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Detox Done Right (Part 4)

In the first three articles in this series (one, two, and three) we discussed the use of methadone as a way to detox from heroin. Methadone is more commonly used for maintenance, however. In this case, the addict is exchanging an addiction to illegal heroin for an addiction to legal methadone. Maintenance has a number of benefits and a number of draw-backs. But for the right person, it is just what the doctor ordered.

Why Addicts Avoid Methadone Maintenance

Normally, people do not consider methadone maintenance until a lot of other attempts to stay off heroin have failed. Two reasons are normally given staying away from methadone maintenance. The first is the widely held belief in the heroin subculture that methadone is a worse addiction than heroin. This is untrue.

Myth: Methadone Addiction is Worse Than Heroin

There is no indication that long-term methadone use is worse on the body than long-term heroin use. Regardless, methadone would have to be a lot worse than heroin in this regard if it were to offset the collateral damage due to heroin use. Heroin is pretty much always injected, smoked, or snorted--all of these administration routes have negative long-term consequences compared to methadone which is eaten (there is also IV methadone but it is very rarely seen).

The lifestyle that goes along with heroin addiction does not encourage the healthiest habits. Addicts rarely eat enough or well. They usually get little sleep. The proximity of other illegal drugs tend to cause heroin addicts to do more of these other drugs than they normally would. Two of the most common drugs--cocaine and speed--are very damaging to the body. On the other hand, alcohol is one of the few drugs people on maintenance can get away with using. This may cause more drinking from people on maintenance and this would counteract some of the heroin lifestyle issues.

Methadone Withdrawal

Another reason addicts think methadone is worse than heroin is that it is widely believed that detox from methadone is worse than from heroin. This too is false. Methadone detox is, however, different from heroin. Qualitatively, the two are similar: sweats, chills, insomnia, vomiting, diarrhea, and depression. Methadone withdrawal is less violent--less intense--than heroin withdrawal. Just the same, methadone withdrawal lasts longer.

Maintenance Constrains Patients' Lives

The other reason heroin addicts avoid maintenance programs is rational: being in a program constrains the addict's life. Programs have variations, of course, but in general patients will be constrained in a number of ways. First, new patients will be required to come in every morning to dose. After a period of time, patients will be allowed "take home" doses so that they needn't come in every day. Just the same, patients are rarely allowed more than six take home doses, which means that they will have to come into the clinic at least once a week. As a result of this, long vacations are difficult to arrange and vacations outside of the country are almost impossible.

The programs usually intrude into the patient's private life. They are tested for drugs, for example. Many clinics require attendance at NA meetings. Normally, the patient will have the equivalent of a social worker who may interfere with the patient's life any number of other ways.

Reasons to Avoid Methadone Maintenance

Maintenance is not for everyone. If you can answer "yes" to any of the questions below, you are a poor candidate for methadone maintenance.

  1. I have tried to detox from heroin less than ten times.
  2. I have only tried one kind of detox (cold turkey, medicated, methadone, ibogaine, and so on).
  3. I am very independent.
  4. I stand a good chance of going to jail, even when I am not using drugs.
  5. I need to travel outside the country.
  6. I travel a lot.

You should only go on methadone maintenance if you have failed giving up heroin a number of times. Maintenance is an extreme measure which should only be used if other approaches have failed. Similarly, just because you have failed at one kind of detox does not indicate that you will fail at another kind. This is especially true if the one type you have tried is cold turkey--the most difficult form of heroin detox.

If you are independent, you will likely find the clinic environment difficult to deal with. It is highly bureaucratic and intrusive. Be careful in answering this question for yourself, however. Almost anyone could justify an answer either way. It might be easier to check out a clinic and see if you can imagine yourself fitting in there.

As discussed earlier, it is very hard to be on methadone and travel much. You will be tied to the clinic on a fairly short leash. This is a restriction that will not change unless the laws change. The government places methadone maintenance programs in a special category of medicine. As a result, patients are not given prescriptions for their medicine--their medicine is administered under close scrutiny. There have been some rumblings that the laws will change, but don't depend upon it.

Why Maintenance Might Be A Good Idea

In many ways, a person is more constrained on methadone maintenance than he would be by being addicted to heroin. Why then, would an addict choose to go on maintenance? For most addicts maintenance provides a way to get out of the heroin subculture without much pain. Also, maintenance is not usually endless. Most people use it for between six months and two years before detoxing. Meanwhile, the addict's freedom from needing to "take care of business" has allowed him to create a regular life away from the heroin subculture.

Tips on Using a Maintenance Program

Pick the Right Program
Not all methadone clinics are equally good. If you live in an area where you have a choice--or you can move to be close another clinic--use the best clinic. There are online resources which provide information about clinic quality. For a start, check out the National Alliance of Methadone Advocates (NAMA). (I don't know what's become of the Methadone Information Exchange, but they don't seem to be online anymore.)
Plan You Life
A junkie's life is difficult, regardless of how he manages to get by. Going on maintenance will make this very apparent to you. If you don't have a plan on how to use the program, you will likely find that life is pretty boring. Before you start the program, decide what you are going to do with all the free time you now have that you used to spend getting money for heroin, scoring heroin, and using heroin. For some addicts, this will be all your waking hours. Regardless, there will be a correlation between the number of hours you need to fill up and the amount of work you will need to create a heroin-free life.
Visualize the kind of life that you would like to have. Once you have this image in mind, it should be fairly easy to come up with a plan for realizing your image. Being a junkie is actually good experience for anything you want to do, because there are few things that are as difficult as feeding a heroin habit. If you apply the same energy and creativity to building your ideal life, you will have it before you know it.
Plan Your Detox
Have some idea of how long you want to stay on maintenance. This will, of course, depend upon what you are doing with your life outside the clinic. But don't put yourself in a time bind. It is not unreasonable to decrease your daily methadone dose by 1 mg per week. That means if you are maintained at the relatively low dose of 80 mg, it will take you a year and a half to detox. Plan ahead!
Don't get two habits
A lot of people go on methadone maintenance but then continue to use heroin. If you do this, you will end up with a double addiction. What's more, the methadone you are taking will make the heroin less effective so it will cost a lot more to get high. The bottom line is: if you aren't ready to give up heroin, don't go on maintenance.
"Work" the Program
Many programs have silly rules like not allowing clients any take home doses unless they work during dosing hours. Do what you must to get past the clinic red tape. If this requires "working" the program so it works for you--so be it.
Avoid Other Clients
The maintenance program is a tool that will help you build a new life. By becoming too involved with the clinic culture or other clients, you will be looking in the wrong direction: backwards to where you used to be, not forward to where you want to go. Also, clinic clients are as likely as not to be using heroin on the side. They will be a bad influence. If you want to return to the heroin subculture, do it. But don't cheat yourself: go back to the real subculture; don't use the clinic losers as substitutes.
Keep Your Dose Low
The lower you keep your daily methadone dose, the easier and the quicker will be your final detox. Just the same, don't keep your dose so low that you are uncomfortable--this will tend to make you you go out and use heroin.
Stay Clean
By staying clean you will quickly get clinic privilege such as take home doses. This is a big deal because going into the clinic each day to dose is a drag and it interferes with your life. Again, if you want to use drugs, go ahead. But doing so while on a methadone maintenance program is not a good idea.

Conclusion

This article really only scratches the surface of how to best take advantage of a methadone maintenance program. If you are interested, you should check out the National Alliance of Methadone Advocates (NAMA) and Harm Reduction Coalition. Both contain a lot of useful information as well as links to other helpful sites.

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


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