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Common questions about methadone
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GPs are in the best position to judge the benefits patients are getting from methadone and also to recognise potential problems which can arise. Where patients state that they are on any medication a few relevant questions are appropriate. The patient's dose and prescriber should be noted. One may inquire about the level of illicit drug use currently, and whether this is affecting the patient adversely. They should be asked if the methadone is helping them, and if they are attending an appropriate dispensary near home or work.

Many patients will be pleased for the opportunity to discuss their treatment with their GP, even though they may have presented with an apparently unrelated problem. A number of GPs are now prescribing methadone themselves, although is still commonly administered from specialist clinics, both public and private.

Patients often ask difficult questions about addiction which we are unable to answer. However, there is a great deal of research evidence in the use of opioids which allows us to respond to a number of common concerns:

Does methadone cause deterioration of the teeth and the bones?

There is certainly no affect on the skeleton from methadone use. Many patients have poor dental hygiene while using street drugs, and bad caries may be first recognised when starting methadone. There is a tendency to dry mouth on high doses of methadone which usually comes in the form of a sweet syrup. Although both of these can theoretically lead to dental caries, many patients on methadone have perfectly normal teeth. Calcium metabolism appears to be normal.

Can it cause overdose?

Overdoses from methadone can occur in the first week of treatment if excessive doses are given. This should be a rare event by using an initial dose of 30mg and by close daily supervision in early treatment. Those new to treatment are inherently unstable. They come from a life of uncontrolled use of various street drugs. Methadone treatment reduces the incidence of fatal overdose by about 75%.

Is it just a free fix?

When on regular doses of methadone, patients describe having no euphoria from the drug. Some say it gives them energy, others that it allows them to relax. In the majority of cases, it permits previously unstable heroin addicts to lead normal lives in virtually every respect. It is certainly not 'free'. Apart from the time and effort in attending for dosing every day (including Sundays in some instances), the patient usually pays a contribution towards their dose, even in public clinics. In private clinics, patients pay around $40 per week for methadone dispensing in New South Wales.

Do patients on maintenance get fat and inactive?

All patients eventually lose weight on street heroin. Hence it is understandable that a number gain weight when on methadone treatment. With the average age of methadone patients now in the mid-thirties, some are bound to get 'middle age spread'. Some eat unbalanced diets and get insufficient exercise. All of these factors are well within the province of the GP to address.

Can they work while on methadone?

There are no restrictions on employment in patients on regular methadone. These patients currently work in virtually every field, including labouring, clerical, domestic and even in medical practices!

Do they ever give up taking methadone?

Yes. Up to 10% quit their legal narcotic habit each year. They are usually in their early thirties and have often used drugs for over ten years. More than 33,000 patients have been on methadone in the past seven years in NSW while only 11,000 are currently in treatment.

Do patients continue to use other drugs?

Approximately half appear to cease all illicit drug use, while the remainder reduce their harmful drug use by more than 90%. By means as yet unexplained, this also applies to alcohol and other non-opioid drugs such as cocaine, but not to tobacco. The lack of urgency and the availability of clean injecting equipment make the risks from residual drug use very much lower.

Do they inject the methadone?

After years of injecting street drugs, it is not surprising that many patients inject their Sunday take-away methadone doses on a number of occasions in early treatment. Injected methadone syrup causes intense pain and it is excreted faster than oral absorption. Most methadone patients cease the practice of injecting spontaneously when they are on sufficient oral doses. While it may seem contradictory, most addicts state that they 'hate needles'. One only has to attempt to take a blood test to see the performance!

Most of the news about methadone is good news. GPs should help demolish the myths, and ensure that patients are getting access to this cheap, simple and effective treatment modality.

Dr Andrew Byrne is a Sydney GP with a special interest in addiction treatment. He is a member of the Australian Professional Society on Alcohol and other Drugs (APSAD) and is the author of "Methadone in the Treatment of Narcotic Addiction".


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