Harm Reduction

Methadone is one of the most researched medicines available, and if used correctly, is safe. Specific care should be taken to keep out of the reach of children, they seem to find the green syrup visually attractive. This is another area where methadone receives negative attention as thoughtless storage has caused infant fatalities leading to a call for stricter controls.

Methadone is available as a mixture, tablets, ampoules and suppositories. The usual strength is Mist. Methadone 1:1 (Drug Tariff Formula). The tablets are 5 mg, white

Although they are relatively rare, there is some concern over the acidity of methadone ampoules. Certain clients seem to suffer tissue damage at injection sites. Injecting oral methadone in any of its formulations should not be attempted.

Dosing levels are, of course, critical to the success of any treatment intervention.  The evidence shows that doses between 60–120mg of methadone daily are most effective at reducing heroin use and improving health and social functioning. Many services are not yet up to speed on this, but thesituation is slowly improving in most areas. Release’s survey of 2002 found that of 1689 Heroin users questioned, 728 were on methadone scripts and on top of these another 116 (16%) of people regularly increased their intake by buying extra ‘grey’ market supplies, this strongly suggests many are on inadequate doses.

Getting the Dose Right

The client is given a starting dose and this is increased until no withdrawal symptoms can be observed. This may take three days returning to the unit, or in reviews, disputes or unusually high dose cases a period as an inpatient.  Before commencing, a positive urine (for opiates) will be required and a drug history taken. If you are already on a ‘script’, and moving area, you should be able to keep your dose, but will need to be assessed.

Methadone ‘failures’ are, in reality, often less a fault of the drug itself than either the way it is delivered (inappropriate dose, inconvenient collection regimes) or an unrealistic expectation on the part of the prescriber/clinic or client. Being a long acting agonist it accumulates in the body and offers an alternative to the sedation/withdrawal cycle evident with street heroin or morphine. This is why stability is often mentioned in connection with methadone maintenance therapy.

The advantages are clear; the drug is legal and its strength/purity guaranteed. Dosing is once daily and oral formulations are clearly less risky than injecting. If dosed properly it has a blockade effect on other opiates/opioids.

However, in comparison with heroin, the drug is not euphoric. Much has been written on it’s overdose potential, particularly in combination with alcohol and anxiolytics. Withdrawal unless handled extremely competently can be protracted and difficult. Methadone, like other opioids reduces the sex drive (one potential reason for their popularity with people with non-tactile and poor attachments in childhood).