What causes people to abuse drugs?
	What are the characteristics of heroin addiction?
	What are the physical, social and economic consequences of heroin addiction?
	Why do heroin addicts seek treatment?
	What is methadone treatment for opiate addiction?
	What is appropriate methadone dosing?
	Is methadone treatment medically safe?
	Does methadone treatment impair mental function?
	What other pharmacotherapies may be useful in the treatment of opiate addiction?
	How is success in methadone and other pharmacotherapy treatments defined?
	Who is eligible for methadone treatment?
	How are methadone treatment programs monitored?

Study of the biological basis for addiction has revealed brain mechanisms and body chemistry changes involved in drug abuse. Basic medical research has now strongly established that addiction is a chronic, relapsing disease of the brain, with a range of physical, behavioral, social and public health manifestations.

The psychological factors associated with drug abuse are the most familiar to the public. Psychological theories suggest that people abuse drugs in an attempt to self-medicate to avoid unpleasant feelings or emotions, and to escape from the pressures and realities of living. It is generally held that addicts are taking drugs to feel better/normal (self-medicating) or to feel good (sensation-seeking).

Social/environmental factors are also critical. Family and cultural beliefs about drugs and alcohol, family substance use, availability of drugs in the community, and acceptability of use within the social environment and peer group may contribute to drug use. Unemployment, poverty, poor housing, homelessness, and educational deficits also correlate with increased drug use.


What are the characteristics of heroin addiction?

Physiological/Psychological Characteristics: The effects of heroin last four to six hours and during the initial period of use, are highly pleasurable (euphoria, pain relief, calming). To continue feeling these desired outcomes, however, increasing amounts of the drug must be used to achieve the same effect. This is known as 'tolerance'. The user may at first inhale ("sniff") heroin or inject it into the skin or muscle, but as tolerance builds, direct injection into a vein (commonly known as 'mainlining') often results.

As the addiction develops, the individual requires shorter intervals between doses and increasing amounts of heroin to avoid withdrawal symptoms, which include muscular and abdominal pains, chills, nausea, diarrhea, yawning, runny nose, generalized weakness and insomnia. Even after the acute phase of the withdrawal syndrome is over (48 to 72 hours), individuals may experience prolonged symptoms, including irritability, insomnia and drug craving, for months after drug use has stopped.

Social/Behavioral Characteristics: As addiction develops, the individual's life increasingly focuses on drug-related endeavors, with consequent inattention to daily responsibilities and needs. Basic changes in the individual's activities, self-image and relationships usually emerge. Since the addicted person must, with rare exception, deal with a criminal market, a way of life evolves which commonly entails physical and emotional hazards, general deterioration of health and hygiene, and isolation from most non-dependent friends, associates, and family. The short-acting nature of heroin precludes stability in daily living.

What are the physical, social and economic consequences of heroin addiction?

Physical Consequences: Heroin users often experience extreme deterioration of health. They are at high risk for infections, drug overdose HIV/AIDS, Hepatitis B and C, sexually transmitted diseases, and tuberculosis.

	Use of heroin by needle injection poses risk of improper injection or contact with unsterile needles that cause infections such as septicemia (blood poisoning), endocarditis (infection of the heart lining), skin abscesses, and tetanus, or accidental injection of air leading to rapid death.
	Sharing of needles, syringes and other injecting equipment substantially increases the occurrence of hepatitis (inflammation of the liver), and risk of exposure to the Human Immunodeficiency Virus (HIV).
	Heroin users have been observed to have abnormalities in cellular immunity, compromising overall immune system function.

Social/Economic Consequences: Regular users often have difficulty maintaining concentration and alertness.

	With life pursuits focused on drug procurement and related activities, family and friends uninvolved in drug use may be disregarded. Sexual function and interest is often impaired and intimacy inevitably suffers. Family stability is threatened.
	While some can manage jobs, the urgency involved in maintaining heroin use often results in lateness, absenteeism, performance deficits and alienation at the workplace, if not ultimate job loss.
	If financial resources are insufficient to support the addiction, family and housing stability are threatened and criminal activity as a means of support may arise.

Why do heroin addicts seek treatment?

The impetus to stop heroin use and seek treatment may derive from complete exhaustion and 'burnout' from addiction's harsh and demanding lifestyle: or it may arise from fear of the dangers of street life or serious illness. The catalyst may be pressure from family, friends, employers, the legal system, or personal financial cost. It can also be the result of repeated unsuccessful personal attempts to stop heroin use, or of personal, family or economic collapse. Opiate dependent individuals seek professional help to find support for change, to handle life stress, to break unhealthy connections with drug-related associates and places, to regain a sense of stability, and to repair health and social problems.


What is methadone treatment for opiate addiction?

Methadone treatment provides the chronic opiate dependent person with health, social and rehabilitational services, and medically prescribed methadone to relieve withdrawal symptoms, reduce opiate craving, and allow normalization of the body's function. Methadone treatment has been the most widely studied approach to opiate addiction and has been in use effectively for over thirty-five years.

Methadone treatment programs are staffed by professionals with extensive medical, clinical and administrative expertise. Patients receive individually prescribed methadone medication from a licensed medical staff member (physician, registered physician's assistant, registered or licensed practical nurse, or pharmacist). Patients routinely meet with a primary counselor (social worker, caseworker, or certified substance abuse counselor), attend clinic groups, and access medical and social services.

