What is : Methadone Maintenance Treatment ? Detox, short-maintenance, or FOR LIFE?
WORLDS MOST ADDICTIVE DRUG
We are humans.Nothing more than product of mother nature made of flash and blood, with until today unrevealed brain parts and its functions. As a humans, we make mistakes. Maybe as youngsters, maybe in elder stages - but we do them. Some of us from curiosity, some of us from really strange reasons and some of us ... Well, some of us from unknown reasons - TRY DRUGS.
The words most addictive and, by the words of many, worlds most dangerous drug - HEROIN - is the drug that takes more and more lives, and the drug that has it's own negative contribute to the society - in general. So, what are the actions that we can take against this chronic decease called " opioid dependency " ? What is the, by the W.H.O , most effective way of getting of it?
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By World Health Organization (the "W.H.O") , substitution therapy with opioid is the most effective and most spread kind of treatment for heroin addicts. What are the basics of substitution therapy and what are medicines used in other therapies?
- Substitution therapy, is meant to be applied as substitution maintenance treatment with an medicine (synthetic or semi-synthetic opiate).
- Substitution treatment is meant to last 21. day , and after that it's meant slow tapper-down with 20% tapering down per day = 20% less of the substitute every next day.
- If the patient still wants to be on its substitute, the substitution therapy is becoming maintenance treatment that can last up to 6 months - short maintenance , and over six months - long/prolonged maintenance treatment.
- Although, substitute maintenance treatments with full-agonist opiates are most common - the "first line of defense" are full opiate ANTAGONISTS or partial-ANTAGONISTS. Examples:
- Short lasting antagonist (only active by I.V use) is " Naloxone " , while long-lasting antagonist, active orally administrated, representative is " Naltrexone " .
- Long lasting partial-agonist partial-antagonist: buprenorphine. ( NOTE: buprenorphine + naloxone = Suboxone , buprenorphine + _________ (nothing active) = Subotex )
- Short lasting full agonist are heroin (diacetyl-morphine, diamorphine BAN,morphine hydrochlorid... ) - all these are short-lasting SEMI-SYNTHETIC opiates.
- Long-lasting synthetic opiate world-wide-used and known , the "Gold Standard", is Methadone,Pentazocine,Fentanyl,etc... There are different ways of long lasting mechanisms, so there are semi-synthetic opiates - more effective then methadone that could be used like hydromorphone, and diacetyl-morphine (medicine heroin).
- By official statistics over 40% of those who are included in some kind of treatment, on global level, are in some kind of substitution maintenance treatments. (methadone,buprenorphine,slow-release morphine...)
Methadone Maintenance Treatment , any other options?
What methadone maintenance does is to suppress the withdrawal symptom, and eliminate the cravings/need for heroin/opiates. As an strong synthetic opioid, methadone the most common substitute used in maintenance treatments. Methadone's became an "Gold Standard" when it is about treating the heroin addiction. It has been proven that methadone does NOT provide euphoric effect on patients, but, it has the very small part of the opiate effect, along with partial sedative effect. Methadone's toxicity is less than its therapeutic effect - so it has been approved for over 40. years for maintaining heroin addicts off the illicit drugs. Because of it's effect on NMDA receptors in brain , methadone is has an anti-depressive effect to some of the patients. What is the most important thing, when it is about " M.M.T " (Methadone Maintenance Treatment) , treatment has to be (and it is, generally) individualized. What does it means ? It means that every patient has different kind of ongoing therapy because of methadone's different reaction on every different person.Methadone, generally, metabolizes in five parts of liver. The liver enzymes are responsible for the methadone dosage efficiency. Some of us, doe several things like speed of metabolism,liver activity, etc... ; need higher and some of use lower dosages for stabilizing the state. There are some heroin users that were ten years on needle, and some of them need 70-90mg ,and there are some of H users that were using heroin for two or three years and they need 90-120(+)mg. The specialist should decide and measure the dosage needed for every person individually. Patients approved for M.M.T come for their dose usually every day, for the six months. If they prove tho the medical staff, that follows his state, that he is "reliable" and responsive person with all negative drug test and good behavior - patent can be approved for "take-home" doses for whole week, or several days - depends of country policy.But, generally - it is like that.For example, prescribing benzodiazepines with methadone is strictly avoided - due increased breath depression combined - but, in some countries (Serbia), they are usually prescribed as the most common pattern of the treatment (Methadone + Diazepam 5-10mg) There is the question of stigma and toxicity of methadone that is topic of great discussions of worlds most finest specialist. These two things can, and are, the most intolerable things and the reasons why patients fail on treatment or quit them.Good number of them find using heroin more flexible for their job,family, and other "every-day" life things.That's why, some of countries have approved more substitutes (than just one - methadone) to the addicts on maintenance with severe side-effects, and those who are already failed previously on methadone. Other used opiate substitutes, from dozen of studies - few times more effective and less toxic than methadone, are: slow-release morphine, diacetyl-morphine (or diamorhine in Britain BAN ) ,and hydromorphone which was approved for maintenance in Australia in 2002. when the first hydromorphone trial for its usage in maintenance of addicts began.There was another one in 2009 , huge where diacetyl-morphine was used too. The results showed that the percentage of those who quit is several times larger in those groups where methadone is used, and the percentage of those who remained in treatment with hydromorphone is several times greater than those on methadone. Amazing fact is that the addicts included in this trial could badly feel the difference of diacetyl-morphine and hydromorphone (I.V) ,and that the percentage of those who were on hydromorphone is greater when it is about staying in trial/treatment.
The H.A.T treatment , or Heroin Assisted Treatment (or HAT) is introduced in UK first in late 20's .It was approved for heavy addicts, who were in "risky" zone (HIV and Hepatitis positive patients). Late, the treatment as banned due its abuse in 60's ... In nova-days, Switzerland introduced H.A.T treatment in '92 , and until today it has it. By the Swiss experience, several other countries decided to engage in to trials with medicine (pure) heroin - diacetyl-morphine. The countries that have now the H.A.T treatment are: UK, Switzerland,Denmark,Norway,Australia,Germany,Belgium. The countries with slow-release morphine are (SOME OF THEM) : "Austria,Germany,Spain,Luxemburg,Lichtenstein,Bulgaria,Slovenia,Croatia,Sweden,Norway,Switzerland,Australia,Belgium....
The number is large! That's is encouriging and good! FREEDOM OF CHOICE, FREEDOM OF CHOOSING WHAT AND HOW WE WANT TO BE MEDICALY TREATED - IS PRIMARY HUMAN RIGHT! DO WE HAVE IT ???
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