Methadone Replacement for Heroin
If you stop taking heroin, methadone can prevent or reduce the unpleasant withdrawal symptoms. Many people stay on methadone long-term. However, some people gradually reduce the dose and come off drugs altogether. You should not take any street drugs or much alcohol when you are taking methadone.
What is heroin addiction?
If you are addicted to heroin it means that you develop withdrawal symptoms within a day or so of the last dose. Therefore, if you are addicted to heroin you need a regular dose to feel 'normal'. Withdrawal symptoms can include:
- Feeling hot and cold.
- Runny eyes and nose.
- Being off food.
- Stomach cramps.
- Feeling sick (nausea) or being sick (vomiting).
- Poor sleep.
- General aches and pains.
- Just feeling awful.
Withdrawal symptoms tend to ease and go within five days. However, you may then have persistent craving for heroin, remain tired and have poor sleep for quite some time afterwards.
What is methadone?
Methadone is a drug that is similar to heroin, although it lasts a lot longer in the body. It can be prescribed. If you take methadone, you are unlikely to develop withdrawal symptoms if you stop heroin (or the withdrawal symptoms are much less severe). If you take methadone under supervision from a doctor instead of street heroin, you are:
- More likely to be able to get away from the street 'drug scene'.
- Likely to feel better in yourself.
- More likely to be able to get off drugs for good.
Who prescribes methadone, and when?
A typical plan
Most GPs will refer you to a community drug team to be assessed. Following assessment, a member of the community drug team will usually contact your GP quite quickly to recommend a dose of methadone and a plan for follow-up. Some GPs who are specially trained may assess some cases and prescribe without the need for referral.
This usually includes:
- Taking details of your health and social circumstances.
- Taking details of your past and current drug taking and whether methadone is needed or appropriate.
- An examination.
- A urine test (or a mouth swab test) to confirm the drugs you are taking.
- An assessment of what you think you need at this present time.
If you have been injecting drugs such as heroin, it is also common to advise:
- A blood test which includes testing for HIV, checking the health of your liver (liver function tests) and checking for hepatitis A, B and C.
- Immunisation against hepatitis A, hepatitis B and tetanus (if not previously immunised).
- If appropriate, immunisation against hepatitis B for your partner and children.
- About the dangers of injecting, of using shared needles and syringes and on other ways to reduce harm to yourself.
Starting off with methadone
Methadone is usually started some time after assessment when the results of the urine test are back. An initial dose is chosen. The aim is to prevent withdrawal symptoms. However, methadone can cause serious harm, or death, in overdose. Therefore, at first your doctor will prescribe a low-ish dose to 'play safe' and see you frequently to adjust the dose. Be patient, this early stage is very important. The initial dose is usually gradually increased to a regular maintenance dose. But note:
- Methadone takes 2-4 hours to reach its peak effect level in the blood. However, the time it takes to produce its maximum effect can vary from person to person.
- Methadone accumulates in your body. So, you will feel a greater effect of the drug over a few days even without increasing the dose.
- It may take a few weeks to get to the correct dose which prevents all withdrawal symptoms.
Try to accept that you may have some, or partial, withdrawal symptoms until the correct dose is found. The correct dose varies from person to person depending on how much heroin you were using and how your body deals with (metabolises) the methadone. You should not take any street drugs or much alcohol when you are on methadone.
Maintenance and coming off ('detox')
Once established on a regular dose, most people stay on methadone for a long time or even long-term. This is called maintenance and helps you to keep off street drugs. Some people gradually reduce the dose and come off it. This is called detoxification, or 'detox'. However, it usually takes months and sometimes years before most people are ready to consider 'detox'. It is often safer to stay on methadone than to 'detox' before you are ready.
Methadone is usually prescribed as a once-daily dose in liquid form. You will usually be asked to take it under the supervision of the pharmacist who dispenses the methadone to you. This means there can be no doubt about how much methadone you take at each dose. This supervision may be relaxed after a few months of your taking a regular maintenance dose.
Important note: it is essential that you take the methadone regularly. If you miss three or more daily doses your body may lose its ability to break down the drug (tolerance). You can still continue with the withdrawal programme but you may need to start again with a lower dose.
Some other points about taking methadone
- You are more likely to succeed in staying off heroin if you have support and counselling during this difficult time. This may be from a local drug community team (or similar). Self-help groups or other agencies may also be of help. It is much harder to 'do it alone' - so do go for counselling and help if it is available in your area.
- Some prescribed medicines may interfere with methadone - for example, some used to treat tuberculosis (TB) and epilepsy. Tell the doctor who prescribes methadone if you are taking any other medicines. However, most prescribed medicines can be taken in the normal way.
- Other street drugs such as benzodiazepines ('benzos'), and alcohol can affect methadone. It is best not to take any other drugs and not to drink too much alcohol.
- You will be asked to give a urine sample from time to time by your doctor.
- Driving. If you use heroin, methadone or similar drugs, you should tell the DVLA. You are likely to be banned from driving. However, if you are on a supervised methadone programme, you may be allowed to drive again subject to an annual medical review.
- Pregnancy. If you become pregnant you should not suddenly stop your methadone withdrawal programme. It is riskier to stop methadone suddenly in the first three months of pregnancy than to continue on your regular dose. Many women choose to withdraw from methadone during pregnancy and this is best done during the third to sixth month of pregnancy (the 'second trimester'). Your doctor will advise.
- Keep methadone and any other drugs out of reach of children.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
- The name of the medicine which you think caused it.
- The person who had the side-effect.
- Your contact details as the reporter of the side-effect.
It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.
Further reading & references
- Evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP; British Association for Psychopharmacology (May 2012)
- Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care; Royal College of General Practitioners (2011)
- Drug misuse and dependence UK guidelines on clinical management; Dept of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive (2007)
- Opioid dependence; NICE CKS, April 2015 (UK access only)
- Roux P Dr, Michel L Dr, Cohen J, et al; Initiation of Methadone in primary care (ANRS-Methaville): a phase III randomized BMC Public Health. 2012 Jun 28;12(1):488.
- Savvas SM, Somogyi AA, White JM; The effect of methadone on emotional reactivity. Addiction. 2012 Feb;107(2):388-92. doi: 10.1111/j.1360-0443.2011.03634.x. Epub
- Bart G; Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis. 2012;31(3):207-25. doi: 10.1080/10550887.2012.694598.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Laurence Knott
Dr John Cox