What is appropriate methadone dosing?

Methadone is a medication, and like all mediations, proper dosing is contingent upon the patient's individual needs. Taken orally, methadone is rapidly absorbed from the gastrointestinal tract, appears in plasma 30 minutes after ingestion, and peaks one hour later. Methadone is also widely distributed to body tissues where it is stored and then released into the plasma. This combination of storage and release keeps the patient comfortable by preventing opiate withdrawal. As is the case for any other medications (such as insulin or antihypertensives), proper methadone dosing is determined through the doctor-patient relationship, taking into account the patient's medical assessment, individual metabolic needs, and other medical conditions and treatments. Attitudes or opinions about methadone dosing that are based on rationale other than scientific evidence on effective dosing detract from the potential value of methadone treatment.

Is methadone treatment medically safe?

Research and clinical study, particularly the ongoing work of Dr. Mary Jeanne Kreek of Rockefeller University, has demonstrated the unequivocal medical safety of long-term methadone treatment.

Safe for Pregnant Women: With proper stabilization, sexual function normalizes for both men and women in methadone treatment. Women can conceive and have normal pregnancies and deliveries. When properly prescribed for pregnant women, methadone provides a non-stressful, non-eventful environment in which the fetus develops. Because methadone crosses the placental barrier, babies born to methadone patients may at first be physically dependent on methadone, and may need to be weaned. Successful weaning using Paregoric is well established and uncomplicated. These children show normal physical, emotional, and cognitive development. The myth that methadone produces abnormalities in fetuses is unfounded.

Does methadone treatment impair mental function?

Methadone treatment has no adverse effects on intelligence, mental capability, or employability. Methadone treated patients are comparable to non-patients in reaction time, in ability to learn, focus, and make complex judgments. Methadone treated patients do well in a wide array of vocational endeavors, including professional positions, service occupations, and skilled, technical and support jobs. Methadone patients are lawyers, engineers, secretaries, truck or taxi drivers, roofers, gardeners, teachers, salespersons, architects, computer programmers, etc. One recent study tested methadone patient's cognition, perceptual and motor functioning, reaction time, and attentional function, as well as performance of automobile driving behavior. It was concluded, confirming pervious findings, that methadone maintenance treatment does not impair functional capacity.

What other pharmacotherapies may be useful in the treatment of opiate addiction?

Naltrexone, a non-addicting long-acting narcotic agonist, was approved by the FDA in 1985, for the treatment of opiate dependence. It is effective from 1 to 3 days depending on dosage level, and it blocks the euphoric effects of heroin and other opiates. Thus far, research has demonstrated that naltrexone may be most helpful in preventing opiate relapse once an abstinence state has been achieved.

Naloxone is also a narcotic antagonist, blocking the effects of opiate drugs, but has a relatively short duration of action. It is used as an 'antidote' in treating opiate overdose by rapidly reversing the effects of opiate drugs.

Buprenorphine, which was approved for the treatment of opiate dependence by the FDA during October, 2002, is another medication. Early clinical findings suggest that Buprenorphine, a partial opiate agonist, is safe and produces few side effects of withdrawal symptoms.

How is success in methadone and other pharmacotherapy treatments defined?

The primary goals are to help chronic opiate dependent individuals cease heroin use and lead more stable, productive lives. But, as knowledge about opiate dependence and effective treatment practices has grown, so too have the objectives of most methadone treatment programs, which also aim to:

	Decrease criminality and reduce the numbers of substance abusers entering the criminal justice system.
	Assist patients in addressing multiple substance abuse (including crack/cocaine addiction and alcoholism).
	Assure treatment for general health matters, especially those related to drug use, such as HIV/AIDS, tuberculosis and hepatitis.
	Promote patient employability and educational development.
	Identify and treat mental health problems and alleviate homelessness, family substance abuse, and child and family dysfunction.

Reduction in illicit opiate use is the ultimate measure of methadone treatment's effectiveness. But 'success' in methadone treatment is also observed by positive outcomes in the patient's health and social functioning.

Who is eligible for methadone treatment?

In order to be admitted to methadone treatment, Center for Substance Abuse Treatment/SAMHSA standards require:

	A minimum of one year of addiction to opiates as well as current evidence of opiate addiction. Special circumstances apply to opiate dependent pregnant women, who may be admitted without demonstration of the one-year minimum.
	Applicant must also be over 18 years of age.
	If the applicant is under 18, (s)he must have parental consent and demonstrate at least two prior treatment episodes in either drug free treatment or short-term tapering.

Methadone treatment is voluntary and available to persons of any sex, ethnicity, and physical or mental condition, including pregnant women and mentally ill substance abusers.

How are methadone treatment programs monitored?

Methadone treatment is the most monitored and regulated medical treatment in the United States. Federal and state regulatory agencies monitor methadone treatment programs through on-site program reviews. At the Federal level, regulatory oversight is being moved in a multi-year initiative from the Food and Drug Administration to the Center for Substance Abuse Treatment, using an accreditation model. Programs also receive their license from the United States Drug Enforcement Administration.

Q's & A's from - "Regarding Methadone Treatment…and Other Pharmacotherapies." A Review. Committee of Methadone Program Administrators, Inc., New York, 1999.