Methadone is an opiate drug that is used both in the treatment of pain, and as a treatment of opiate addiction.

As an addiction treatment medication, methadone serves as a substitute opiate – you take methadone each day instead of the opiate drug you normally abuse (heroin or OxyContin, for example).

As an opiate, methadone fills the opiate receptors in the brain and thus keeps you from feeling opiate withdrawal symptoms or drug cravings – and when you are on an appropriate daily dosage of methadone, you won’t get high either.

On methadone, you get a chance to get your life back together, without having to go through withdrawal symptoms and without having to battle through excessive drug cravings. On methadone, you don’t have to worry about getting enough money each day to get high and on methadone you’re clear-headed enough to work and to take care of yourself and those dependent on you.

Methadone is hardly a miracle drug, and there are some significant drawbacks to its use, but no other drug works better in keeping severely opiate dependent people from abusing drugs.

How Is Methadone Used?

Methadone is a long acting opiate. A single dose of methadone provides a whole day of relief from withdrawal symptoms and drug cravings.

At the start of your methadone treatment program, you will need to travel to a methadone clinic each day to receive your day’s dosage. Methadone cannot be taken home at first, as it is an easily abused drug with a street value. In time, if you follow the regulations of the methadone clinic, you can earn up to a month’s take-home supply of methadone between clinic visits.

How Long Does Methadone Treatment Take?

There is no set duration for the use of methadone as an addiction treatment medication. Some people use methadone only very briefly, as they transition off short acting opiates – as a detox aid. Other people may use methadone as a replacement and stabilizing medication for a lifetime.

• For the best chances of staying in recovery doctors recommend that you use methadone for at least 1 year
• Methadone, when used as prescribed, does no harm to any of the major organs or bodily systems, and can be used safely, indefinitely
• People who stay on methadone are less likely to relapse back to illicit drug use than people who end their use of this medication

Although some people may choose to use methadone indefinitely, most people eventually decide they want to break free. After a stabilization period and when you are ready to resist the withdrawal symptoms and drug cravings that are associated with dose reductions, you can start to taper your daily dose downward, to an eventual goal of complete cessation. The National Institute on Drugs and Addiction (NIDA) recommends at least a year of methadone treatment and stabilization prior to attempting a taper.

Methadone treatment is effective and when you take methadone as directed, it is very safe. Through more than 50 years of widespread use, methadone has been intensely studied and it is proven safe for use, even by pregnant women.

The Benefits of Methadone Treatment

Methadone is the gold standard treatment for severe opiate addiction – nothing works as well, and unlike some other forms of addiction treatment, the entry costs to a methadone treatment program are very low – a daily dose of methadone can cost just 10$ or 15$.

If you take methadone you are much less likely to also abuse opiate drugs. Some of the peripheral benefits of a drug free lifestyle include¹:

• A reduced risk of HIV/AIDS, Hepatitis C and other infectious diseases
• A reduced risk of criminal activity and imprisonment
• A reduced risk of death
• Improved overall health
• Improved social functioning
• A higher quality of life

The Drawbacks of Methadone Treatment

Although nothing works better at helping people stop abusing opiates, methadone is not a perfect medication and methadone addiction treatment has some disadvantages, such as:

• For the first months (or years) of treatment, you will need to take you daily dosage under supervision at a methadone clinic
• Methadone induces a powerful dependency – some people say that the withdrawal pains of methadone are worse than of heroin
• Methadone treatment is stigmatized
• Methadone is a medication with side effects, such as constipation, weight gain and others

Talk to your doctor about whether methadone is right for you and get information on other options, such as Suboxone or detox based treatment before making any decision. If you and your doctor decide on methadone, know that you are taking the most effective medication for the treatment of opiate addiction and that you have an excellent opportunity to get your life back together!

Image Copyright: Lina Menazzi

Start tapering before you’re ready and your odds of success aren’t great. Take this 16 question self test and find out if you're ready to start reducing your daily dose.

Ready for a challenge?

Most people on methadone hope to taper off and stop using at some point. Unfortunately, your odds of relapse jump once you start reducing your daily dose.

Long duration research studies show that a majority of people trying to taper off methadone either relapse back to opiate abuse or discontinue their tapering attempts.^{1 2}

But while many cannot maintain abstinence without methadone (or Suboxone) a lot of people are able to taper off and avoid relapse.

Thinking about tapering?

While no one can predict the future, researchers have identified certain life factors that indicate readiness to taper and a greater probability of long term abstinence.

If you start now... will you make it clean to ZERO?

Take the following 16 question Tapering Readiness Test and see if you’re ready (simply answering 'Yes' or 'No'). 

The more 'Yes' answers you score the better your odds of long term success; the more 'No' answers you rack-up, the greater your odds of tapering failure.

