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Detox Done Right (Part 1)

Methadone is best known as a "cure" for heroin addiction. The idea is to get heroin addicts addicted to methadone. This accomplishes two tasks. First, the heroin addict suffers from no withdrawal symptoms since methadone affects the body the same way that heroin (morphine) does. Second, the addict's tolerance is so high because of the methadone that it is almost impossible to get high by using heroin.

Methadone is less well know as a means by which heroin addicts may be painlessly detoxed.

A Brief History

During World War II, the Nazis needed a substitute for morphine because they had lost control of the primary opium-producing countries. This resulted in the development of methadone--a purely synthetic opioid.

Methadone is also known as "Dolophine". This has been taken to mean that the drug was named after Adolf Hitler. It is a stretch, however: Adoloph. There are clearly a couple of problems with this connection. First, Hitler's first name is "Adolf", not "Adoloph". Second, methadone wasn't even called Dolophine until it was brought to the United States--after the war was over and Hitler was long dead.

The name "Dolophine", rather than being any kind of homage to the führer, seems to be derived from the Latin word "dolor" which means pain.

Methadone Compared to Morphine

Methadone is an excellent pain-reliever that works by attaching to the opiate receptor sites. Although it is still used as a pain reliever, it is most often used to detox or maintain heroin/morphine addicts. It has several advantages over morphine. It is as potent as morphine when injected, but three times as potent when administered orally. It is also long lasting; its halflife is 24 hours or more--lasting roughly ten times as long as morphine.

The long halflife of methadone means that it layers in the body. When dosing once per day, half the dose from the previous day is still in the body when dosing on the current day. Similarly, 1/4 of the dose from two days before is still present; and 1/8 from the day before that; and 1/16 and 1/32 and 1/64 and so on.

Methadone Detox

The maximum length of a methadone detox is mandated by state law. In California, this length is 21 days. Normally, clinics set the length of their programs at the maximum length that the law allows. The first half of the program is used to detox the patient from the heroin and the second half is used to detox (or ween) him from the methadone. As a result, the doses administered for the first week and a half are pretty much constant--then the doses are decreased at a constant rate.

Methadone Withdrawal

In the heroin subculture, it is widely believed that withdrawal from methadone is worse than withdrawal from heroin. This is false. Withdrawal from methadone is not nearly as intense as withdrawal from heroin. Just the same, methadone withdrawal does take longer. Methadone withdrawal just seems to creep on and on with the patient feeling crumby--sometimes for months.

Detox Times

Although there are laws limiting the maximum amount of time over which a detox can take place, there are no laws stipulating the minimum amount of time over which a patient may be detoxed. Most addicts find that a detox period of between five and ten days works the best for them.

Clinic Bureaucracy

Patients wishing to detox quickly from heroin have one major problem: clinic bureaucracy. Methadone clinics are highly regulated and they do not like to deviate from their set procedures.

Dealing with the Doctor

The best way to deal with this problem is for the patient to talk to his intake doctor about how he would like to go about his detox. Doctors like to see patients taking an interest in their treatment and they certainly want to do whatever is going to be most successful in getting the patient drug free.

Dosing Schedule

If the doctor is willing to set up a short program, there are two options as to how the patient can be dosed. First, the doses can simply be decreased linearly down to zero. Take a typical situation of starting at 35 mg and detoxing over 7 days. In this case the dose would decrease 5 mg per day (see the graph below). Or it is possible to bottom out more slowly: 35, 20, 15, 10, 7, 4, and 2 mg.

Total methadone in the body.

Other Options

If the doctor is unwilling to shorten the length of detox, the patient has other options. First, the patient can get on the lightest dosing schedule available. This may mean the first couple of days are a little uncomfortable for the patient, but it will more than pay for itself at the end of the program.

Since methadone does stay in the body a long time, the patient can dose every other day. This will have a similar effect to starting with a lower dose.

Another option is to simply stop dosing altogether after 5 or 10 days. The problem with this approach is that the patient will be stopping at a high concentration of methadone and this may cause him some discomfort. The longer he has been using the methadone, the worse this problem will be. After 5 days it probably will be okay, but after 10 days the patient will likely regret having stopped so abruptly.

Start Conservatively

Regardless of what a patient decides to do, the first time he tries a methadone detox, he should go along with the program the doctor recommends. For most people this works very well. If he finds that it doesn't work well for him, he should try limiting the length of time he uses on subsequent detox attempts.



Next Time: Our next article will discuss using methadone to detox without using a doctor. This has a lot of advantages including being a lot less expensive under most circumstances. We will finish this series of articles by discussing methadone maintenance programs and how to best use them.

by Dr. H © 2001
Last Modified: 12 January 2004


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