Introduction
Heroin (diacetylmorphine or diamorphine) and other opiates are a group of strong
sleep-inducing painkillers, known as narcotic analgesics, originally extracted from
opium. Opium is the dried milky latex extracted from the fruit of the opium poppy.
Opium contains morphine and codeine, both very effective painkillers. Heroin is easily
manufactured from morphine in even the crudest of laboratories. Freshly made heroin
is a white odourless powder but as it gets older it darkens in colour and develops a
smell of acetic acid (vinegar).
Heroin was originally developed as a safer substitute for morphine, whose medical
uses as a painkiller are limited by its dependence producing potential. Unfortunately
heroin proved to be nearly four times more potent and more addictive than morphine.
Both drugs are still used in medicine to treat the severe pain of terminal cancer and of
heart attacks. In fact the body rapidly converts heroin back into the parent drug
morphine. Heroin for medical use is not available in Ireland though there is nothing in
the Misuse of Drugs Acts that prohibits the prescribing of heroin. This is because, in an
effort to reduce the availability of heroin, licences are not issued which would allow
the drug to be imported into the country.
Heroin often contains other drugs, either produced during manufacture because of a
fault in the process, or added deliberately to make a particular grade of heroin, for
example some types of Far Eastern heroin made for smoking contain strychnine.
Codeine is widely used for less severe pain, often in combination with aspirin and
paracetamol. It is also used in cough mixtures because it suppresses coughing. Concern
has been expressed about young peoples misuse of cough mixtures. It is not certain
which of the components in these preparations gives the sought-after euphoria. A
number of manufacturers have removed codeine from their formulas as a way of
helping to reduce the misuse potential of these medicines. Some synthetic opiates are
also used to suppress coughs and in anti-diarrhoea preparations.
Extracts of opium are also included in various anti-diarrhoea preparations.
A number of synthetic opiates have been developed as painkillers. These include
pethidine, often used in childbirth, which was widely abused in the initial stages of
the development of the drug scene in Dublin in 1968- 69. Dipipanone is another such
drug developed to treat severe pain and sold as Diconal¨ tablets. Ireland had the
dubious distinction of being the first country in the world to report cases of Diconal¨
misuse. Methadone is a synthetic opiate usually used to assist in the treatment of
opiate addiction.
Two other synthetic opiates are Dihydrocodeine [DF 118¨and DHC Continuous¨] and
Buprenorphine [Temgesic¨ or Subutex¨]. Dihydrocodeine, used medically to treat
moderate to severe pain is chemically related to codeine and it too can give rise to
dependence of the morphine type. Buprenorphine has typical morphine-like effects
but a longer duration of action. It also blocks some of the effects of morphine and as a
result it may cause withdrawal symptoms in some individuals who are taking other
opiates. Some studies have shown that buprenorphine reduced self administration of
heroin by addicts and as such it is finding increased use as a ‘maintenance’ drug in
addiction treatment.
Opiates can be swallowed or dissolved in water and injected. Heroin can be sniffed up
the nose like cocaine or smoked from aluminium foil called ‘Chasing the Dragon’. As
with other drugs, injection into a vein maximises the effects and dangers.
Legal Status
The Misuse of Drugs Acts control opiates. It is illegal to possess them, unless
prescribed by a
doctor and supplied by a pharmacist. It is an
offence to import, distribute, produce or sell
them. The penalties for unauthorised possession,
according to the Misuse of Drugs Acts 1984, are a
fine of up to Â1,270 and/or 12 months
imprisonment if the case is heard in the District
Court. If a jury finds a person guilty the penalty
can be a fine, the amount of which is at the
discretion of the Court, or 7 years in jail, or both.
The penalties for illegal supply can be more
severe - in the case of a jury trial, a convicted
person could be sentenced to a maximum of life
imprisonment, or to a lesser period in jail and a
fine the amount of which is unlimited and set at
Chapter 15 - Heroin and other Opiates
64
C
the discretion of the Court. A fine of up to Â1,270,
12 months in jail or both can be imposed by the
District Court.
It is an offence to smoke opium, the only
prohibition on actual use of a drug in the Misuse
of Drugs Acts, to possess utensils for smoking or
preparing opium, to allow premises to be used
for preparing or smoking opium, and to cultivate
the opium poppy. All doctors may prescribe
opiate drugs for medical use although heroin is
no longer available. The other exception is
Diconal¨ whose use is now restricted to hospitals
only. Dihydrocodeine in the form of DF 118¨
tablets are included within the strict requirements
of the Misuse of Drugs Acts as is Buprenorphine.