Readiness to Taper Self-Test ³

1. Have you been abstaining from illegal drugs, such as heroin, cocaine, and speed?
2. Do you think you are able to cope with difficult situations without using drugs?
3. Are you employed or in school?
4. Are you staying away from contact with users and illegal activities?
5. Have you gotten rid of your “works” / ”outfit?”
6. Are you living in a neighborhood that doesn’t have a lot of drug use, and are you comfortable there?
7. Are you living in a stable family relationship?
8. Do you have straight (nonuser) friends that you spend time with?
9. Do you have friends or family who would be helpful to you during a taper?
10. Have you been participating in counseling that has been helpful?
11. Does your counselor think you are ready to taper?
12. Do you think you would ask for help when you were feeling bad during a taper?
13. Have you stabilized on a relatively low dose of methadone?
14. Have you been on methadone for a long time?
15. Are you in good mental and physical health?
16. Do you want to get off methadone?

The Tapering Readiness Inventory was developed originally by researchers at the University of California, San Francisco.

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Four pieces of advice on how long you’ll need to use Suboxone from one of America’s leading experts on the use of the drug.

Although when confronting an addiction to opiates you probably want to ‘get back to normal’ as quickly as possible, in truth, quick fixes don’t tend to work very well and you’re much better off thinking of treatment and recovery as a marathon and not a sprint.

Opiate addiction creates lasting changes in the brain. Opiate addiction changes the way your brain’s memory and reward systems operate in significant and enduring ways and without medications such as Suboxone or methadone which dampen addiction’s influence on our thoughts and behaviors, relapse back to opiate use is depressingly likely.

If you’re considering Suboxone you probably want to know how long you’ll need to take your medication for.

While there is no one right answer – only a right-for-you answer to be determined on an individual basis in consultation with a knowledgeable doctor – here is some general information and advice on how long you should consider using Suboxone for.

How Long to Use Suboxone For

Here are 4 pieces of good advice from leading Suboxone expert, Doctor Jeffrey Junig MD PhD, to get you thinking about how long you’ll need to use Suboxone for, and when you’ll be ready (if ever) to stop using this medication.

According to the Suboxone Doc:

1. You Should Consider Using Suboxone at Least until a Better Medication Is Developed

On Suboxone you can live a healthy and happy life while participating fully in society. Off Suboxone you are always at risk to relapse back to opiate abuse – you are safer just staying on the medication.

The neural changes of opiate addiction may not be reversible, but with medications like Suboxone, these changes can be effectively managed and you should consider using this medication at least until a superior opiate addiction drug is developed.

Learn more about addiction as a brain disease

2. You Should Consider Suboxone a Long Term Maintenance Medication (Not a Medication Just to Manage Withdrawal Symptoms during a Detox)

The short term use (under a month) of Suboxone almost always ends in relapse back to opiate abuse.

Suboxone works best when it is used as a long term maintenance medication, from a minimum of 6 months to a year; and ideally for much longer than that

3. If You Decide You Want to Stop – Make Sure You’re Ready

According to Dr. Junig, if you decide that you want or need to taper off Suboxone then wait until you are ready to do so before making your attempt. Signs of readiness to taper include:

• Being over 30
• Having stable employment
• No longer seeing any friends who are using opiates
• Having no immediate source to secure illicit opiates
• Being in a stable relationship or feeling secure being single
• Having completed relapse prevention work
• Feeling comfortable taking Suboxone once a day on an automatic basis (If you still take it ‘when you need it’ or if the use of Suboxone still provokes a lot of thought or feelings, then you are probably not ready.)
• Staying comfortably on a once daily dose of 8mg for several months

4.  Avoid Using Alcohol, Benzodiazepines, Marijuana and Other Drugs While on Suboxone

People on Suboxone do best when they move forward in life while taking their medication. They do this most successfully when they engage in life through getting and maintaining employment, getting educated, enjoying hobbies and interests, getting sufficient daily exercise and working to forge and sustain healthy relationships.

People who switch from opiate use to the frequent use of another mind-altering substance while on Suboxone are much less likely to make positive life progress in any of the above listed areas.¹

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Think you know methadone? Be careful, because a lot of what’s passed as common knowledge about this controversial medication has little basis in fact. Here are 8 common methadone myths exposed and debunked.

Deciding whether or not to use methadone as a treatment for your opiate addiction is hardly a decision to be taken lightly, and there are some significant advantages and disadvantages associated with this course of treatment, however, it is important that when evaluating your options you make your decisions based on fact and evidence, and not on myth and distorted truth.

Methadone, for a number of reasons, remains a controversial medication and a lot of what is popularly known about the medication has little basis in fact. Here are 8 things people commonly say about methadone…that just aren’t true.

8 Methadone Myths Exposed

1. Methadone Rots Your Bones

Nope, methadone does nothing to the bones. People who are on an insufficient dose of methadone, however, may experience a dull ache in the bones which is actually a symptom of opiate withdrawal. If your bones hurt, then talk to your doctor about adjusting your daily dosage.¹

Although some people may say that methadone leaches calcium from your bones this has never been demonstrated in any clinical study- and there have been a lot of clinical studies done on methadone - the more likely reason that people on methadone sometimes experience low calcium levels is a diet low in calcium in the years prior to beginning to use methadone.

