Addictions

Substance abuse involves the use of drugs, alcohol or other chemicals in a way that interferes with normal healthy functioning. Substance abuse cuts across all lines of race, culture, educational and socioeconomic status. Substance abuse is an enormous public health problem, with far-ranging effects. In addition to the health problems substance abuse can cuase, it is also considered to be an important factor in a wide variety of social problems, affecting rates of crime, domestic violence, sexually transmitted diseases (including HIV/AIDS), unemployment, homelessness, teen pregnancy, and failure in school. One study estimated that 20% of the total yearly cost of health care in the United States is spent on the effects of drug and alcohol abuse.

A wide range of substances can be abused. The most common classes include:

• Opioids (including such prescription pain killers as morphine and demerol, as well as illegal substances such as heroin)
• Benzodiazapines (including prescription drugs used for treating anxiety, such as Valium)
• Sedatives or “downers” (including prescription barbiturate drugs commonly referred to as tranquilizers)
• Stimulants or “speed” (including prescription amphetamine drugs used as weight loss drugs and in the treatment of attention deficit disorder)
• Cannabinoid drugs obtained from the hemp plant (including marijuana)
• Cocaine-based drugs
• Hallucinogenic or “psychedelic” drugs (including LSD, PCP or angel dust)
• Inhalants (including anesthetics as well as paint thinner, gas or glue)
• Alcohol

A number of important terms must be defined in order to have a complete discussion of substance abuse. Drug tolerance refers to a person’s body becoming accustomed to the symptoms produced by a specific quantity of a substance. When a person first begins taking a substance, he/she will note various mental or physical reactions brought on by the drug (some of which are the very changes in consciousness that the individual is seeking through substance use). Over time, the same dosage of the substance will produce fewer of the desired feelings. In order to continue to feel the desired effect of the substance, progressively higher drug doses must be taken. Most substances of abuse tend to either slow or a speed up basic body functions such as breathing, heart rate, blood pressure. When a drug is stopped abruptly, the person’s body will respond by over-reacting. Functions slowed by the abused substance will be suddenly speeded up, while previously stimulated functions will be suddenly slowed. This results in very unpleasant symptoms, known as withdrawal symptoms.

Scientists don’t think there is just one single cause of substance abuse, although it does seem as if certain people have a genetic tendency to develop addictive behaviors. However, other social factors are most likely involved as well, including social problems and peer pressure. Other mental disorders can increase the chance that a person will become addicted.

The symptoms of substance abuse may be related to both its social effects and its physical effects. The social effects of substance abuse may include dropping out of school or losing a series of jobs, engaging in fighting and violence in relationships, and legal problems (ranging from driving under the influence to the commission of crimes designed to obtain the money needed to support an expensive drug habit).

Physical effects of substance abuse are related to the specific drug being abused:

• Opioid drug users may move slowly, lose weight, have mood swings, and have small pupils.
• Benzodiazapine and barbiturate users may appear sleepy and slowed, with slurred speech, small pupils, and occasional confusion.
• Amphetamine users may have excessively high energy, sleep problems, weight loss, rapid pulse, high blood pressure, occasional psychotic behavior and enlarged pupils.
• Marijuana users may be sluggish and slow to react, exhibiting mood swings and red eyes with dilated pupils.
• Cocaine users may have wide variations in their energy level, severe mood disturbances, and a constantly runny nose. “Crack” cocaine may cause aggressive or violent behavior.
• Hallucinogenic drug users may display bizarre behavior due to hallucinations and dilated pupils. LSD can cause flashbacks.

Other symptoms may depend on the type of substance being abused. For example, heroin, other opioid drugs, and certain forms of cocaine may be injected using a needle and a hypodermic syringe. A person abusing an injectable substance may have needle marks on arms or legs, with redness and swelling of the vein in which the substance was injected. Furthermore, poor judgment brought on by substance use can result in the injections being made under horrifyingly dirty conditions. These unsanitary conditions and the use of shared needles can cause infections of the injection sites, major infections of the heart, as well as infection with HIV, certain forms of hepatitis (a liver infection), and tuberculosis.

Cocaine is often taken as a powdery substance which is “snorted” through the nose. This can result in frequent nose bleeds, sores in the nose, and even an eating away of the nasal septum (the structure which separates the two nostrils). Other forms of cocaine include smokable or injectable forms of cocaine such as free base and crack cocaine.

Overdosing on a substance is a frequent complication of substance abuse. Drug overdose can be purposeful (with suicide as a goal), or due to carelessness, the unpredictable strength of substances purchased from street dealers, mixing of more than one type of substance or of a substance and alcohol, or as a result of the ever-increasing doses which a person must take of those substances to which he or she has become tolerant. Substance overdose can be a life-threatening emergency. Substances with depressive effects may dangerously slow the breathing and heart rate, drop the body temperature, and result in a general unresponsiveness. Stimulants may dangerously boost the heart rate and blood pressure, increase body temperature, and cause bizarre behavior. With cocaine, there is also a risk of stroke.

Still other symptoms may be caused by unknown substances mixed with street drugs in order to stretch a batch. A health care worker faced with a patient suffering extreme symptoms will have no idea what other substance that person may have unwittingly put into his or her body. Thorough drug screening can help with this problem.

The most difficult aspect of diagnosis involves overcoming the patient’s refusal to acknowledge the problem. This may cause the person to completely deny the substance use or underestimate the degree of the problem and its effects.

One of the simplest and most commonly used screening tools used by doctors to diagnose substance abuse is called the CAGE questionnaire:

• Have you ever tried to Cut down on your substance use?
• Have you ever been Annoyed by people trying to talk to you about your substance use?
• Do you ever feel Guilty about your substance use?
• Do you ever need an Eye opener (use of the substance first thing in the morning) in order to start your day?

Other, longer lists of questions exist in order to try to determine the severity and effects of a person’s substance abuse. A family history is another helpful tool in diagnosing substance abuse.

A physical exam may reveal signs of substance abuse in the form of needle marks, tracks, damage to the inside of the nostrils from snorting drugs, or unusually large or small pupils. Substance use also can be detected by examining the blood, urine, or hair in a laboratory. This drug testing is limited by sensitivity, specificity and the time elapsed since the person last used the drug.