Certain non-injectable mixtures of codeine with
other drugs, as well as very dilute opiate
mixtures for cough or diarrhoea, are exempt from
most of the restrictions of the Misuse of Drugs
Acts but can only be purchased from a
pharmacist. Because of concern over the abuse of
certain cough mixtures, the Pharmaceutical
Society of Ireland has issued strict guidelines to
all pharmacists in an effort to reduce the
availability of these products to young people.
Prevalence and Availability
Because heroin use is illegal, there is no accurate
method of determining the true number of
addicts. All the indicators available show that
since 1980, heroin availability, use and addiction
increased rapidly, particularly in Dublin.
Estimates of the number of addicts have ranged
from 6,000 to 13,000. Between 1990 and 1999,
7,559 Irish people sought treatment for the first
time for heroin or other opiate-related problems
mostly from the Dublin area. These other opiates
could include morphine sulphate tablets (ÔMSTÕs
or ÔNappsÕ), methadone and dihydrocodeine.
Virtually all the heroin used is illegally
manufactured and imported, mainly from the socalled
Golden Crescent of Afghanistan and
Pakistan but also the Golden Triangle of Burma,
Laos and Thailand. Black market heroin can cost
between Â200-250 per gramme. At street level it is
diluted or ’cut’ to increase its profitability using
materials such as flour, lactose, talcum powder,
glucose and caffeine. It is usually sold in Â20 bags
of gear which contain 4 doses of drug. The purity
of heroin on the Irish market dropped from 45%
to 33% between 1995 and 1999. Diconal¨ tablets
are now virtually unavailable due to the
effectiveness of the prescribing restrictions and
this is reflected in their virtual disappearance
from drug statistics.
Mood Altering Effects
Heroin when injected produces a very rapid
’rush’ lasting less than a minute, and involving
warm flushing of the skin and sexual excitement.
There is a mistaken impression that heroin gives
a more intense feeling of pleasure than other
opiates, but it seems that this reputation is due
more to the rapid onset of action compared with
the slower action of morphine. The initial rush is
followed by a pleasant, dreamlike state of
peacefulness and contentment; pain is reduced,
as are aggressive tendencies and sexual drives.
Much of the euphoria seems to occur early in the
addict’s career, and those truly addicted
experience little euphoria. The side effects of
opiates include reduced sex drive, constipation,
palpitations, rashes and itching, especially of the
nose.
Adverse Effects of Use
Moderate doses of pure opiates produce a range
of physical effects, such as analgesia, suppression
of coughing, and depression of bowel activity
leading to constipation, depression of respiration
and dilation of blood vessels giving a feeling of
warmth. At higher doses these drugs induce
sleep, followed by coma. Death from respiratory
depression can occur, especially if the opiate is
combined with other depressant drugs such as
alcohol and benzodiazepines, if there is a loss of
tolerance, or unexpectedly high potency and is
more likely to happen when the drug is injected.
One hundred and fifty seven deaths have been
reported between 1998 and 2000 in which an
overdose of heroin was implicated, frequently in
combination with alcohol and benzodiazepines.
However, this figure does not include deaths
from other causes, such as HIV or from suicide. It
is believed that opiate users have an overall
mortality rate of up to 20 times higher than
people of the same age in the general population.
Physical damage from long-term use of opiates is
usually associated with unhygienic injection
techniques rather than damage to organs in the
body. There are no serious diseases attributable to
chronic narcotic use that would parallel the
damage to the liver and lungs caused by alcohol
and tobacco. Studies of a small group of middleaged
addicts who were using pharmaceutical Chapter 15 Heroin and other Opiates
65
quality heroin for between 20 and 43 years
revealed evidence of brain damage but the exact
influence of heroin is as yet unclear. Because
opiates suppress the coughing reflex, some
chronic users may have lung problems including
bronchitis. Some researchers have suggested that
opiate dependants are abnormally susceptible to
infections due to an effect on their immune
systems.