2. Methadone Rots Your Teeth

This isn’t true, although there’s a reason why people believe this to be so. Methadone, like most opiates and many other medications, can cause dry mouth, and since saliva protects against dental decay, this can increase a person’s risk of cavities and gum disease.

This is easily managed, however, through attention to dental hygiene, such as regular brushing and flossing and visits to the dentist; and through drinking water regularly or chewing sugar free gum to relieve dry mouth.²

Heroin users and other opiate abusers may also begin a period of methadone treatment after a prolonged period of dental neglect that becomes more obvious once no longer masked by the analgesic effects of high doses of heroin or other opiates of abuse.

3. Methadone Affects Your Memory/Makes You Dumber

You may not be so sharp on an overly high dose of methadone (as you wouldn’t on an excessive dose of any opiate) but an accurate stabilization dose should have no impact on your memory or intelligence.

Longitudinal intelligence test studies on methadone users show that chronic use of the medication results in no intelligence declines.³

4. Methadone Lowers Immune Function

Actually, methadone is about the only opiate that doesn’t negatively affect immune function. Additionally, once stabilized on methadone and no longer engaged in compulsive daily drug seeking/taking, you are far more likely to eat well and take care of your physical and mental health than you were when still abusing opiates.

There’s just no contest here – once stabilized on methadone your overall level of health and your ability to resist illness should improve substantially.

5. Methadone Is Worse for You than Heroin

Methadone is a non toxic medication and studies have shown that people can use methadone as a maintenance treatment for addiction for decades while showing no significant adverse consequences from that use. Methadone, like any opiate, can be dangerous if used at higher than recommended dosages.

Heroin, as it is sold on the street is never 100% pure. So people using heroin expose themselves to a random mix of different cutting agents on a daily basis, and the health consequences from the injection or ingestion of these different cutting agents can be severe. There is no doubt that heroin use is more harmful to the body than methadone.

6. Methadone Causes Weight Gain

Although people commonly complain about gaining weight once on methadone there is nothing in the medication that would cause this to happen. In fact, in one study of methadone maintenance patients, although 10 % of people complained of weight gain after starting on methadone, another 5% of people complained of weight loss after starting the medication!⁴

Researchers think that some people gain weight after using methadone as a side effect of other medications, such as anti depressants which may be prescribed concurrently, or simply as a function of eating better/having an appetite return once no longer abusing opiates.

7. You’re Still an Addict on Methadone…You’re Just Addicted to Methadone Now

Addiction is characterized by things like drug cravings, compulsive use and an inability to control how much and how often you use. Once stabilized on methadone you experience none of these hallmarks of addiction.

Stabilized on methadone you are medication dependent and you need to take your medication daily to avoid adverse symptoms, just as a diabetic or a person with high blood pressure needs medication daily. Once stabilized on methadone you are no longer an opiate addict, just a person dependent on medication.

8. Lower Doses of Methadone Are Better

While some clinics may put a low cap on maximum daily dosages, the research clearly demonstrates that people on higher daily dosages of methadone are more likely to avoid relapse, avoid fatal heroin overdoses and have better psychosocial outcomes.⁵

How much methadone a person needs each day is a very individualized matter, but there is very little benefit in getting a daily dosage that is insufficient to stave off drug cravings and withdrawal symptoms.

Image Copyright: Emanuele Rosso

Thinking about using methadone but worried about the side effects? Well, firstly, know that while there are some side effects associated with the drug, it is a very well tolerated medication and most people find the side effects to be very manageable. Secondly, a lot of misinformation surrounds methadone, so some of what you may have heard may be untrue. Learn more about the side effects of methadone and learn if it might be a form of addiction treatment that will work for you.

Methadone is one of the most intensely researched medications ever developed and it has been in very wide use for over 50 years.

Doctors have a very good understanding of what side effects people on methadone will and will not experience, yet despite this wealth of knowledge, a lot of people still don’t have their facts straight on this pretty controversial, but effective, medication.

Methadone Is Dangerous, but Also Very Safe

Methadone is a very potent opiate and its use has been linked to many overdose deaths. If you take methadone other than as prescribed or if you mix methadone with other recreational or even prescription drugs you are putting yourself in grave danger. However, if you use methadone strictly as directed, methadone will do you little harm.

Studies on people who have been using methadone for decades have shown that the medication does no damage to any of the body’s organs or major systems, even when used chronically.¹

Methadone Side Effects

Side effects are more commonly experienced at the beginning of treatment and during periods of dose adjustment. Once you get stabilized on an effective dose, side effects will often diminish.