Treatment has several goals, which include helping a person deal with the uncomfortable and possibly life-threatening symptoms associated with withdrawal from an addictive substance, helping a person deal with the social effects which substance abuse has had on his or her life, and efforts to prevent relapse. Individual or group psychotherapy is sometimes helpful.

Detoxification may take from several days to many weeks, and can either focus on “cold turkey” (complete and immediate ending of all substance use) or by slowly decreasing the dose which a person is taking to minimize the side effects of withdrawal. Some substances absolutely must be tapered, because “cold turkey” methods of detoxification are potentially deadly. Alternatively, a variety of medications may be used to combat the unpleasant and threatening physical symptoms of withdrawal. A substance (such as methadone in the case of heroine addiction) may be substituted for the original substance of abuse, with gradual tapering of this substituted drug. In practice, many patients may be maintained on methadone and lead a reasonably normal life style. Because of the rebound effects of wildly fluctuating blood pressure, body temperature, heart and breathing rates, as well as the potential for bizarre behavior and hallucinations, a person undergoing withdrawal must be carefully monitored.

Alternative treatments for substance abuse include treatments specifically designed to aid a person who is suffering from the effects of withdrawal and the toxicities of the abused substance, as well as treatments which are intended to decrease a person’s stress level, thus hopefully decreasing the likelihood that he or she will relapse.

Treatments thought to improve a person’s ability to stop substance use include acupuncture and hypnotherapy. Ridding the body of toxins is believed to be aided by hydrotherapy (bathing regularly in water containing baking soda, sea salt or Epsom salts). Herbs also may help, including milk thistle, burdock, and licorice. Anxiety brought on by substance withdrawal is thought to be lessened by using other herbs, which include valerian, vervain, skullcap and kava.

Other treatments aimed at reducing the stress during detox include biofeedback, guided imagery, and various meditations such as (yoga and tai chi).

After a person has successfully withdrawn from substance use, the even more difficult task of recovery begins. Recovery refers to the life-long efforts of a person to avoid returning to substance use. The craving can be so strong, even years and years after initial withdrawal has been accomplished, that a previously addicted person is virtually forever in danger of slipping back into substance use. Triggers for such a relapse include any number of life stresses such as problems on the job or in the marriage, loss of a relationship, death of a loved one, financial stresses. While some people remain in counseling indefinitely, others find that various support groups or 12-Step Programs such as Narcotics Anonymous and Alcoholic Anonymous are the most helpful way of monitoring the recovery process and avoiding relapse.

Another important aspect of treatment is the involvement of close family members. Because substance abuse has severe effects on the functioning of the family, and because research shows that family members can accidentally develop behaviors which inadvertently serve to support a person’s substance habit, most good treatment will involve all family members.

Prevention is best aimed at teenagers, who are at very high risk for substance experimentation. Data compiled in 1987 showed that 25% of high school seniors had used an illegal substance (other than marijuana) in the preceding year. Education regarding the risks and consequences of substance use, as well as teaching methods of resisting peer pressure, are both important components of a prevention program. Furthermore, it is important to identify children at higher risk for substance abuse including victims of physical or sexual abuse, children of parents who have a history of substance abuse, especially alcohol, and children with school failure and/or attention deficit disorder. These children will require a more intensive prevention program.

What Kind of Drug Is It?

Methadone is a synthetic drug, meaning that it is made in a laboratory from chemicals. It behaves like an opiate drug in the brain. Opiates are drugs, derived from the opium poppy plant, that tend to decrease restlessness, bring on sleep, and relieve pain. The natural opiates—such as codeine, heroin, morphine, and opium—are known for their painkilling properties, but also for their addictive nature. Such substances encourage abuse because they induce euphoria, or feelings of extreme happiness or enhanced well-being.

Methadone works differently. Its slow onset and long-lasting impact lessen the chances that the user will get high from taking it. At the same time, it blocks the receptors in the brain that are stimulated by opiates, so those using methadone do not get high even if they take heroin or morphine too. (Entries on codeine, heroin, morphine, and opium are also available in this encyclopedia.) Methadone is best known as the medication prescribed to help opiate addicts end the destructive behavior associated with drug addiction.

People with opiate addictions often use drugs such as heroin and morphine more to avoid withdrawal symptoms than to achieve a high. Withdrawal is the process of gradually cutting back on the amount of a substance being taken until use can be discontinued entirely. Indeed, withdrawal from opiates—even prescription drugs such as OxyContin and Vicodin—can be difficult and challenging. Methadone eases all symptoms of opiate withdrawal, including anxiety and insomnia, a sleep disorder. Those who receive methadone treatment from trained, licensed doctors—and who follow the treatment schedule carefully—face little danger of overdose, infectious disease, or organ failure. When used properly, it is a medicine that helps users end their addictions and get on with their lives.

When Methadone Is Abused

When used illegally or improperly, though, methadone is one of the most dangerous drugs on the street. According to the Drug Abuse Warning Network (DAWN), emergency room visits related to methadone overdose tripled between 1997 and 2001. Since then, methadone-related deaths and hospitalizations have continued to rise. Two factors have contributed to the spike in methadone-related emergencies. First, doctors are prescribing the drug more often as a painkiller. In that form, methadone is dispensed by pharmacies as pills and taken into homes. Sometimes it is either used improperly by the patient or sold on the street or to drug dealers.

Methadone is dispensed in sugary liquid. AP/Wide World Photos.
The second possibility for methadone ER visits involves multi-drug use. Numerous drug deaths have occurred when people combine methadone with other painkillers, opiates, cocaine, tranquilizers, or alcohol. (Separate entries on these drugs are available in this encyclopedia.) The presence of other substances increases the likelihood that methadone will cause COMA, breathing difficulties, and even death.

Since the beginning of the twenty-first century, drug enforcement agents have seized greater quantities of methadone that have been diverted or put into illegal use. Concern over this diversion has led to high-level government meetings and studies on how to keep this powerful pain reliever with many useful qualities out of the wrong hands.

