Dr. Gott: What is normal methadone use?

DEAR DR. GOTT: I am hoping that you can shed some light on the use of clinically dispensed methadone.

I have several family members who have used this medication for more than 10 years. I understand that the use of methadone offsets the desire for heroin by starting with a high dose and then eventually going down to a very low dose.

I want to know about the side effects of long-term use. Do you think that methadone is just an excuse to get “high”? I have witnessed these people “nodding off” at the dinner table, which I find quite upsetting. One family member even continues to be on the highest dose even after more than 10 years. Also, I have heard that methadone was originally named Adolophine (after Adolf Hitler) and wonder what it was used for during that time.

DEAR READER: I will start with the easiest question. There is a popular urban legend that methadone was once called Adolophine. To the best of my knowledge, there is no truth to this. One of the brand names of methadone is Dolophine, which looks and sounds similar to the mistaken name, so it is easy to see how the misinformation was put out and perpetuated.

Methadone is a synthetic opioid pain reliever. It is, as you stated, used in certain detox or maintenance programs for people addicted to other opioids, such as heroin or other morphine-like drugs. When used in this way, the drug must be distributed by a specialized clinic certified by the Substance Abuse and Mental Health Services Administration and registered by the Drug Enforcement Agency. It must also be accompanied by appropriate social and medical services, which may include counseling and timely drug testing.

The medication contains a black-box warning because of the risk of death (cardiac or respiratory), iatrogenic (physician-caused) overdose and respiratory depression. Other side effects include abuse, dependence, lightheadedness, nausea, vomiting, sweating, dizziness, sedation, headache, weakness, swelling, various cardiac abnormalities, abdominal pain, dry mouth, weight gain, skin rashes, hallucinations and many more. Often, during the prolonged administration of a stabilized dose taken for addiction, the result is a gradual, progressive disappearance of side effects. This process may take several weeks; however, if sweating or constipation is experienced, side effects may persist.

Because I have never prescribed methadone either for pain relief or drug addiction, I cannot provide further information about whether it is typical for users to continue using it for many years. There are several online resources that I can refer you to so that you can read more in-depth on the subject. The first is www.drugs.com, which is essentially a drug database. It contains both patient and physician sources for additional information on nearly every over-the-counter or prescription drug available. It provides information such as what forms the medications are available in, side effects, dosages, how to take them, and what to do if a dose is skipped. The physician/professional information is more in-depth and typically uses complex medical and scientific terms. Information comes from the Physicians’ Desk Reference, the Food and Drug Administration, Micromedex and others.

The second source is the American Pain Society. Their Web site provides the history and recommendations of the drug, when it was discovered, when it received FDA approval and more easy-to-understand information. The publication is www.ampainsoc.org/pub/ bulletin/sep00/upda1.htm. The article was written by several pharmacists.

I suggest you talk to your family members regarding the situation to express your concerns. They may even be your best resource for more information, since they have firsthand experience.