People using methadone may experience some or all of these more common side effects:

• Sedation – Methadone, like all opiates, can make you feel a little bit sleepy. This sedation tends to lessen as you get more accustomed to using the medication over time. You may feel excessively sleepy when your daily dosage is too high.
• Sweating – Many people experience increased sweating while on methadone, and for some people, this is a side effect that does not dissipate in time and must be managed by other means, such as by the use of light and breathable clothing.
• Constipation – This is one of the most commonly experienced side effects of methadone. This is best managed by natural means, such as by increasing the fiber in your diet or by increasing your activity level.
• Changes in Sex Drive – Some people find that methadone interferes with sex drive (some people find that it increases sex drive). If your medication is reducing your sex drive, it’s best to talk to your doctor about the problem.²
• Itchiness and Flushing
• Weight Gain – A few extra pounds are a common side effect of methadone. It may not be the drug, however, that is causing the weight gain, and it may just be a return to greater health and the restoration of a healthy appetite that leads to weight gain on methadone.

Other possible side effects include dizziness, headache, nausea or vomiting and respiratory depression.³

There are a substantial number of more rare or very rare side effects that are also possible. In general, people are able to tolerate methadone well and the side effects of this medication tend to be greatly less severe than the side effects of abusing recreational opiates – in fact,  the most common side effect experienced by people on methadone compared to people abusing recreational opiates is improved health and well being!

The three stages of treatment with Suboxone are:

The Induction Phase

This is the introductory stage. Before you take Suboxone for the first time, you must have no opiates in your system and be in a state of moderate opiate withdrawal. If you do not wait until in opiate withdrawal before taking suboxone, you risk precipitated withdrawal (sudden extreme withdrawal).¹

The length of time you must wait after last using opiate drugs before beginning treatment with Suboxone depends on the half life of the drug you have been using. Drugs like heroin or OxyContin have a short half life and so exit the body within hours. It is recommended that people using short acting opiates wait between 12 and 24 hours following last use before initiating treatment with Suboxone. Other drugs, such as methadone, have a very long half-life, and so if you have been using a long acting opiate you must wait longer before initiating Suboxone treatment.

Once in a state of withdrawal you will take your first dosage of Suboxone or Subutex under observation in a doctor’s office. If you have no adverse reactions and respond well to the treatment, your dosage will be adjusted until you have no further opiate withdrawal symptoms or drug cravings.

The induction phase will take about a week, on average. The goal of the induction phase is to find a Suboxone dosage that provides best relief from withdrawal symptoms and drug cravings.

The Stabilization Phase

Once you no longer feel any opiate withdrawal symptoms due to your use of Suboxone, and you are no longer abusing opiates, you are considered to have entered into the stabilization phase. The stabilization phase lasts until you start feeling very stable and strong on Suboxone and very able to resist the abuse of opiates.

The stabilization phase lasts between 1 and 2 months, on average.

The Maintenance Phase

Patients that are doing very well on a steady dose of Suboxone are considered to have entered into the maintenance phase of treatment. There is no set duration for this stage of treatment, and some people may choose to stay in the maintenance stage with Suboxone indefinitely.²

Ending Treatment

People will end treatment with Suboxone by tapering down their dosage until they reach complete cessation of use. Suboxone tapering begins either at the end of the stabilization phase or the end of the maintenance phase.

Suboxone won’t work for everyone. Some people won’t find that Suboxone offers enough relief from withdrawal symptoms and these people will need to take methadone to get full relief from withdrawal symptoms and drug cravings. To understand why, you need to understand the drug's ceiling affect

The Ceiling Effect

Suboxone has a ceiling effect. Taking greater dosages of Suboxone results in greater effects until a ceiling of effective action is reached - and after that, taking additional Suboxone will not result in greater effects. Some people with very high opiate tolerances require more opiate receptor activation than Suboxone can possible provide – these people are not appropriate candidates for Suboxone.

Many people coming off heavy OxyContin or heroin habits will need a 100 mg or more of methadone a day to experience relief from withdrawal symptoms. People needing this amount of methadone will not find that Suboxone is able to provide sufficient relief from withdrawal symptoms.

• A meta analysis of research studies has shown that Suboxone is more effective than 25 – 35 mgs of methadone a day, but less effective than 50 – 80 mgs of methadone per day.

• At a dosage of between 8 and 16 mg per day, Suboxone is about as effective as a 60 mg daily dose of methadone.¹
  

Although because of its easier withdrawal and take home doses you may prefer the thought of Suboxone over methadone, what is most important is that you get a medication that works well for you, and that offers you full relief from withdrawal pains and drug cravings. Talk to your doctor about your options, and choose the medication that’s going to work best for you.

Suboxone is an effective drug used in the treatment of opiate addiction. It works similarly to methadone, but unlike with methadone treatment, you do not have to travel to a methadone clinic each day to take your medication, you can instead be prescribed a month’s dosage as take-home.

Because of this, and because of some other significant advantages, many prospective patients prefer the thought of Suboxone over methadone, but not everyone who wants buprenorphine can or should take it.

Before your doctor agrees to prescribe you Suboxone, she will want to run through a checklist of possible contraindications, to make sure that you will be able to use Suboxone safely and effectively.

