Heroin addiction

[Nik]

Saw something on BBC news where a woman was saying methadone is more addictive than heroin and that it's easier to get off heroin rather than methadone. Could someone explain that ??
I thought the point of methadone was to wean addicts off heroin, not to change their addiction to another opioid. Is there an alternative to methadone which has a lower potential for abuse/addiction ?

[Shwampa]

This extract from: Methadone - Factsheet - Drug Facts might be helpful...

methadone patients do not experience the extreme highs and lows that result from the waxing and waning of heroin in blood levels. Ultimately, the patient remains physically dependent on the opioid, but is freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts.

Withdrawal from methadone is much slower than that from heroin. As a result, it is possible to maintain an addict on methadone without harsh side effects. Many MMT patients require continuous treatment, sometimes over a period of years.

[JonF]

The discussion on BBC Breakfast was promoting the programm on Channel 4 tonight at 9pm, called 'Mum, Heroin & Me' ,which does looks quite interesting!

The mother was calling for diamorphine to be prescribed instead of methadone, which was when she made the remark mentioned above.

[Nik]

But is there a particular reason as to why methadone is more addictive than heroin ? (so the lady said). Is there some sort of scale which rates drugs on their potential for addiction ?

[JonF]

As said before the 'high' you get from methadone is nowhere near that you get from heroin, so users will crave heroin more.

Physical withdrawal symptoms will last much longer with methadone so that may be why it is perceived as more addictive??

Never heard of an 'addiction scale' as such, but i stand to be corrected!!

[Jen the 3rd]

I think its something to do with desensitisation of seratonergic pathways rather than anything to do with potency at the opioid receptor

Just found this really intersting article
http://www.drugabuse.gov/PDF/perspec...s-Neurobio.pdf

[Nik]

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

[funkeeduck]

Because it's generally considered much safer.

Much of the danger of opioid abuse (misuse?!) is due to the risks associated with injecting: (blood borne infections/abcesses/gangrene/veins 'shutting down'); or the risks of overdose from an uncut (ie purer) batch. Plus can be a risky lifestyle generally (though that is a generalisation as I've known many addicts who get jobs/manage to hold them down/live a normal life -whatever that is! -they just come in to the pharmacy regularly for medication for a chronic condition like most of our other patients...).

One way of looking at it anyway, not that I have rose tinted glasses on. It's great when a pt does manage to gradually taper dose down to nought, but not that common. Many addicts seem to use the methadone as a 'breakthrough' remedy for their continuing heroin habit (much like the Oramorph for the MST user!).
BUT it's bloody hard to conquer addictions for some people; weak? maybe, but maybe has more to do to their genetic propensity for addiction? (Just throwing that out there).

While heroin has a short half life, and leaves the body in, I think 5 days or so depending on blood conc. (please correct me, this is from memory so may be wrong), it takes much much longer to break the psychological addiction. Methadone gives people the chance/time to sort through issues/whatever lead to addiction in first place while dose is gradually titrated down (in theory at least, though lack of detox/rehab/ongoing counselling in UK means methadone often ends up being sole therapy which is not a solution IMHO...)

Do we have anyone working with DAT services on the forum btw?

[Rafael]

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

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.

[funkeeduck]

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.

You're probably right Raoul lol ; most things boil down to money after all it's not a limitless pot...
money so tightly controlled in my hosp that at one time we had to supply our own biros and only had one computer (no printer) for almost 100 staff within pharm dept for non-dispensing use!