methadone as an AD.

> Methadone gave me energy, stability, strength. Rid me of my anxiety therefore I could listen and learn and remember under stress. It put me on an equal
> footing with everyone else. Gave me a positive, I-can-do-to-it, force. And on and on......

Sounds familiar.

> I agree 100%. Elizabeth is able to put this subject in better perspective. It's too much of an emotional issue for me. It angers me that I can't get the one thing that works for me.

(Thanks :) )

I agree with you -- it's unfair that you have to take extraordinary measures just to feel normal.

re HMOs:
> I'm quite sure they wouldn't either and I find that a real shame.

My prescription plan (through an HMO) pays for my buprenorphine.

> In my mind, everything has abuse potential and can be addictive. Methadone has the least abuse potential of all the pain killers. See above.

"...of all full opioid agonists" is what I think you mean, and if so, I agree. Buprenorphine has less abuse potential, and NSAIDS like Toradol and Advil have none. To say a drug has "abuse potential" just means that you can get high on it. Even MAOIs have (*very* modest) "abuse potential."

> Can a psychiatrist prescribe methadone? Can a psychiatrist prescribe methadone for pain?

A psychiatrist can prescribe methadone, but not for maintenance treatment of opioid dependence. That has to be done through a methadone clinic. Also, if a psychiatrist (or any other sort of doctor -- even *pain* specialists!) prescribes methadone "too often," the DEA might show up questioning the necessity of it.

> I want my Methadone. I don't want to have to lie to a doctor to get it. The rules governing methadone prescribing are archaic. They are not based on currant knowledge but on old
> unfounded fears.

Fears that are still held by many people, even physicians -- the result of government propaganda. Nobody should have to lie to their doctor to get adequate treatment.





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