Suboxone May Not Appropriate for People Who:¹

• Are dependent on or abusing benzodiazepines or alcohol
• Are homicidal or suicidal
• Have a serious untreated concurrent mental illness
• Have tried maintenance treatment without success on multiple occasions
• Have tried treatment with Suboxone before, with poor success
• Have serious medical complications or medical complications that are beyond the knowledge base of the prescribing doctor
• Are not likely to follow a prescribed treatment plan
• Are not likely able to use or store Suboxone safely
• Do not understand how Suboxone treatment works
• Are pregnant
• Are taking medications that will interact with Suboxone
• Have a very poor recovery environment

If none of the above contraindications describe your situation, then you may be an appropriate candidate for office based take home treatment with Suboxone. Some people however, even those who would otherwise be appropriate candidates, cannot use Suboxone as it is not strong enough for their needs. Suboxone has a ceiling effect. After a certain daily dosage, taking additional suboxone results in no additional effects. Some people with heavy opiate habits, such as those who were using high doses of heroin daily, will not find that Suboxone is able to provide sufficient relief from withdrawal symptoms. These people will need to use methadone instead.

A person dissatisfied with Suboxone treatment can easily switch over to methadone, but methadone users cannot as easily switch to Suboxone.

Why Is It Difficult to Switch from Methadone to Suboxone?

There are 2 primary reasons why it can be tough to switch from methadone to Suboxone:

1. Methadone is a full opiate agonist and so it’s a lot stronger than Suboxone

Methadone is a very strong, full agonist opiate medication and Suboxone is a partial opiate agonist medication. Taking additional doses of Suboxone provides additional relief from withdrawal symptoms until this dosage ceiling is reached – and after that, taking more Suboxone has little extra effect.

People on moderate to high daily doses of methadone are receiving opiate receptor activation at a level that is above what Suboxone can provide, at any dosage. If someone switches from a moderate to high daily dosage of methadone to a high daily dose of Suboxone, they will experience a dramatic decrease in opiate receptor activation – which will result in opiate withdrawal symptoms.

Because of this, people wanting to switch from Methadone to Suboxone are advised to reduce their daily methadone dosage down to 30 mg a day for at least a week prior to switching (the switch can occur at higher daily doses, in some cases). ¹

2. Methadone has a long half-life, and so stays in the body for a relatively long time

You must be experiencing significant opiate withdrawal symptoms before you take your first dosage of Suboxone. Methadone is a long lasting medication that stays in the body for a long time and so you must wait at least 36 hours (or longer) before taking your first Suboxone pill. Because withdrawal symptoms can emerge slowly, this can be an uncomfortable wait.²

Image Copyright: Michael Sharman

complications including a significantly elevated risk of miscarriage. Although you may wish to quit using opiates entirely upon learning of a pregnancy, the withdrawal symptoms of an opiate detox can be very hard on the fetus and can result in miscarriage as well. Fortunately, methadone (and in some cases, buprenorphine) is proven a safe and effective medication for use by pregnant women. Methadone is the recommended treatment for pregnant opiate abusing women.

Why take methadone (or Suboxone) during a pregnancy? - As a mom to be, you want to do what’s best for your baby, and getting on something like methadone, which causes a withdrawal syndrome in newborns, may not feel like the right thing to do.

While it’s obviously preferable for a pregnant women to abstain from all opiates, those who become pregnant while addicted to opiate drugs should not try to quit ‘cold turkey’ and should rather use an opiate substitution medication, like methadone, to manage drug withdrawal symptoms and to maintain better health.

Although your natural impulse after learning of a pregnancy may be to abstain from future drug use to safeguard the fetus, the sudden cessation of opiate drugs is very difficult on the unborn child (as it is on the mother) and is likely to result in miscarriage. Additionally, opiate abusing women who attempt to quit without appropriate addiction treatment and assistance are at high risk of relapse back to opiate abuse – which greatly increases the chances of pregnancy complications.

Although taking methadone while pregnant may seem a bit strange, methadone is the gold-standard treatment for pregnant women – the treatment that is most likely to promote good health in mother and child.

The Risks of Opiate Abuse during Pregnancy

Opiate abuse may have affected your health and if you abuse opiates during your pregnancy, you are putting the health of the unborn child at risk as well. Getting treatment for your addiction while pregnant lets you regain personal health and wellness prior to delivery as it also reduces the odds of medical complications that can be directly caused by the abuse of opiates.

Opiate abusing women are statistically more likely to suffer from disorders that can affect the unborn child or be transferred during childbirth, such as STDs, HIV/AIDS, Hepatitis B and C and others.

The abuse of opiates during pregnancy can cause medical complications that may include:

• Reduced fetal growth
• Intrauterine death
• Insufficient placenta
• Hemorrhage after birth
• Preeclampsia
• Premature delivery
• Miscarriage
• Others

Abusing opiates during pregnancy put mother and child at greatly increased risk of poor outcomes.

Methadone during Pregnancy

Methadone has been intensely studied for more than 50 years, and it is a confirmed safe drug for mother and child during pregnancy. As a long acting opiate, mothers taking methadone maintain a very stable level of the opiate drug in the blood, which spares the fetus the stress of intoxication and withdrawal cycling each day.