Overview

Naturally occurring opiates are derived from the sticky sap of the opium poppy. Opium products have been used for many thousands of years, both for their pain-controlling properties and for the feelings of intense happiness and well-being they provide. From the ancient Egyptians to the celebrated British poets of the nineteenth century, opiate users have known of the plant’s effects—and of its drawbacks. The latter includes addiction, TOLERANCE, and death by overdose. In his book Illegal Drugs: A Complete Guide to Their History, Chemistry, Use and Abuse, Paul M. Gahlinger noted that the famous ancient Roman general Hannibal kept a fatal dose of opium in a ring on his finger and actually used it to kill himself in 183 BCE.

Beginning in the nineteenth century, scientists worked with opium products, trying to isolate the painkilling qualities from the habit-forming qualities. They met with little success. In fact, all natural and synthetic opiate and OPIOID products on the market in the twenty-first century are still known to be addictive. Methadone is no exception. Users develop a dependence, or a physical need for the drug in order to ward off withdrawal symptoms. And they suffer withdrawal symptoms if they do not follow a careful program of specific directions for use.

Usage Grows in the 1940s and 1950s

Methadone was developed in Nazi Germany in 1939 because of wartime shortages of morphine. The German scientists called it Amidon and used it as a painkiller. At the end of World War II (1939–1945), the American pharmaceutical company Eli Lilly began clinical trials of the substance. Lilly called it “methadone.” The drug has also been marketed as Dolophine, leading to nicknames such as “dolls” and “dollies.” Methadone was found to be an effective, long-lasting painkiller and cough suppressant.

According to a report issued by the Substance Abuse and Mental Health Services Administration (SAMHSA), in 1950 researchers began using methadone to treat the many symptoms of withdrawal associated with heroin dependence. Heroin addicts typically need two to three “FIXES” of the drug each day to ward off the wide range of symptoms that occur when the brain craves opiates. The desperate search to buy the illegal drug leads some addicts into criminal behavior, ranging from theft and burglary to prostitution and drug-dealing. People with opiate addictions feel trapped by their dependency. The desperation is sometimes described as a “monkey on the back.”

Treating Addictions with Methadone

In 1964 a group of researchers discovered that heroin addicts could avoid the drug and live more normal lives if they received a daily dose of methadone. The methadone eased withdrawal symptoms and lessened cravings for heroin. Better yet, people taking methadone could not get high on heroin because methadone binds to the same brain receptors that heroin does.

Some problems remained. Methadone is itself an opioid, so it causes dependency too. Its side effects are identical to the natural opiates and include constipation, nausea, drowsiness, dry mouth, and the possibility of breathing problems. Researchers concluded that some people trying to wean themselves off heroin or other opiates by following a methadone treatment plan might have to take methadone for a very long time. The treatment was not foolproof, either. Many addicts returned to drug abuse, sometimes turning to cocaine to get high. Because methadone and cocaine work differently in the brain, methadone treatment does not help cocaine addicts stop using cocaine, nor does it block the effects of cocaine. (An entry on cocaine is available in this encyclopedia.)

Despite these drawbacks, methadone has remained the drug of choice for treatment of opiate dependency since the 1960s. It is not a “perfect cure,” but it does provide a way for motivated people to straighten out their lives, hold jobs, and otherwise live more normally. The SAMHSA report stated: “Methadone is a medication valued for its effectiveness in reducing the mortality associated with opioid addiction as well as the various medical and behavioral morbidities associated with addictive disorders.” In other words, even the U.S. government believes that methadone, when used properly, saves lives and cuts down on crime.

Methadone Clinics Open

In the late 1960s, the U.S. government began sponsoring methadone clinics in many parts of the country, especially the nation’s largest cities. At methadone clinics, people line up to take their daily dose of the drug under the watchful eye of a nurse or other health care worker, and then leave. After a period of months, a patient who has followed the treatment program carefully might be allowed to carry one or two doses home. These doses are called “CARRIES.” Most patients use their “carries” as carefully as the doses given to them at the clinics, but some turn the “carries” over to illegal use. In addition, the drug is being prescribed more by doctors. Some patients sell their medications to others. In these ways, some of the drug makes its way on to the street illegally.

In some of the nation’s largest cities, addicts go to clinics daily to receive their dose of methadone. They take it under the watchful eye of a nurse or other health care worker and then leave. AP/Wide World Photos.

What Is It Made Of?

Methadone is not derived from the opium poppy plant. It is synthetic, or made from chemicals in a laboratory. Pure methadone is an odorless white powder that dissolves easily in water, juice, or alcohol. Hospitals also have solutions of methadone that can be delivered by injection.

Methadone takes effect slowly and stays in the brain for a period of twenty-four to thirty-six hours. During that time the user—assuming he or she uses no other drugs—will function normally, perhaps feeling a bit sluggish or groggy. Sleep cycles will be normal, but appetite may be lessened. Constipation is a troublesome side effect.

How Is It Taken?

In most clinics, methadone is dispensed in sugary liquids and swallowed by the patient. The drug can also be taken as a biscuit (”diskette”) or in pill form. Very rarely, in a hospital or clinical setting, the drug is injected into a muscle. Methadone is not commonly used in post-surgical settings because other drugs such as morphine and fentanyl work faster to relieve pain. (Separate entries on morphine and fentanyl are available in this encyclopedia.) Rather, methadone is used for long-lasting pain, such as that resulting from cancer, back injuries, or severe arthritis.

In 2000 the federal government relaxed rules on prescribing methadone in pill form. Doctors who complete an eight-hour training seminar become certified to dispense methadone pills that vary in strength from 20 to 120 milligrams.

The first week of methadone use for chronic pain can be difficult and dangerous. Doctors need to monitor patients carefully because the drug acts slowly on the pain and accumulates in the body. Patients must be watched for tolerance levels so that they are not given deadly doses. They must also be cautioned that methadone is not a “quick fix” for pain, and that taking an extra dose will not make the drug work any faster. Typically, patients will see little or no pain relief from methadone for the first twenty-four to forty-eight hours. After that, methadone works well for chronic pain, provided the user follows the directions and does not mix the medication with other drugs, except on the advice of a doctor.

