Heroin addiction

[Jeff]

So is there any particular alternative for methadone ? Why is methadone preferred considering the many downsides to its use in treating addiction ?

The measurement of success of a DAT is the number of people it treats.

The idea isn't necessarily to make patients drug free, or non opioid dependant - but to enable them to take back control of their lives.
If we think of addiction as a chronic condition rather than an acute curable condition - then long term methadone maintenance makes sense.

If it is or not is under debate at the moment.

See some of the newsletters here

SMMGP - Welcome

as well as the NTA treatment guidelines.

Methadone isn't the only treatment used.

Alternatives - add ons.

Heroin - but political opposition - and phased out many years ago - possibly due to a misinterpretation of a study showing a high dose of methadone to be superior to a low dose of heroin.

(Heroin is is now being tried again in a few pilot studies)

Subutex - useful, but a pain to supervise - generic version due out very soon

Suboxone - little evidence of it being any better than subutex - but subutex patent about to expire.

Naltroxone implants - not licensed. Tend to be the preserve of private clinics.

CBT - often used - though we don't see it on a script

Motivational therapy - again not seen on scripts

Lofexidine - used to lessen withdrawal symptoms when stopping

Zopiclone to aid sleep

Anti-depressants.

Lavender oil, hot baths, thistle milk - the list could be endless.

Jeff

[funkeeduck]

I worked in a store with lots of methadone patients while on pre-reg a few years back, and one of the regulars was having much more difficulty getting off the zopiclone that was part of the initial 'rattle pack' than the heroin...
Still lesser of two evils etc etc!

[krishug]

the last 2 drug centres i went to couldnt wait to pump methodone into me,its cheap and easy.drug centres are over worked and are looking for a easy way and quick fix,it aint gonna work.methodone is NOT the answer.its ten times worse to get of than smack,it having such a long half life.put it this way,i went back onto heroin to get of meth and i know a lot of people who have done the same. getting of heroin takes time that unfortunatley most local drug centres do not have

[Sir_Dispensalot]

many of us agree that methadone is not the answer to everything. As someone referred to in a much earlier thread (i think? or did i read it on a blog? Damn my memory! ) there was a clinic in the wirral which successfully used diamorphine for addicts.

After a few years addicts would lose interest in using - much of the activities in getting hold of money for heroin (eg crime) were no longer needed as they were getting the diamorphine safely and legally - letting them run a normal life again - they could then go on dose reduction and detox regimens.
I believe pressure in the 80's from the usa (the 'war' on drugs) made clinics like the wirral one 'unfashionable' for the powers that be and they were pressurised into switching to methadone instead.

would some drug treatment centres now offer dexedrine to help detoxing from meth? Not that i even have the first clue about detoxing from it but as they are both amphetamines (admittedly dexedrine has a much shorter half life) would it help as substitution therapy?

[Jeff]

the last 2 drug centres i went to couldnt wait to pump methodone into me,its cheap and easy.drug centres are over worked and are looking for a easy way and quick fix,it aint gonna work.methodone is NOT the answer.its ten times worse to get of than smack,it having such a long half life.put it this way,i went back onto heroin to get of meth and i know a lot of people who have done the same. getting of heroin takes time that unfortunatley most local drug centres do not have

Krishug,
Don't they have a shared care system in Scotland - where you can be treated by a GP and key worker with more time?

Jeff

[Tony Schofield]

Heroin, despite the outcomes of the RIOTT trial is unlikely to be used as a therapeutic alternative to methadone. It will be used for really resistant cases to stop drug seeking behaviour (ie crime reduction!) but as it's half life is so short and there are dangers associated with self injecting it will never be used as a drug that is intended to enable people to rebuild their lives.

Methadone and buprenorphine have a bad press but at the moment there are precious few alternatives. Lots of theoretical alternatives. The orange guidelines recommend lofexidine as a viable option but I don't know anyone who has successfully used it. I have used it a few times to transfer patients from methadone to buprenorphine but even then it took incredible motivation from the patient. I think lofexidine is as much use as a chocolate fireguard.

Using naltrexone requires the patient to be drug free first so it isn't an alternative to methadone etc but can be given daily orally supervised by a family member to avoid the expense of implants. It is very useful once successfully detoxed.

Jeff, in his excellent contribution, referred to CBT etc as interventions that don't get prescribed. There are many psychosocial interventions that are used in tandem, not instead of substitute medication. There is no point trying to detox someone who uses drugs/alcohol to blot out memories of child abuse or for someone who is sleeping rough. These things and many others must be addressed and stabilising on substitute medication is a good start that facilitates the process.

I accept that, just as not everyone responds to morphine as an analgesic, not everyone responds to substitute medication but there is enough evidence to support it's use to try patients on it initially.

Dexedrine is an amphetamine and methadone is an opiate. I can't imagine dexedrine having a place in treating opiate addiction although I have known psychiatrists to prescribe it for stimulant users! It isn't recognised as a treatment option.

[Tony Schofield]

it is preferred because the NHS budget is limited! Methadone is a way cheaper than suboxone. suboxone is a better alternative as it does not cause dental decay/easier to take, contains subutex+ naloxone(opoidantagonists) which means if addicts inject any drug, they would not get the euphoric effect of the drug due to blocking opioid receptors by naloxone.

This is not the case. I will answer it later as I need to work to pay for my leisure time in which I can mouth off on this forum!!

See you later

[the old merlin]

Anyone else read yesterdays Observer? Quite a good, sympathetic article there.

[krishug]

hi jeff, i have been to my doc 3 times in the last 6 months begging them to prescribe me dihydrocodeinne to get myself clean (after 5 years have got down to a bag a day) they werent interested.i was told to sign up with drug agency in area (7 week waiting list just to be assessed).i needed help then an there i was ready to get clean.i was told by doc it was surgery policy not to prescribe to addicts.i was even willing to go to surgery every day and swallow pills infront of them but to no avail.when you are ready to get clean being told you have another seven weeks,if not more before you can get help can depress you so much that its this time that most people give up the good intentions and revert back to bad habits.there is still such a stigma about heroin addiction

[Tony Schofield]

it is preferred because the NHS budget is limited! Methadone is a way cheaper than suboxone. suboxone is a better alternative as it does not cause dental decay/easier to take, contains subutex+ naloxone(opoidantagonists) which means if addicts inject any drug, they would not get the euphoric effect of the drug due to blocking opioid receptors by naloxone.

Suboxone is a dreadful combination and a cynical attempt to extend patent life on buprenorphine. Naltrexone is not absorbed if suboxone is "snorted" (which is the principal method of abuse) but if a patient injects it, it will cause a precipitated withdrawal which is absolutely horrendous. Not using it has zip to do with cost.

All opiates, including buprenorphine cause a reduction in saliva production which is the principal mechanism involved in poor dental health. (not sugar in the formulation of methadone!!)

Buprenorphine is an alternative to methadone but is subtly different. It does not have much in the way of sedative effect and patients report feeling "sharper" than when on methadone. Some patients prefer feeling sharper and some prefer feeling dozy!! Buprenorphine is also longer acting so missing a dose is less likely to result in withdrawal symptoms. Buprenorphine adheres to the receptor more strongly and can displace other opiates (precipitated withdrawal) but of course, when patients attempt to use other opiates after first taking buprenorphine, they get no effect so staying drug free is easier.

Buprenorphine is the drug of choice in France and is now off patent so price differences will narrow soon.