Additionally, women taking methadone have frequent contact with medical staff, and ideally (often) this results in improved prenatal care for mother and child. This improved prenatal care is associated with a further reduction in medical complications.

Methadone is considered the gold standard of care for opiate abusing pregnant women and it is FDA approved for the treatment of this population.

In the past, mothers on methadone have attempted to reduce their methadone dosage over the course of a pregnancy to spare the unborn child methadone withdrawal symptoms after birth. Research has not shown that reducing the dosage of methadone reduces the likelihood of neonatal abstinence syndrome (NAS) but studies have shown that women who attempt to taper down their dosage while expecting have

• Decreased weight gain
• More illicit drug abuse
• Less compliance with prenatal care guidelines
• Lower birth weights
• Smaller infant head circumferences
• Slower fetal growth
• Premature delivery

Methadone and Neonatal Abstinence Syndrome (NAS)

One of the biggest concerns most women have while pregnant and on methadone is the probability that their infant child will suffer through an opiate withdrawal syndrome in the first days of life.

Between 60% and 80% of infants born to mothers using methadone will experience NAS symptoms. Symptoms generally begin within the first 2 to 3 days, but can be delayed by as much as 4 weeks. Symptoms generally endure for between 10 and 21 days, but can last as long as 42 days.

Symptoms of NAS include:

• Irritability and a characteristic shrill crying
• Oversensitivity to external stimulation
• Tremors
• Frantic sucking on digits, which can interfere with the ability to feed normally
• Vomiting and diarrhea
• Rapid respiration
• Fever
• Yawing
• Others

Infants with NAS can be treated with medications, such as tincture of opium, which reduce the severity of withdrawal symptoms. Keeping these infants in rooms with low stimulation and swaddled can also reduce distress.¹

Women on methadone can breastfeed normally.

Buprenorphine during Pregnancy

While methadone is the accepted standard of care drug for pregnant opiate addicted women, doctors may, in some cases, decide that buprenorphine is a better choice.

Due a lack of controlled study data demonstrating the safety of buprenorphine for use by pregnant women, the FDA has not yet approved buprenorphine for use by pregnant women unless the benefits of its use outweigh the potential harms of non use. When doctors choose to prescribe buprenorphine to pregnant women, they will customarily prescribe Subutex (buprenorphine only) rather than Suboxone (buprenorphine and naloxone), to reduce the risks of precipitated withdrawal on the fetus.

Initial case studies of buprenorphine (the active ingredient in Suboxone and Subutex) on pregnant women indicate that it is a well tolerated and effective medication for use by pregnant women.

Doctors may choose to use buprenorphine during a pregnancy in some situations, such as:

• When methadone services are locally unavailable
• The patient cannot tolerate methadone or refuses to use it
• The patient has been informed of the risks of buprenorphine use during pregnancy (a lack of studies)

Using buprenorphine during pregnancy can result in neonatal abstinence syndrome (NAS)

In clinical studies, about half of babies born to women using buprenorphine suffered from NAS that was severe enough to merit treatment. Women in these studies may have been using other drugs that exacerbated the NAS, and so buprenorphine only may result in NAS less frequently.

Buprenorphine NAS symptoms most typically peaked within 3 or 4 days and dissipated within a week.²

The Importance of Integrated Addiction Treatment and Prenatal Care

Opiate addicted pregnant women generally benefit from more than basic addiction treatment. Women emerging from a period of opiate addiction may need assistance in developing good health, stability in financial, relationship and housing situations and readiness to be a good parent. For best outcomes for mother and child, opiate addiction treatment should include elements such as³:

• Prenatal care
• Family therapy and relationship counseling
• Parenting classes
• Assessment and support for those enduring domestic violence, financial problems and housing issues
• Testing for infectious diseases

Getting Help

Although taking an opiate medication while pregnant seems wrong, decades of research have proven that methadone (or buprenorphine, in some situations) is the best treatment available for both mother and child during pregnancy.

If you are pregnant and abusing opiates, getting into a methadone treatment program, getting your life back on track and really getting prepared to be a good mother is the best way to start taking care of you and your child.

Getting into a methadone or Suboxone treatment program and off the abuse of opiates is a monumental step to better health and a better life, but medication alone is rarely enough! Those that give themselves the best chances of a lifetime of recovery take the time of stability that medication offers and use it to take back control of their lifestyle, their finances, their relationships and social support network and many other things. Read on to find out what must be done during maintenance treatment before you can begin thinking about tapering off your medication.

Although some people may choose to use Suboxone or methadone indefinitely as a form of lifetime maintenance treatment, most people will eventually decide to discontinue their use of these medications; and when they do, they once again face an elevated risk of relapse back to opiate abuse.

In general, longer periods of methadone and Suboxone treatment are associated with better eventual outcomes, and the National Institute on Drug Abuse (NIDA) recommends that 1 year be considered a minimum period for the use of methadone treatment.

Once off methadone or Suboxone, you will likely once again experience increased drug cravings. You need to be prepared for this.

