How long does it take to get off methadone

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NCBI Bookshelf. Geneva: World Health Organization; Methadone is an opioid, like heroin or opium. Methadone maintenance treatment has been used to treat opioid dependence since the s. This reduces their withdrawal symptoms and cravings for opioids. Methadone is addictive, like other opioids. However, being on methadone is not the same as being dependent on illegal opioids such as heroin:. This highlights its importance as a treatment for heroin dependence. In closed settings, MMT should be available to patients who have been receiving MMT in the community and wish to continue this treatment in the closed setting, and patients with a history of opioid dependence who wish to commence MMT.

Patients should receive MMT for the entire duration of their detention in the closed setting. This ensures the maximum benefits of the treatment are obtained. Hong Kong has had a methadone maintenance treatment program since The program was started in response to rising levels How long does it take to get off methadone drug use. More recently, the program has been crucial to controlling the HIV epidemic.

Hong Kong methadone clinics have several important characteristics that make them easy for drug users to access:. Open seven days per week and are open from early in the morning to late at night. Non-judgemental approach that includes providing How long does it take to get off methadone reduction information and condoms.

Research conducted with patients of the Hong Kong methadone program has shown that patients who attend the clinic regularly show reduced levels of drug injecting and HIV risk behaviours. It has also been shown that patients receiving methadone doses of greater than 60mg per day were less likely to use or inject drugs than patients receiving doses of less than 60mg per day.

In countries where MMT is available in the community, it should also be available in prisons. This is in line with the public health approach to HIV prevention and the principle of equivalence of care. There are several compelling reasons for providing MMT to opioid dependent patients in closed settings:. MMT in closed settings reduces drug injecting by prisoners. Many drug users experience multiple episodes of detention in closed settings. However, patients who remain in MMT after leaving closed settings are less likely to return to closed settings than non-treated heroin users.

People who leave closed settings often relapse to regular drug use within a few days or weeks of being released. Being in MMT in the closed setting and then continuing treatment in the community reduces the risk of relapse. Indonesia established a pilot methadone maintenance program in prison in The program was started as part of Indonesia's comprehensive HIV prevention strategy for prisons.

Other components of the strategy include distributing condoms and bleach for cleaning used needles and syringes in prison and providing free antiretroviral treatment for HIV-positive prisoners. Some of the patients in the methadone program are continuing treatment begun in the community, while others have started methadone treatment in prison. Patients who are HIV-positive receive free antiretroviral treatment in addition to methadone.

There are plans to expand the methadone maintenance program to other prisons in Indonesia. The success of this pilot program has demonstrated that it is feasible to introduce methadone maintenance treatment in resource-poor settings.

Only a medical doctor may prescribe methadone. A medical doctor should conduct the assessment on which the decision to prescribe methadone is based. Doctors also take part in treatment planning and treatment reviews. Nurses are required to conduct methadone dispensing and supervision of its consumption.

Other roles for nurses in methadone maintenance treatment include:. Although not essential, the following staff can also assist patients in methadone maintenance treatment:. Psychologists can assist patients suffering from co-morbid mental illnesses and psychiatric problems such as depression, anxiety or post-traumatic stress disorder. Social workers and welfare workers can provide general counselling and assist patients with practical concerns such as contacting their family or finding How long does it take to get off methadone for when they leave the closed setting.

A community liaison officer is employed specifically to assist patients to transfer to community-based MMT programs on their release from the closed setting. This person may have skills or training in social or welfare work. Methadone should be dispensed via a medical clinic within the closed setting. The clinic must be staffed and open to patients seven days per week. The clinic should be equipped with a dispensing pump or measuring cylinder for ensuring accurate methadone dosing, and should also maintain adequate supplies of basic first aid and resuscitation equipment.

Methadone must be stored in a secure area within the medical clinic, for example, locked in a room or safe. It should not be obvious to patients that this is where methadone is stored.

Following dosing, How long does it take to get off methadone must move into a supervision room located next to or close to the medical clinic. This is to help prevent diversion of methadone to others. Patients in the supervision room must be monitored for around minutes after dosing.