Illegal Use

People also use methadone illegally as a recreational drug, which is a drug used solely to get high, not to treat a medical condition. People have been known to grind up methadone tablets and snort the powder or inject the drug. This can be extremely dangerous, even in the absence of other drugs or alcohol. Because methadone works so slowly, it does not provide the RUSH of euphoria that the user craves. This may entice the user to take more methadone, eventually leading to a deadly build-up of the drug in the body. It is often hours and sometimes even days before the poisonous effects of methadone become apparent, as the user first slips into a deep sleep, then into a coma, and then stops breathing.

Are There Any Medical Reasons for Taking This Substance?

Methadone is an effective means of taking control of an opiate habit. It lessens the withdrawal symptoms of opiate abuse and helps control—but does not eliminate—cravings for opiates. People driven to desperation in their search for illegal heroin or painkillers can resume a normal lifestyle if they follow a methadone treatment plan. Studies have shown that long-term use of methadone in the absence of other drugs and alcohol has no adverse effects on the heart or other internal organs.

Someone who stops using methadone suddenly will suffer the withdrawal symptoms typical of all opiates, including diarrhea, nausea, chills, muscle pains, anxiety, insomnia, sweating, and frequent yawning or sneezing. In order to quit using the drug without these symptoms, it is necessary to lower the dose slowly over a period of months. This allows the body to adjust its brain chemistry gradually. Again, patients must be highly motivated to stay with the program, as even small reductions in dosage can bring a mild onset of withdrawal symptoms.

An epidemic of illegal OxyContin abuse since 2000 has led more doctors to prescribe methadone for chronic pain. Methadone is very effective in this role, but patients must be aware that the full effects of the pain relief may take as much as a week to achieve. During that time, they must be careful to monitor sleep patterns and to be aware of how the drowsiness might affect them while driving or operating machinery. If the painful condition improves, patients must taper their use of methadone gradually to avoid withdrawal symptoms.

In 2004 a group of Russian doctors visited the University Health Center methadone clinic in Vermont to learn more about how to treat heroin addiction with methadone. Heroin use has increased dramatically in Russia in recent years. AP/Wide World Photos.
Drugs like methadone are not prescribed on an “as needed” basis. The kind of pain for which methadone is used is a crippling, ongoing, day-and-night pain that may never improve. For extremely sick cancer patients, methadone allows a quality of life that might be impossible otherwise. The drug does not cure the cancer or even slow its progress, but it can help patients manage the pain. The same holds true for other conditions such as chronic back pain and osteoarthritis.

Usage Trends

The amount of methadone dispensed in clinics for the treatment of opiate addiction has remained stable for decades. However, between 1999 and 2002, the number of doctor-generated prescriptions for methadone increased by 331 percent, according to a report by SAMHSA. Pills and biscuits account for almost all of this increase.

Researchers at SAMHSA acknowledged several reasons for the jump in prescriptions for methadone—and a related jump in methadone deaths. First, doctors began prescribing more methadone for pain, believing that its potential for abuse is less than that of oxycodone (OxyContin) and hydrocodone (Vicodin). Second, some doctors began prescribing methadone to patients who are trying to recover from oxycodone or hydrocodone habits. The SAMHSA researchers also suggested that some opiate addicts do not want to be seen visiting a methadone clinic and may be turning to their personal doctors for help in kicking their habits. Getting a prescription from a doctor, and having it filled at the local pharmacy, is far more anonymous than arriving at a clinic every morning. Some communities even fight expensive legal battles to keep methadone clinics out of their neighborhoods.

Methadone on the Streets

The increase in methadone prescriptions has led to an increase of the drug being sold on the street. Seizures of illegal methadone by drug enforcement agents increased 133 percent between 2001 and 2002. Deaths associated with methadone have grown sharply since the early 1990s. SAMHSA used data to show that between 1993 and 2002, methadone-related fatalities jumped 200 percent in the state of Washington. The report declared: “While overdose mortality was declining among [clinic] patients, such fatalities were rising in the overall population.” DAWN statistics are quite similar. Between 1994 and 2001, DAWN reported a 230-percent increase in the number of emergency room patients being seen for methadone related problems or multi-drug problems with methadone in their systems.

According to the “Pulse Check” report in 2004, methadone addicts tend to be “white, middle-socioeconomic males older than 35.” Florida, Pennsylvania, Ohio, Indiana, and Texas are among the states with the largest methadone problems. The availability of the drug in these states stems from patients in treatment centers who are saving their doses and selling them on the streets. “Pulse Check” authors noted that the cities of Tampa and St. Petersburg, Florida, in particular, have seen a “dramatic increase in emergency department episodes and deaths involving methadone.”

Increased Abuse of Painkillers

The Join Together Web site published a survey by Kentucky’s Louisville Courier-Journal that found 345 fatalities in that state from methadone overdoses between January of 2003 and May of 2004. In Kentucky during that same period, methadone surpassed OxyContin as “the most misused prescription drug in the region,” according to the article.

The “2003 National Survey on Drug Use and Health” also determined that illegal use of methadone was on the rise among teenagers. The survey found that methadone use had increased 25 percent in just one year, part of a general increase in the abuse of prescription painkillers. Overall, methadone is becoming less associated with heroin addicts trying to go straight and more associated with the quiet epidemic of prescription painkiller use and abuse. The epidemic includes men and women of all races, ages, and economic levels.

Effects on the Body

Taken by mouth in pill, biscuit, or liquid form, methadone passes into the digestive system and from there is broken down in the liver. The liver releases the drug into the bloodstream, and it is carried to the brain and spinal cord, where it attaches to opiate receptors.

When no drugs are in the brain, opiate receptors take in ENDORPHINS and ENKEPHALINS, two brain chemicals that regulate feelings of well-being, overall motor coordination, breathing and coughing, and moods. Opiates replace these natural chemicals quickly and in such quantity that the user experiences a rush of pleasurable sensations and a calm drowsiness for hours afterward. This is the “high” that opiate users seek.

No “Rush” with Methadone

When methadone is introduced to the opiate receptors, it does not cause the rush of pleasure that other opiates and painkillers do. Its onset is slower, and it stays in the brain and body longer. Users may feel drowsy and relaxed. Any kind of pain will gradually cease, and it will not return as long as the user takes regular, carefully prescribed doses of the drug. As the dose of methadone leaves the brain and body—generally in about twenty-four to thirty-six hours—the user will begin to feel the discomfort of withdrawal unless a new dose is taken.