A sufficient period of Suboxone or methadone treatment lets you get your life back on track without having to worry about drug cravings and withdrawal symptoms while doing so. Over time, once you have built your strength and social support networks up, you are in a much better position to resist temptation and are more likely going to be able to stay addiction free, even without medication assistance.

Although you may not feel like you need counseling and other forms of addiction treatment while on Suboxone or methadone, this treatment assistance can prove invaluable as you work towards stability and emotional health in your daily life – putting you in a far stronger position for an eventual attempt towards ending your use of Suboxone or methadone.

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If a person uses Suboxone or methadone as prescribed then no more is she a drug addict than is someone physically dependent on blood pressure medications! Addiction and physical dependence are not the same. Although a person on Suboxone or methadone will need to take their medication each day, they will not experience the compulsions or harms from use that are characteristic of addiction.

People using methadone or Suboxone as directed for the treatment of an opiate addiction are not drug addicts, although they still physically dependent on opiates.

To understand the difference it is important to understand the difference between Physical Dependence and Addiction.

Physical Dependence

The body naturally adapts (physical changes occur) to the use of certain drugs and medications, and the sudden cessation of use of such medications can lead to withdrawal symptoms.

Opiates cause physical dependence and so the use of medications like methadone and Suboxone will result in a state of physical dependence and upon cessation of use, a period of drug specific withdrawal symptoms.

Other medications that produce physical dependence include certain anti depressants, anti anxiety medications, beta blockers for high blood pressure and others.

Although someone using beta blockers to control high blood pressure would experience withdrawal symptoms upon the sudden cessation of use, you would hardly call a person using such a medication on a daily basis a drug addict!

Addiction

The American Academy of Addiction Medicine considers addiction to be a chronic condition that is characterized by behaviors such as a loss of control over the use of drugs or alcohol, using drugs or alcohol compulsively, craving the substance and using this substance despite obvious harms from its use. ¹

A person using methadone or Suboxone as prescribed will take just enough of their medication each day to feel normal, not high. They will not lose control over their use, not use their medication compulsively, not crave their medication and experience benefits, not harms, from their use. By all measures, the use of methadone or Suboxone as an addiction treatment does not equate to an addiction.

Break Free from Addiction with Methadone or Suboxone

Although while using methadone or Suboxone you will remain physically dependant on opiates, by switching from opiates of abuse (heroin OxyContin, etc.) to methadone or Suboxone you end your compulsive use of opiates and all the harms that are associated with such a loss of control.

Methadone and Suboxone aren’t perfect medications, and if you decide to stop using these drugs you do need face a period of opiate withdrawals, but once stabilized on wither of these medications you’ll no longer get high each day and you’ll no longer feel a desperation to use or to get the money you need to use. Once stabilized on methadone or Suboxone, you’ve broken free from addiction and from there you’ve got an excellent chance to get your life back on the right track. ²

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Pain often leads to pain medication – which too often leads to addiction – but what do you do when trying to overcome an opiate addiction but still have need for acute or chronic pain management? Here is a brief guide to treating pain while on Suboxone.

For people in recovery from opiate addiction, the treatment of severe pain presents some challenges.

Pain management should, ideally, first be attempted with non opiate based analgesics, such as anti inflammatory drugs, and/or with other therapies, such as physical therapy. If such treatments do not control pain, then stronger medications are needed – no one should have to live through pain being denied medication that can control it.

Managing Strong Pain While on Suboxone

Although the buprenorphine in Suboxone is an analgesic, it may not be strong enough to provide relief from severe pain – additionally, because the onset of analgesia can be slow, Suboxone may not work quickly enough to manage acute pain satisfactorily.

Buprenorphine has a very strong affinity for the opiate receptors in the brain. If, after taking buprenorphine, you try to take another opiate analgesic for pain relief, the buprenorphine will block access to these opiate receptors and you will experience no real benefit from the additional analgesic taken.

Because of this:

• Patients needing temporary opiate treatment for severe pain should stop taking Suboxone for the duration of their temporary need for pain management. Once pain becomes manageable with non-opiate based medications, the patient can resume Suboxone treatment. Until the buprenorphine in Suboxone clears the body, patients may need temporarily higher than normal doses of short acting opiates to achieve sufficient pain relief

• Patients needing chronic opiate treatment for lasting pain are not good candidates for Suboxone treatment, and should consider treatment with methadone instead. ¹
  

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Suboxone is an opiate replacement drug that takes away opiate withdrawal symptoms and drug cravings without getting you high. Suboxone is a medication that works similarly to methadone, but unlike methadone, it can be taken home in month long doses and it doesn’t cause such a difficult withdrawal. If you’re addicted to opiates, Suboxone can get you feeling normal again so you can get your life back on track.

Suboxone is an FDA approved medication that is used to help people stop abusing opiate drugs.

Suboxone helps people by taking away the symptoms of opiate withdrawal and drug cravings that are normally associated with quitting or reducing use. Suboxone is an opiate replacement drug. You replace your opiate of abuse (heroin, OxyContin for example) with Suboxone, an opiate that won’t get you high but that will keep you from feeling sick.