Methadone is a synthetic opioid agonist. This means it produces effects in the body in the same way as heroin, morphine and other opioids. It is taken orally as a tablet or syrup. When an opioid dependent person takes methadone, it relieves withdrawal symptoms and opioid cravings; at a maintenance dose, it does not induce euphoria.

Onset of effects occurs 30 minutes after swallowing and peak effects are felt approximately three hours after swallowing. At first, the half-life the length of time for which effects are felt of methadone is approximately 15 hours; however, with repeated dosing, the half-life extends to approximately 24 hours.

It can take between 3 and 10 days for the amount of methadone in the patient's system to stabilise. Most people beginning MMT experience few side effects. However, there are some side effects of methadone, including:. Interactions between methadone and other drugs can lead to overdose or death. Drugs that depress the respiratory system e. Drugs that affect metabolism can induce methadone withdrawal symptoms. Clinically important drug interactions are listed in Table 12 p. In particular it is important to note interactions between methadone and medications used to treatment HIV and tuberculosis:.

Patients receiving these medications, or other medications listed in Table 12in combination with methadone should be monitored for s of withdrawal or intoxication, and their methadone dose adjusted accordingly. Patients in methadone maintenance treatment can become tolerant to the pain-relieving effects of opioids.

In the event that an MMT patient requires pain relief, non-opioid analgesics such as paracetamol can be given. If methadone patients are provided with opioid analgesics, they may require higher than normal doses to experience pain relief. Methadone maintenance treatment is indicated for patients who are dependent on opioids or have a history of opioid dependence. In closed settings, it is important to remember that patients not currently physically dependent on opioids can benefit from the relapse prevention effects of methadone maintenance treatment.

Patients with severe liver disease should not be prescribed methadone maintenance treatment as methadone may precipitate hepatic encephalopathy. Patients who are intolerant of methadone or ingredients in methadone formulations should not be prescribed methadone. There are few risks associated with the long-term use of methadone.

Methadone does not damage any of the major organs or systems of the body. There are few side effects of methadone and those that do occur are less harmful than the risks associated with illicit opioid use. The major risk associated with methadone is overdose. Overdose is a particular concern in the initial stages of MMT and when methadone is used in combination with other depressant drugs.

Methadone overdose may not be obvious for three to four hours after ingestion. Patients should be closely monitored during the first week of treatment for s of overdose, including:. Overdose is more likely to occur if the patient is using other drugs that depress the central nervous system e. Patients should be informed of the risks of using these drugs in combination with methadone.

In case of overdose, naloxone should be administered. This reverses the effects of methadone. Because methadone has a long half-life, it is necessary to provide a prolonged infusion or multiple How long does it take to get off methadone of naloxone over several hours. Patients who have overdosed should be transferred to a hospital and monitored for at least four hours. Methadone should be prescribed with caution to patients who are using other drugs, particularly those that depress the central nervous system e.

Patients should be advised of the increased risk of overdose associated with using methadone in combination with other drugs. Before beginning MMT, the patient must be given enough information for him or her to make an informed decision about commencing treatment. The patient should be told:. As part of informed consent, tell the patient about the rules that must be followed to receive methadone treatment.

For example:. The patient should be given a patient information statement containing all of the above information and asked to read it. If the patient cannot read, the patient information statement should be read aloud. A sample patient information statement is shown on If the patient is happy to begin treatment after this process, he or she should a consent form to this effect.

A sample consent form is provided on After obtaining informed consent from the patient, develop a treatment plan that outlines the patient's starting dose and the schedule by which doses will increase. See 28 for more information about treatment plans. The first dose of methadone given to a patient is low.

The size of the dose is gradually increased until the maintenance dose is reached.

The maintenance dose is the amount of methadone the patient requires to prevent opioid withdrawal symptoms, but does not induce euphoria. The first dose of methadone should be between mg. Patients who have recently used opioids can be given a first dose at the higher end of this range. The first dose given to a patient who has not recently used opioids should be no greater than mg.

When determining the size of the first dose, keep in mind that deaths from methadone overdose in the first two weeks of treatment have occurred at doses as low as mg per day.

How long does it take to get off methadone

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