About Methadone

Posted on: January 27th, 2012 by
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About Methadone

Methadone hydrochloride is a mu-agonist; a synthetic opioid analgesic with multiple actions qualitatively similar to those of morphine, the most prominent of which involves the central nervous system and organs composed of smooth muscle. The principal therapeutic uses for methadone are for analgesia and for detoxification or maintenance in opioid addiction.

What Is The Most Important Information I Should Know About Methadone?

  • Methadone can cause life threatening breathing problems which can lead to death. These problems are more likely to happen when Methadone is first started or in someone who is not already taking other narcotic (opioid) pain medicines.
  • There were 5500 methadone related DEATHS in 2007.  There were 5000 methadone related DEATHS in 2010.
  • Breathing problems from Methadone may not happen right away after taking a dose. Sometimes breathing problems will happen a while after you take a dose, even after pain has returned.
  • Methadone can cause life-threatening heart beat problems that can lead to death. Most heart problems have happened in people using large doses of Methadone for pain treatment. Some heart problems have happened in people using smaller doses of Methadone for treatment of narcotic drug addiction.
  • Methadone is generally thought to have a ‘narrow window of safety’: the dose needed for effective maintenance may be very close to the dose that will kill an individual.

Safe Methadone induction and Stabilization

What Dose of Methadone is Lethal? – Click HERE for article.

Methadone may cause slowed breathing and irregular heartbeat, which may be life-threatening. If you experience any of the following symptoms, call your doctor immediately: difficulty breathing; extreme drowsiness; slow, shallow breathing; fast, slow, pounding, or irregular heartbeat; faintness; severe dizziness; or confusion.

The risk that you will experience serious or life-threatening side effects of methadone is greatest when you first start taking methadone, when you switch from another narcotic medication to methadone and when your doctor increases your dose of methadone.

 

METHADONE OVERDOSE

Methadone is a very strong and long-lasting opioid medication. Patients, and their close relatives or friends, need to be on their guard for any signs/symptoms of overdose.

Signs and Symptoms

  • Unusual Snoring while sleeping
  • Groggy, dizzy, disoriented, and sleepiness
  • Body is limp
  • Breathing is more shallow or slow than usual
  • Vomiting
  • Unable to wake up or arouse
  • Pupils are pinpoint
  • Heartbeat may be irregular and/or decreased
  • Speech may be slurred
  • Lack of oxygen: fingertips and/or lips turning blue
  • Skin may be cold and clammy
  • Muscle twitching
  • Excess Energy is often an unrecognized symptom

POINTS TO REMEMBER

  • If overdose is suspected, immediately call for emergency help without delay
  • A patient who feels or acts over-medicated should not just “sleep it off.” The person should  stay awake and seek medical treatment.
  • Signs/symptoms of over-medication or overdose may take time to develop – a methadone overdose may occur 2 or 3 days after dose.
  • Most patients will start to exhibit signs and symptoms of overdose (e.g., sleepiness, sedation) within 5 hours, although some patients may not exhibit symptoms until 10 hours or longer have passed.
  • Don’t assume emergency rooms are familiar with how to treat methadone overdoses.      Many doctors are not educated about the dangers of methadone.
  • Most overdose deaths occur within the first two weeks of starting methadone.

 

DID YOU KNOW?

  • Methadone represented less than 2% of prescribed opiates but was attributed to 1/3 of all opioid related deaths.
  • A dose that is therapeutic for one person may be lethal to another person.
  • Methadone’s unique properties make it unforgiving and sometimes lethal.
  • Most doctors are not aware of the true dangers of methadone and the number of deaths they have caused.
  • Most deaths associated with methadone have other drugs involved, therefore most deaths certificates report methadone deaths as poly pharmacy. The CDC gets their information for statistics from death certificates and if methadone is not listed (just polypharmcy) then these deaths go unreported on the methadone related death statistics. So I wonder what the TRUE number of methadone deaths are?
  • The fact that other drugs are involved make it easier to blame deaths on poly pharmacy and keeps the main culprit….methadone under the radar.
  • The drugs that are involved in poly pharmacy deaths with methadone are still be prescribed together.
  • Methadone can cost less than a dollar a dose and is 12 times cheaper than brand-name Oxycontin.
  • People think that methadone is safe because it’s been on the market for so many years, but in all actuality, there have been very few studies on this drug used to treat prescription drug abuse.
  • While pain relief from methadone might last four to eight hours, the drug can linger in the body for days, potentially building to toxic levels.
  • The pharmacokinetic and pharmacodynamic properties of methadone are complex and incompletely documented.

  • Methadone has little cross-tolerance with other opiates; therefore, even patients with a high degree of opioid tolerance may be at risk for overdose when switched to methadone.

  • Inexperienced clinicians should consult with an expert before initiating methadone; even in an opioid tolerant patient.

  • Being overweight puts you at a higher risk for sleep apnea. If you have sleep apnea and take methadone it increases your risks of respiratory depression and death…..even with therapeutic levels.

