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Bored

The following letter asks a number of very good questions related to opioid use. The most important is the effect of boredom on drug usage.

Letter

In the past 20 years I have been a recreational drug user. Intermittently, I've done most drugs in most ways. I've been blessed with good genetics and a good, educated brain; habituation and addiction have never kicked my ass. I was hooked on narcotics briefly, but I detoxed by myself. Afterwards, I left them alone for years: never craving, never doing all the mental emotional BS that the terminal-12 steppers insist everyone go through.

Twenty years later I had health problems: cancer (I survived chemotherapy!), Fibromyalgia, and a host of genetic and other medical disorders that are both invisible and hard to pronounce. It all left me a chronic pain sufferer. Kind doctors have put me on methadone, which, in the right dose, makes life livable.

However, now I am experiencing the feelings of "addiction": I crave heroin; I crave injection. It's making me crazy. Why is methadone so powerfully addicting, when my years with heroin were nothing for me to control.

What's more I'm worried that my insurance will cut out because I may need to take disability. There seems to be a lack of information on methadone withdrawal, mixing drugs, and so on.

What is methadone withdrawal like? How long does it take? Is it worse than heroin withdrawal? If I need to do it to cut back medications, can I do it at home (I'm tough)?

I have access to pharmaceutical diazepam (Valium®) in injectable form and have been doing it off and on. What effects of IV Valium® should I be aware of? It seems to diminish the craving for heroin and feeds the injection craving, but I am mixing it with methadone (oral). Are there special problems mixing these drugs?

I have always had an emergency kit with Narcan in the house. Does Narcan reverse an overdose from methadone as well as morphine/heroin? There are times my regular pain dose leaves me laid out and I worry that one time, I'll be too laid out, so this isn't just an issue of my recreational drug use.

As to why I don't want to chat with my doctor about this: my doctor only knows my medical history, not my recreational history. It is not her business to know my past, it's only her business to treat me in the now.


Answer

First on my mind is your craving. I have a hunch that your medical problems have left you unable to work or at least less able to work. I think this because I suspect your craving has more to do with being bored than it does with taking methadone. Even if I'm wrong, you should look at your lifestyle and see if anything has changed. The best deterrent to addiction is an active family/social life. If your condition is limiting your options, I highly recommend that you cultivate new interests to entertain yourself and keep your recreational drug use, well, recreation.

Methadone for Pain

I'm glad your doctor is prescribing methadone. It is an excellent drug and is under-utilized because of its association with heroin addiction. Chronic pain sufferers are still more likely to get short-acting opioids straight or time-released (the effective half-life of oxycodone in OxyContin® is only 50% greater than for immediate release - 4.5 hours instead of 3 hours - big deal). It's very hard to stabilize people on these. But methadone is no longer under patent, so doctors don't get glossy advertisements for it; and intelligent people always base their decisions on advertisements - especially doctors.

I wouldn't worry about your insurance cutting out. As long as you can still get to a doctor who will prescribe methadone, it is very cheap. Methadone in pill form cost 0.1 cents per mg. That means 100 mg of methadone per day will cost you 10 cents or $3.00 per month. Be careful that your doctor keeps you on methadone and doesn't change you to something expensive like OxyContin® without extremely good reason.

Methadone Withdrawal

Methadone withdrawal is very similar to heroin withdrawal. It is not as intense - it never gets as bad. On the other hand, it lasts longer. Whereas heroin withdrawal (primary) is over in roughly 5 days, methadone withdrawal lasts about 2 weeks. It is very easy to wean from methadone, however. In fact, you should not do a cold turkey withdrawal from methadone - especially if you are not in the best health.

Mixing Opioids with Benzodiazepines

Valium® is a member of the benzodiazepine family. This family also includes Xanax®, Librium®, and Klonopin®. High intravenous doses of benzodiazepines cause retroactive amnesia. This is very similar to an alcoholic black-out, and makes their recreational use limited.

You should be very careful with any benzodiazepine--they should not be mixed with opioids. They potentiate the effect of opioids and can causes overdoses. They affect the body very much the same as alcohol does, so any warnings about alcohol apply to benzodiazepine.

Narcan

It is good to have the emergency kit. In some countries, such kits are given away at syringe exchanges and overdose deaths have decreased. Narcan will work to offset the effect of any opioid, including methadone. It is not effective on Valium®, but that doesn't really matter because it is the combination that is deadly. If you stop the effect of the opioid, you stop the problem.

Remember that Narcan is only effective if someone is around to administer it. I know that probably sounds obvious, but you'd be surprised at what people forget. If you live with someone, you should discuss how the Narcan should be administered before it is needed. During an emergency is not the time to learn.

You must be careful with the dosing of Narcan. Since you are physically dependent upon methadone, too large a dose will bring on withdrawal. If the Narcan dose is very high, the withdrawal could be dangerous and even fatal.

Dealing with Doctors

Your concern about your doctor is valid. Once a doctor knows that you have "abused" drugs (any use of a drug not exactly in accordance with the medical theocracy is considered abuse), she will not treat your pain properly. At least this is true of 90% of doctors. Opioid addicts require more opioids than normal when they are in pain (understandably). Most of the time they are given less.

Just the same, in some cases your drug use history will be important to your doctor. It is hard to say when you should supply what information to your doctor. This is one of the worst results of making doctors the gate-keepers of narcotics.

by Dr. H © 2003
Last Modified: 10 January 2004


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