Suboxone works similarly to methadone, but there are some significant differences. Suboxone can be taken home in month long doses, it is a safer medication than methadone and it is easier to stop using Suboxone than methadone.

What’s in Suboxone?

Suboxone contains 2 active ingredients:

1. Buprenorphine
2. Naloxone

Buprenorphine is a partial opiate agonist. It enters the brain and fills and activates the opiate receptors, like opiate drugs do. With opiate receptors filled, the body does not go into opiate withdrawal and drug cravings are lessened or eliminated. However, as buprenorphine is only a partial opiate agonist it does not stimulate the opiate receptors enough to cause intoxication in someone with an opiate tolerance.

After you take suboxone, the buprenorphine in the medication fills your opiate receptors and you stop feeling sick, you stop craving drugs and you don’t get high. Using suboxone, you start to feel normal again and you can get your life back on track.

Naloxone is an opiate antagonist that is added to Suboxone to reduce the likelihood of abuse and diversion.

• If you take Suboxone as directed, the naloxone within is not activated and does nothing.
• If you try to abuse Suboxone (injecting it, for example) the naloxone is activated. Once activated, the naloxone fills the opiate receptors in the brain and turns them off all at once. With all opiate receptors inactivated at once, you go into immediate and intense opiate withdrawal. The naloxone blocks other opiates from activating these receptors, so taking opiates after naloxone has no effect – once in a precipitated naloxone withdrawal, there is no reversing it.

The naloxone in Suboxone makes it a difficult drug to abuse. This makes it safer for the user and enables doctors to prescribe this medication in mont- long take home doses. Methadone, which is very easily abused, is much more tightly regulated.

How Do You Get Suboxone?

Suboxone can only be prescribed by doctors that are specially licensed to do so, and these doctors can only prescribe Suboxone to a limited number of patients. Ask your doctor for a referral to a Suboxone prescribing doctor, or visit the federal govt. buprenorphine physician and treatment locator.

Suboxone isn’t a miracle cure to drug addiction. You will still need to work your recovery and staying drug abuse free always takes effort and commitment. Taking Suboxone, however, gets you feeling normal and healthier again in a hurry, and from there you are in a much stronger position to work on your continuing recovery.

Opiate withdrawal symptoms normally strengthen gradually over a period of hours or days, but in precipitated withdrawal, a medication can cause the emergence of full strength – agonizing - opiate withdrawal symptoms almost instantly.

Nobody would ever want to experience precipitated withdrawal, so it’s important to understand the 2 ways that Suboxone can lead to it and so learn how to avoid it for sure.

Once you go into precipitated withdrawal after using Suboxone incorrectly, it is very difficult to reverse it. In a normal situation, opiate withdrawal symptoms can be eliminated through the ingestion of an opiate – this will not work for Suboxone caused precipitated withdrawal!

The 2 ways that Suboxone can lead to precipitated withdrawal are:

1. Taking Suboxone Too Soon for the First Time

Buprenorphine (the active ingredient in Suboxone) has higher affinity for the opiate receptors in the brain than opiates of abuse (like heroin or OxyContin, for example).

What this means is – if you are on an opiate drug and you take Suboxone, the buprenorphine in Suboxone will flood the brain, kick out the opiates from the opiate receptors and then fill and block these opiate receptors.

Buprenorphine only partially activates the opiate receptor, unlike regular opiates which fully activate this receptor, so when these receptors are suddenly filled with buprenorphine instead of the opiate they were filled with only moments before – the net result is a sudden and dramatic loss of activation of these opiate receptors. And it is when these opiate receptors do not get sufficiently activated that we experience opiate withdrawal symptoms.

It is for this reason that you must wait until you are experiencing opiate withdrawal symptoms before you can take your first dose of Suboxone. Once you are experiencing opiate withdrawal symptoms, many of your opiate receptors in the brain are already insufficiently activated, and taking Suboxone serves to increase this activation, thus reducing the discomfort you feel.

2. Injecting Suboxone

Suboxone contains 2 active ingredients, buprenorphine and naloxone.

• If Suboxone is taken as directed, sublingually (under the tongue) then the naloxone is not well absorbed and has little or no effect.
• If Suboxone is injected, the naloxone in the medication floods the brain.

Naloxone, like buprenorphine, also has a very high affinity for opiate receptors and it will also ‘kick out’ any opiates from opiate receptors and fill these receptors itself. Unlike buprenorphine, however, naloxone will not partially activate these receptors, it will fully de-activate them – resulting in a sudden complete loss of opiate receptor activation and an immediate entry into a full state of opiate withdrawal.

Naloxone is added to the Suboxone formulation to limit the medication’s abuse potential.

Take Suboxone as Directed

If you follow your doctor’s instructions, wait until you are in opiate withdrawal prior to taking your first dose and never attempt to abuse this medication, you do not have to worry about precipitated withdrawal.

It is your own best interest to follow your doctor's instructions!