Click HERE For More Information About Methadone

Increases in Poisoning and Methadone-Related Deaths: United States, 1999-2005   NCSI Methadone Deaths Statistics

 

CDC Methadone Deaths Statistics

42 CFR 8.12 – Click HERE Federal opioid treatment standards.

DAWN-Drug Abuse Warning Network- (Statistics)-

Applying Legal Risk Management To The Clinical Use of Methadone -Click Here

Preventing Overdose when using Methadone  (FDA)- Click Here

Avoiding  Methadone Overdose Deaths  Click Here 

Methadone Can Kill Even In Therapeutic Levels-  Click Here

06/23/2011 FDA Issues Health Advisory For Methadone- Click Here

SAMHSA Emerging Issues in the Use of Methadone  Spring 2009 Substance abuse Treatment Advisory

SAMHSA OTP Clinical Staff Training Curriculum June 2009

Dear Colleague Letter September 2007 from SAMHSA

Dear Colleague Letter November 2008 from SAMHSA

Propoxyphene (Darvon, Darvocet) was second to methadone in deaths. Propoxyphene was withdrawn from the market at the request of the FDA in 2010 but Methadone remains available. Why?

  • November 19, 2010 – Propoxyphene (Darvon, Darvocet): Xanodyne Pharmaceuticals has agreed to withdraw propoxyphene, an opioid pain reliever used to treat mild to moderate pain, from the U.S. market at the request of the FDA, due to new data showing that the drug can cause serious toxicity to the heart, even when used at therapeutic doses. FDA concluded that the safety risks of propoxyphene outweigh its benefits for pain relief at recommended doses. FDA requested that the generic manufacturers of propoxyphene-containing products remove their products as well. Health-care professionals should stop prescribing and dispensing propoxyphene-containing products to patients, contact patients currently taking propoxyphene-containing products, inform patients of the risks associated with propoxyphene, and discuss alternative pain management strategies.

 

 

 

2 Responses to About Methadone

  1. Pingback: » Thinking About Cissy Houston, and All the Other Mothers Who Will Get a Terrible Call Today » mamapundit

  2. tonya1968 had this to say about that:

    Methadone

    Methadone Side Effects: Brand names are Methadose and Dolophine. Dosage forms available are 5 and 10 mg tablets and various
    concentration solutions. Also available in a 40 mg tablet restricted for use in authorized opioid detox facilities. Methadone has become very well known for its use in so called, “methadone clinics” where
    opioid addicts, primarily heroin addicts receive daily methadone doses to prevent opioid withdrawal and to facilitate abstinence from heroin use. Methadone is also used as an opioid analgesic. Its primary
    benefits are relatively low cost and fairly long half-life. Methadone side effects are largely class side effects and mimic oxycodone side effects and those of other opioid medications.

    Black Box Warnings: Methadone has incomplete cross tolerance, and the fact that an individual has high tolerance to another opioid does not assure tolerance to methadone, and iatrogenic overdose has occurred by initiation of high dose methadone treatment on the assumption of this
    opioid tolerance. Respiratory depression and death can occur with methadone used, and is especially a concern during dose titration and conversion from other opioids. It is key to understand that the respiratory depression methadone side effects occur later and last longer that the desired analgesic benefits of methadone. QT
    prolongation and torsade de pointes has occurred with methadone, and its use should be considered only when the potential benefits outweigh these risks. Methadone use for opioid withdrawal therapy is only
    permitted by authorized methadone clinics with specific state authority.

    Common Methadone side effects: The common methadone side effects are similar to the common side effects of most opioid drugs. These include constipation, nausea and vomiting, sweating, lightheadedness,
    dizziness and confusion. Sedation is very common with methadone use, especially in non-opioid tolerant patients.

    Serious Methadone Side Effects: First see the Black Box warnings above. Respiratory arrest, cardiac arrest, death, prolongued QT
    prolongation, torsades de pointes, ventricular tachycardia,ventricular fibrillation, severe bradycardia, cardiomyopathy and death are all possible with methadone, and are serious cardiorespiratory methadone side effects. Hypotension, seizures, syncope, pulmonary
    edema and respiratory depression are also seen. The most common of the serious methadone side effects is probably abuse and diversion of the medication. Prescription opioid abuse is epidemic in the U. S. and
    abroad and is a leading cause of drug overdose deaths.

    Cautions and Drug Interactions: The list of cautions for methadone use is very long, and readers should refer to the manufacturer’s
    prescriber guidelines for a complete list. The more common conditions include significant cardiac or respiratory disease, especially cardiac conduction abnormalities. Use in patients at risk for urinary
    retention is cautioned. Use with thioridazine is contraindicated, and
    use with other phenothiazines may increase risk of severe constipation and even gastrointestinal obstruction. Use with quinidine can greatly increase cardiac arrhythmia risks. Use with venlafaxine or other tricyclic or tetracyclic antidepressants may combine to cause serious
    QT prolongation. Use with any medications that can affect cardiac conduction is cautioned. Use with other opioids may lead to additive effects and increase the risk of methadone side effects.

    Pregnancy and Lactation: Pregnancy Category C and use in lactation is probably safe. Use of opioids in late pregnancy can lead to opioid habituation in the fetus, and to serious opioid withdrawal after delivery for the neonate.

    Unusual Methadone Side Effects: The cardiac rhythm side effects of methadone are relatively unique to this particular opioid, and warrant particular note.

    Special Considerations: Abuse and diversion of opioids including methadone are serious problems. Special care needs to be taken to
    attempt to avoid these concerns. Most physicians insist on a pain medication agreement when opioids are prescribed for long term pain management. In addition drug screening is commonly done randomly in
    physician offices to assure the patient is using the drug themselves and not to look for concurrent other opioid or illegal drug use. Even with diligent attempts to prevent abuse and diversion these issues remain rampant in many U.S. communities.

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