The drug methadone is an opioid agonist, and is classified as a slow acting drug. It has a high efficacy in the treatment of opioid misuse as well as opioid withdrawal. The use of opioid has been started from the 1960s for the treatment of heroin addiction. Some of the reports declare that the use of methadone for withdrawal is better than the abstinence based approach. (Richard P Mattick, Courtney Breen et al., n.d.)
Aims of treatments and selection of patients
The use of methadone as a therapy for opioid withdrawal is recommended for such patients who have no contraindications. The patient must be able to provide the consent form to the authorities.
Methadone drug is the first drug of choice for the treatment of opioid withdrawal.
Following are the goals of methadone therapy:
· To decrease the withdrawal symptoms
· To stop the illicit opioid effects
· To decrease the cravings
To engage the patient in normal routine activities
Course of the Therapy
The initial dose of methadone depends upon the physical condition of the patient. In most studies the recommended dose of methadone is 10-30mg. The assessment of the patient is done after 2-4 hours of initial dosing. (Baxter, Louis E. Sr MD, FASAM, 2013)
The tolerance of the patient is monitored very carefully. The higher authorities recommend the use of methadone at induction to be not greater than 50mg or to be not greater than 50mg in 24 hours.
Methadone has a longer half-life. The dosing of this drug needs careful monitoring. It should be evaluated in first three weeks of dosing until the complete action of methadone is noticed. (Chin B Eap 1, Thierry Buclin, n.d.) The dose of methadone depends on the following points:
· The physical dependence of patient
· The metabolism of patient
The complete dose should be split in small doses for the patients with a fast metabolism. (Rockville (MD), 2006) For some patients the dose required is between 80-120mg. It is reported that the dose of less than 30mg can be helpful in acute withdrawal, but the effect on reduction of cravings and other symptoms is not reported. (RainerSchmid & Psychiatrische Universitäts Klinik, Währinger Gürtel, n.d.)
· QT-interval prolongation
· The treatment should involve the relapse monitoring. Frequent testing for psychoactive and alcohol should be done.
· Length of treatment
Mostly this therapy requires a longer time for complete treatment. The treatment length depends on the collaboration of patients with a physician as well as his physical dependence.
Switching to Other Treatment
Studies show that the methadone treatment can be switched to other therapies if
· No visible effect occurs
· The patient wants to switch to another therapy
· Intolerable side effects of methadone appear on the patient
Switching to buprenorphine
This is recommended if the patient is at low dose of methadone (30-40mg per day or less)
Switching to naltrexone
There is a limitation for switching to naltrexone therapy. There should be no methadone in the blood of a patient while switching to this drug.