In other parts of the body, methadone causes the same symptoms as other opiates and opioids. It inhibits the muscles in the bowels, leading to constipation, and works as a cough suppressant. If taken improperly, it can also affect breathing and lead to asphyxiation—the inability to breathe, which results in death.

Dr. Warren Bickel displays a sample of buprenorphine, a painkiller used to treat opiate addiction. Buprenorphine works the same way as methadone, but is not believed to pose the risk of an overdose. Photo by Jordan Silverman/Getty Images.
Users may also experience nausea and loss of appetite, dry mouth that can lead to tooth decay and gum disease, and pinpoint pupils leading to sensitivity to light. Methadone may also lessen sexual function and desire.

At the end of methadone treatment, users must taper doses slowly to allow all the bodily systems to return to normal. A sudden end to methadone use brings on diarrhea, anxiety, insomnia, and flu-like symptoms.

Reactions with Other Drugs or Substances

Methadone becomes far more dangerous when combined with other drugs or alcohol. All types of tranquilizers, sedatives, antidepressants, and anti-anxiety drugs will increase the likelihood of breathing problems if taken along with methadone. The drug should not be combined with other painkillers, even over-the-counter medications like acetaminophen (Tylenol) and ibuprofen (Advil), unless supervised by a doctor.

In a 2004 report, the National Drug Intelligence Center revealed that in 65 percent of all emergency room visits related to methadone use, another drug was also present. Frequently the second drug was alcohol. When used together, methadone and alcohol magnify each others’ effects. Drinking while taking methadone can lead to very poor motor control, vomiting and breathing problems, coma, and asphyxiation.

Illegal users of methadone sometimes combine it with cocaine as well. Cocaine causes a different sort of high in the brain, one that is unaffected by methadone. Users of cocaine and methadone find themselves in the difficult position of being addicted to two different substances at the same time, with a host of side effects unique to each substance.

Methadone should not be combined with medications that increase metabolism time in the liver. These include medicines for tuberculosis, such as Rifampin, and medicines for seizures and EPILEPSY, including Dilantin. Some antibiotics, and even over-the counter vitamins, can increase the level of methadone retained in the bloodstream. Methadone decreases the power of medicines prescribed for the human immunodeficiency virus (HIV), the virus that can lead to acquired immunodeficiency syndrome (AIDS). Methadone can worsen nausea, vomiting, and fatigue in patients with AIDS. Since people can be infected with HIV by sharing needles to inject heroin, some ill addicts might not be able to tolerate a methadone plan of treatment.

Treatment for Habitual Users

Habitual use of methadone is encouraged in people trying to kick an opiate habit. This is because proper use of methadone allows addicts to resume a normal life again. Studies from many countries show that heroin addicts who have lost jobs and contact with their families, and have fallen into criminal behavior, can turn their lives around as long as they adhere to a strictly supervised methadone plan. Sometimes recovering addicts take methadone for years. In other cases, the methadone doses are gradually decreased over a period of months until a full recovery is achieved.

However, many addicts who start a methadone treatment program will have difficulties following the plan. Some quit and go back to hard drugs. Others falter here and there, or become dependent on

Ann Livingston, the director of the Vancouver Area Network of Drug Users, leans against a poster seeking volunteers to participate in an opiate study in 2005. The controversial program is designed to help hard-to-treat heroin addicts in Vancouver, British Columbia, Canada. Under the 12-month program, half of the participants are given prescription-grade heroin while the other half are treated with methadone. Photo by Jeff Vinnick/Getty Images.

another drug such as cocaine. Some combine methadone with other brain-altering drugs or alcohol. This greatly complicates the treatment process.

One researcher in a nationally published report by SAMHSA likened opiate addition to illnesses such as diabetes and extreme obesity. People with diabetes know that they have to manage their weight and watch what they eat. Some do, others do not. The ones who follow doctors’ orders live longer than the ones who ignore the advice and carry on with their habits. The same holds true for obesity. People must be highly motivated to lose weight. Some are, some are not. The ones who make a commitment to change often live longer than the ones who do not change their lifestyles. Drug addicts are also suffering from a disease, and their willingness to fight the disease influences their ability to overcome it.

Most doctors realize that simply dispensing methadone tablets to people with a drug addiction will not end the cycle of abuse. Opiate addicts must also undergo talk therapy with counselors who are trained to offer strategies for combating drug use. Self-help groups such as Narcotics Anonymous can be helpful but might not be enough for those requiring methadone therapy. Most methadone clinics combine drug treatment with personal counseling.

Self-Healing on the Street

Studies are being conducted of methadone abuse on the streets to see how the drug is used recreationally. Some researchers suggest that ILLICIT methadone is used less for the high it produces and more as a self-treatment for withdrawal symptoms when other opiates are not available. Methadone is not a safe recreational drug. It is habit-forming. Anyone using it for any reason should be under the close supervision of a doctor.

Consequences

When used properly, methadone can literally save lives. Heroin users expose themselves to many deadly diseases, including HIV and hepatitis (a liver disease), when they share dirty needles. Heroin users are also prone to commit crimes or indulge in risky behavior. By stopping heroin use, the cycle of the desperate pursuit of the next “fix” ends. A thirty-one-year-old recovering heroin addict, quoted in the York Daily Record, said he rode a bus two hours each way from his home every day for his methadone treatments. Admitting he had been jailed “at least ten times,” the man said that methadone “gives me the ability to get on with my day.” While methadone treatment for drug abuse is not easy, quick, or always successful, it does offer hope to people who are harming themselves and others.

As a prescription painkiller, methadone use must be monitored very carefully for the potential of poisonous build-up in the body. Doctors prescribing it for pain need to be quite knowledgeable about how to adjust the doses and how to monitor patients for overdose. Patients must be aware that they need to take the medicine exactly as prescribed or face possibly fatal consequences. Doctors must be particularly careful when patients are taking any other medications, either prescription or over-the-counter drugs. When used as a prescription painkiller, methadone is typically a drug of last resort.

