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What
causes people to abuse drugs?
The underlying causes of drug abuse involve biological, psychological,
and social/environmental factors.
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.
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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. |
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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).
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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.
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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. |
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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. |
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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.
Absence of Serious
Adverse Effects: When taken as prescribed, long-term
administration of methadone causes NO adverse effects to the heart,
lungs, liver, kidneys, blood, bones, brain or other vital body organs.
Minor side effects - constipation, water retention, drowsiness,
skin rash, excessive sweating, and reported changes in sexual libido
- may occur during the initial stages of treatment. These symptoms
subside or disappear as methadone dosage is adjusted and stabilized,
or when simple medical interventions are initiated. The myth that
methadone is physically harmful has been shown scientifically to
be unfounded.
Absence of Harmful
Medication Interactions: No harmful interactions
have been noted between methadone and other medicines. Patients
with conditions such as HIV/AIDS, hypertension, diabetes, pneumonia,
cardiac conditions, cancers, psychiatric disorders, etc., may be
treated effectively with routine regimens and medications. Coordination
of methadone with certain other drugs is necessary. Dilantin for
epilepsy and Rifampin for tuberculosis increase the body's metabolism
of methadone and thus prompt the need for methadone dosage increase.
Opiate agonist/antagonist drugs (such as Talwin and Buprenorphine)
should not be prescribed for methadone treated patients, as they
will produce opiate withdrawal illness.
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:
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Decrease
criminality and reduce the numbers of substance abusers entering
the criminal justice system. |
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Assist
patients in addressing multiple substance abuse (including crack/cocaine
addiction and alcoholism). |
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Assure
treatment for general health matters, especially those related
to drug use, such as HIV/AIDS, tuberculosis and hepatitis. |
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Promote
patient employability and educational development. |
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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:
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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. |
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Applicant
must also be over 18 years of age. |
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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.
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