Any use of methadone with other drugs and alcohol in a recreational setting can be fatal. Failure to store the medicine properly can lead to poisoning in children. Crushing methadone pills and snorting or injecting them for recreational use can cause death, sometimes many hours or even a day or two after use. Methadone overdose generally causes the user to fall asleep, and the sleep then deepens into a coma that ends when the user’s breathing stops.

Methadone is a habit-forming drug. Community leaders often fight against having methadone clinics in their neighborhoods because the clinics attract drug abusers who may have committed criminal acts. Anyone considering experimentation with methadone should keep in mind that those who really need the drug have very difficult lives with extremely challenging mental or physical illnesses.

The Law

Methadone is a Schedule II controlled substance, meaning that the U.S. government finds it to have some medical uses but also a high potential for abuse and addiction. Penalties for possession and sale of illegal methadone vary from state to state and can be quite harsh, since the drug carries so many potential dangers. Even a first conviction for possession or sale of illicit methadone can carry jail time. Second and third offenses can result in a lifetime in prison.

In 2000 the FDA relaxed some of the restrictions on the legal prescription of methadone. Still, doctors who prescribe the drug must attend training sessions to learn about methadone’s profile, how to prescribe the drug safely, and how to monitor patients for life-threatening side effects. Doctors who finish the training are issued a special license to prescribe methadone. Needless to say, any doctor or pharmacist who issues methadone without the proper documentation can face prosecution as a criminal.

Methadone’s dangerous side effects, its history as a substance used to help addicts, and its long-lasting effects on the body have all combined to bring its uses—both legal and illegal—under greater scrutiny.

Official Drug Name: Methadone; Dolophine

Also Known As: Dolls, dollies, fizzies

Drug Classifications: Schedule II, opioid narcotic

Pharmacy Mix-Ups

According to the Knight Ridder/Tribune Business News, several deaths have occurred in children because methadone has a name similar to methylphenidate, the generic name for Ritalin. (A separate entry on Ritalin and other methylphenidates is available in this encyclopedia.) In a few cases, children who were prescribed Ritalin to treat attention-deficit/hyperactivity disorder (ADHD) actually received methadone pills instead.

It is important to note that methadone is never prescribed for ADHD. Children should never be allowed to take Ritalin without having the tablets checked by a parent to be certain that the tablets are Ritalin, and not methadone. Anyone who has a prescription for Ritalin filled has the right to examine the product at the pharmacy counter and to double-check with the pharmacist that no one preparing the prescription has confused methylphenidate with methadone. Mistakes can be fatal.

Methadone Chronology

1939 German scientists develop a synthetic opioid painkiller in response to wartime shortages of morphine. They call the new drug Amidon.

1947 American pharmaceutical company Eli Lilly begins trials of the painkiller. Lilly calls the drug methadone.

1950 Researchers begin using methadone to treat withdrawal symptoms in heroin addicts.

1964 Researchers in Lexington, Kentucky, conclude that a daily dose of methadone allows heroin users to avoid withdrawal symptoms while also being unable to experience a heroin high. The first methadone clinic opens in Lexington.

1970 The U.S. Controlled Substances Act places methadone on its list of Schedule II substances, recognizing that the drug has medical uses but also the potential for misuse and abuse.

2000 Prescriptions for the pill form of methadone rise sharply in response to abuse and illegal use of other opiate/opioid painkillers such as Vicodin and OxyContin.

2003 U.S. trials begin on the drug buprenorphine for use as an alternative to methadone.

Alternative to Methadone

Beginning in the early twenty-first century, the U.S. Food and Drug Administration (FDA) approved trials on a drug called buprenorphine (marketed as Buprenex, Subutex, and Suboxone). A painkiller used in Europe to treat opiate addiction, buprenorphine works the same way as methadone without some of the complications of methadone treatment. The drug has similar effects on the body as methadone but it is not as addicting as other opiate or opioid-like drugs. In its Suboxone form, it contains naloxone, a drug that rids the body of opiates. Scientists are optimistic about the possibilities of Suboxone because grinding it up and snorting or injecting it will simply release the naloxone and cause withdrawal symptoms rather than a high.

In the News

How many ways can methadone kill? Newspapers reveal personal stories of tragic deaths.

In 1999, an eight-year-old boy died following a mix-up in his prescription, having taken methadone instead of Ritalin (methylphenidate). It was one of six documented cases of confusion over the similar names for the two drugs.
In 2001, an eight-year user of prescription methadone, a father with a young child, died in Ontario, Canada, after doctors refused to place him on a liver-transplant list. The man died of liver failure unrelated to his methadone use. A physician admitted that the victim was discriminated against because he used methadone.
In 2002, a Fort Lauderdale, Florida, woman died in her home at age forty-one of a multiple-drug overdose, including prescribed methadone. She was being treated for an intensely painful back deformity.
In 2002, a two-year-old boy died of methadone overdose in Sheffield, England, after drinking the sweetened liquid containing methadone that his mother had brought home from a clinic. His mother was high on heroin at the time.
In 2002, a fifteen-year-old Toronto girl lapsed into a coma and stopped breathing many hours after drinking a beverage laced with methadone. Someone had spiked her drink without her knowledge.
In 2004, a Colorado State University student died a month before his twenty-first birthday from a combination of alcohol and methadone. He collapsed on a street near the campus.

See Also

Cocaine; Codeine; Fentanyl; Hydromorphone; Morphine; Opium; Oxycodone; Ritalin and Other Methylphenidates

REFERENCES

Clayman, Charles B., ed. The American Medical Association Encyclopedia of Medicine. New York: Random House, 1989.

Gahlinger, Paul M. Illegal Drugs: A Complete Guide to Their History, Chemistry, Use and Abuse. Las Vegas, NV: Sagebrush Press, 2001.

Smith, D., and Richard Seymour. Clinician’s Guide to Substance Abuse. New York: McGraw-Hill, 2000.

Periodicals

Babb, J. J. “Colorado State U. Student’s Death Result of Alcohol, Methadone.” America’s Intelligence Wire (January 18, 2005).

“Cocaine Abuse by Methadone Patients Is a Growing Problem.” The Addiction Letter (March, 1995): p. 1.

Dalrymple, Theodore. “An Official License to Kill.” New Statesman (March 3, 2003): p. 30.

“Florida’s Prescription Drug Deaths Now Exceed Those from Cocaine, Heroin.” South Florida Sun Sentinel (November 13, 2002).

Gebhart, Fred. “Methadone-Related Deaths on the Rise, Report State Boards.” Drug Topics (October 11, 2004): p. 65.

Hawaleshka, Danylo. “Too Many Deaths: As Ontario’s Methadone Program for Drug Addicts Expands, So Do Fatalities.” Maclean’s (February 25, 2002): p. 44.

Henle, Mark. “Dartmouth College: New Hampshire Methadone Clinic Stymied by Zoning.” America’s Intelligence Wire (May 10, 2004).

Higgins, Michael. “Deerfield, Ill.-Based Walgreens Admits Giving Methadone to Brain-Damaged Boy.” Knight Ridder/Tribune Business News (October 8, 2003).

Kinross, Ian. “Methadone Clients Denied Life-Saving Liver Transplants.” Journal of Addiction and Mental Health (March-April, 2001): p. 3.

Patterson, Karen. “Beyond Methadone: New Hope for Heroin Addicts Comes in Tablet Form.” Dallas Morning News (January 11, 2003).

Randerson, James. “Painkiller Linked to Rise in Overdose Deaths.” New Scientist (March 6, 2004): p. 14.

Sadovsky, Richard. “Public Health Issue: Methadone Maintenance Therapy.” American Family Physician (July 15, 2000): p. 428.

Schulte, Fred, and Nancy McVicar. “Rx for Death: Patients in Pain Overdosing in Alarming Numbers.” South Florida Sun-Sentinel (May 12, 2002).

Smith, Sharon. “York County, Pa., Heroin Addicts Make Daily Trek for Methadone.” York Daily Record (November 7, 2003).

Wainwright, Martin. “Boy, 2, Died from Mother’s Methadone.” Europe Intelligence Wire (October 8, 2002).

Wilson, Clare. “Fixed Up: When Nothing Else Works, Heroin Addicts Should Be Prescribed the Drug They Crave.” New Scientist (March 30, 2002): p. 34.

Web Sites

“2003 National Survey on Drug Use and Health (NSDUH).” Substance Abuse and Mental Health Services Administration (SAMHSA). http://www.drugabusestatistics.samhsa.g ov (accessed July 29, 2005).

“The DAWN Report: Trends in Drug-Related Emergency Department Visits, 1994-2001 At a Glance” (June, 2003). Drug Abuse Warning Network: Office of Applied Studies, Substance Abuse and Mental Health Services Administration. http://dawninfo.samhsa.gov/old_dawn/pub s_94_02/shortreports/files/TDR_EDvisits _glance_1994_2001.pdf (accessed July 31, 2005).

“Information Bulletin: Methadone Abuse Increasing” (September, 2004). National Drug Intelligence Center. http://www.usdoj.gov/ndic/pubs6/6292/62 92t.htm (accessed July 28, 2005).

“Methadone” (April, 2000). Executive Office of the President, Office of National Drug Control Policy (ONDCP). http://www.whitehousedrugpolicy.gov/pub lications/factsht/methadone/index.html (accessed July 28, 2005).

“Methadone Abuse Surpasses OxyContin in Kentucky.” Join Together. http://www.jointogether.org/sa/news/sum maries/reader/0,1854,570886,00.html (accessed July 28, 2005).

“Methadone-Associated Mortality: Report of a National Assessment.” Substance Abuse and Mental Health Services Administration. http://dpt.samhsa.gov/reports/methodone _mortality-03.htm (accessed July 31, 2005).

“Pulse Check: Drug Markets and Chronic Users in 25 of America’s Largest Cities” (January, 2004). Executive Office of the President, Office of National Drug Control Policy. http://www.whitehousedrugpolicy.gov/pub lications/drugfact/pulsechk/january04/j anuary2004.pdf (accessed July 28, 2005).

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Is fetal abuse a social problem? Studies conducted on the effects of substances such as alcohol, marijuana, cocaine, heroine, and nicotine on the unborn child. Cites several case studies and recommends solutions for the problem.

Fetal Abuse is a social problem that has caused heated debate for the past two decades. Since 1985, many studies have been conducted on the effects of substances such as alcohol, marijuana, cocaine, heroine, and nicotine on the unborn child. This marked the beginning of fetal abuse’s transformation from a social issue to a social problem. After these studies were conducted, the results found were very concerning to society. Negative effects were found in children born to mothers using the substances, effects that are permanent, including physical deformities and mental impairment.
An example of the negative effects of substance abusing pregnant women can be seen in the phenomena of Fetal Alcohol Syndrome, and the related, less severe, Fetal Alcohol Effects. A woman puts her child at risk for developing many problems when she consumes alcohol during pregnancy. These problems include: low birth weight, irregularly small head size, clubfoot, facial deformities, mental retardation, learning disabilities, behavioral problems, and problems with the liver, kidneys, heart, and joints.

Infants who are born to drug addicted mothers are often faced with going through withdrawal from their mother’s drug of choice. The symptoms of withdrawal that an infant may experience include: hyperactivity, sleeping and eating problems, fussiness, breathing problems, vomiting, diarrhea, and convulsions. Long-term development is also at risk of being affected in infants whose mothers’ used drugs while pregnant.

The effects that were found in the studies done on infants and children who were exposed to these various substances shocked and alarmed society. Political leaders, community organizations, and religious associations all began to express their opinions on the subject. This is were the claims-making process began. People felt that the babies that were being born to these mothers were subjected involuntarily to these dangerous substances and through no choice of their own they were made to endure the long-term consequences. As society began to recognize the problems brought about by substance abusing pregnant women what was once a social issue became defined as a social problem. These pregnant women were creating a problem that would effect American communities socially, politically, and economically.

Socially, the problem impacts both the mother and the child. The stereotypes that exist are that drug abuse is predominantly a problem effecting the lower class. The mothers who are unable to afford prenatal care and substance abuse treatment are seen as a burden to society. Economically, the burden is placed on society when a child is born to a drug addicted mother. Long-term medical care of these children is often related to increased health-care costs. Often, when mothers are deemed unfit to care for their child, the government is the party that absorbs the costs of the child’s care. Then there is the political debate regarding the rights of a fetus that this problem has brought to society’s attention. Many people feel that the fetus is separate from the mother and deserves special protection against the actions of the pregnant mother. Other’s feel that the fetus is not separate and can only been seen as such when it is viable and able to live outside of the womb. These people feel that any laws creating fetal rights would be an infringement on the rights of the pregnant woman. They feel that society has no right to define acceptable behavior for pregnant women and any law put in place in order to do so would ultimately end up overturning the Rowe vs. Wade decision and denying women the right to choose.

Currently there has not been one state that has put any laws in place that criminalize a woman’s conduct during her pregnancy. However, in thirty states women have been prosecuted for using drugs while pregnant, under statutes that prohibit child abuse and neglect. The only state that has criminal child abuse laws regarding the fetus is South Carolina. This is seen as a response to the rise of “crack” use in the early eighties. An example of this is seen in the court case Whitner vs. South Carolina. Cornelia Whitner was arrested and charged with “endangering the life of an unborn child” because of her crack use during pregnancy. In her trial, Whitner pleaded guilty to child neglect and was sentenced to an eight-year prison term. Whitner appealed to the Supreme Court but they refused to hear the case and the sentence was upheld. Apparently, the Supreme Court was not ready to address the issue of whether or not a fetus is entitled to protection rights. Another issue avoided by the Supreme Court when they refused to hear the Whitner appeal was whether or not women using drugs during pregnancy should be punished criminally.

While there are approximately seventeen states that have civil laws that allow a child to be taken away from a drug using mother, fetal abuse as a crime is rarely seen in law books across the United States. In Pennsylvania, in the Commonwealth vs. Kemp case, charges of endangering the welfare of a child were dismissed because the court ruled that the fetus could not be viewed as either a “person” or a “child.”

Another interesting example can be seen in the story of Sally DeJesus. Sally was a heavy cocaine user who had decided to become clean and sober when she was pregnant with her third child. In her ninth month of pregnancy, Sally had an incident were she slipped and used the drug again. She reported this to her mid wife and asked for help. In turn, the mid wife reported this to the hospital where Sally gave birth to her baby and the hospital conducted a drug test on the infant without Sally’s knowledge. The hospital called the police when the baby tested positive for traces of cocaine. Sally is now awaiting a trial to see if she will be found guilty of criminal child abuse which could result in a sentence of jail time.

This story brings up the question of whether or not criminal action against drug abusing mothers is a good deterrent or simply a reason why these women do not try to seek help. For many women who are addicted to alcohol or drugs, they are not purposely trying to harm their unborn child. They feel that they are unable to ask for help for fear that it will lead to criminal prosecution. If these women were able to receive help in overcoming their addictions it would greatly reduce the occurrence of Fetal Abuse. This raises the question of whether or not deterrent theory should be used in the Fetal Abuse problem. What good does locking a mother up or taking away her child ultimately lead to? Many people, including myself, feel that no good at all comes from these actions. We are left with women who still have substance abuse problems and children without their biological mothers in their life. How is this a good solution to the problem? The other negative factor in using deterrence in this case is that in many situations it simply causes women to hide the problem and avoid seeking prenatal care. Sally would have most likely never told the mid wife about her slip if she knew what consequences it was going to have. While it makes sense to many people to make “examples” out of women like Sally, I just don’t understand what good it does. Women who have these addictions often have them way before becoming pregnant. So why is it that we want to punish them when they are in need of help more than ever? It seems to me that punishment is less of a deterrent to the actual substance abuse and more of a reason to hide that it is going on. This is one ethical dilemma that arose for me while I was researching the topic for this paper.

It is generally agreed that a woman’s actions during pregnancy have an effect on the fetus. It has been documented that using drugs, drinking alcohol, and smoking while pregnant has detrimental effects on the fetus. Why then do we see the continued problem of fetal abuse occurring? I believe it is the severe lack of help to addicted women that is available and the lack of education for pregnant women on these effects. It is a fact that these women are endangering the lives’ of their unborn children. However, this should not make them subject to criminal prosecution. Instead, these women should be encouraged to seek help for their addictions. The importance of prenatal care should be addressed and women should not be afraid to seek this care because they have an addiction problem. When a pregnant woman is found to have an addiction problem rather than threatening her with criminal punishment, help in the form of treatment and education should be made available. Testing babies born to drug addicted mothers is not a solution to this problem, realizing the problem exists after-the-fact is little help to the mother or the child. We need to make substance abuse treatment of pregnant women a main priority. If this were the case, we would be faced with the problem of having children taken away from mothers and what to do with these children, far less often. A support system needs to be implemented for these women. This would include clinics with an open door policy for pregnant women and group therapy so that these women know that they are not alone in dealing with this problem. Also education of these women is key and I feel that it would be more of a deterrent than criminal punishment. When a pregnant woman has a drug problem she may not be thinking of or even aware of the effects that the drugs can have on her baby. Once the woman is taught the adverse effects that could in many cases be long-term she would be far more motivated to seek treatment for her problem. I do not feel that women should be jailed because of their drug use during pregnancy, however women who have serious drug problems and are resistant to getting help while pregnant should in my opinion be able to be admitted for treatment, even if it has to be involuntarily.

Then there are the women who smoke while they are pregnant. This topic is addressed far less than it should be. It has been proven that women who smoke often have babies with low birth weights and that are at a higher risk for developing asthma and respiratory infections that could lead to life long problems. Simple warnings printed on the side of a pack of cigarettes do not seem to be effective deterrents to me. Nicotine addiction is classified as a disorder in the DSM. It’s effects on the fetus are proven. Why then are we not making more serious attempts at educating society on the dangers of smoking while pregnant. I feel that this could be done by running awareness commercials during prime time television viewing hours. Another way to increase a pregnant woman’s awareness of the problem is to have pamphlets printed up and placed in popular baby stores such as “Babies R Us” or “The Children’s Place.” These pamphlets should also be given to women by their health care providers. When it is known that a pregnant woman is a smoker, the health care provider should be able to refer her to a class held by the hospital to educate women on smoking’s dangerous effects. It is my belief that in any type of drug use regarding pregnant women if we increase awareness and the availability of help we will see a decrease in the problem.