The way the drug is used causes most medical
problems, including blood poisoning and
infection of the heart valves from using nonsterile
water and syringes. Adulterants that do
not dissolve can cause abscesses, clots in the
lungs, gangrene and loss of limbs. Types of
heroin that do not dissolve in water, such as
South West Asian type 1 and Chinese no.3, have
caused problems when addicts have used lemon
juice, vinegar, car battery acid or citric acid in
efforts to dissolve the drug. In Australia, France
and Scotland fungal infections leading to
blindness have resulted from the use of
contaminated lemon juice. In summer 2000, 8
people died in Ireland from a gangrene-like
condition caused by a germ called Clostridium
that contaminated the heroin they dissolved in
citric acid and then Ôskin poppedÕ into muscle
tissue rather than injected into a vein. The
sharing of the injection equipment - the ÔworksÕ
(needle, syringe, filter spoon and tourniquet) by
several people can result in the transmission of
viral hepatitis such as Hepatitis C, which can
cause liver cancer. Hepatitis C can also be passed
on through contact with body excretions and by
sexual contact. IV opiate misusers (ÔmainlinersÕ)
are a high-risk group for HIV infections, which
can result in the development of AIDS.
Injection of heroin was the main route of
administration in Ireland in the late 1980’s with
88% of those seeking treatment in 1990 reporting
that they injected. By 1996 that percentage had
dropped to 49% as most users reported smoking
or ’chasing’ the drug but by 1994 the number of
those injecting had reportedly risen to 69%,
perhaps because those who previously smoked it
had developed tolerance to such an extent that
the relatively more ÔefficientÕ way of using the
drug by injection became inevitable.
Given the high levels of injecting reported by
Irish heroin users it is hardly surprising that
levels of infectious diseases associated with such
injections remain significant. Levels of Hepatitis B
among injecting drug users in Irish prisons is
reported to be approximately 18%. For Hepatitis
C, figures for Dublin show that it ranged from 5289% among drug users in treatment compared to
a seropositivity rate of 5.8% for HIV. Cases of
AIDS in drug users account for nearly half of the
349 people who have died from AIDS since 1982.
The combination of disease, malnutrition, crime
and self-neglect through compulsive involvement
with the drug and the risk of overdose creates a
serious health risk to add to the social harm and
legal problems associated with being an addict.
Dependence
The first experience with heroin is often
unpleasant because of nausea and vomiting. This
feeling is often sufficient to deter many people
from using heroin again. Others continue to use
the drug, becoming occasional users. Others
become regular users and others become
compulsive users. There is evidence that repeated
use of heroin does not invariably lead to
compulsive daily use. One US study estimated
that about 23% of those who experiment with
heroin become dependent on it.
Tolerance develops rapidly to the effects of
opiates. Heroin dependants are able to take
amounts that would kill a non-tolerant person.
Some US soldiers in Vietnam were reported as
using 2.5 gms of pure heroin daily. It is likely that
even the heaviest of heroin users in Dublin are
using only a fraction of that amount each day.
Tolerance disappears rapidly when use is
stopped and overdoses are most likely to occur
following this loss of tolerance by a user who has
been detoxified in hospital or in prison. They
then cannot use the high doses they formerly
could tolerate.
Dependence, both physical and psychological,
though not inevitable, is a very frequent and
likely result of continuous use of opiates,
particularly if they are injected. The length of
time taken for dependence to develop is affected
by the physical and mental make-up of the
individual, and by the quality and frequency of
drug consumed. Dependence can occur after a
few days. More serious dependence can take
weeks or months to develop. Withdrawal
symptoms, called ’cold turkey’ because of the
chills and gooseflesh that are part of withdrawal,
begin 4-12 hours after the last dose of the drug.
Chapter 15 - Heroin and other Opiates
66
They reach a peak after one and a half to three
days and then subside. The seriousness of the
symptoms depends on the mental state of the
individual and on the extent of drug use. It is
likely that most addicts using weak adulterated
heroin do not have the full symptoms, and for
many the effect would be similar to severe ’flu’.
Withdrawal symptoms can include yawning,
tears, running nose, sneezing, tremors, headache,
sweating, anxiety, irritability, insomnia,
spontaneous orgasm, loss of appetite, nausea,
vomiting, diarrhoea, cramps and muscle spasms.
It is relatively easy to detoxify an opiate
dependant but relapse rates are quite high, partly
due to the fact that some withdrawal effects last
for months with strong feelings of discomfort and
loss of well being.
The high relapse rates after withdrawal effects
have subsided also suggest that psychological
dependence is more important than physical
dependence in the compulsion to continue use.
Studies of large number of American soldiers
who were heavily dependent on heroin while in
Vietnam do not seem to support the belief that
Ôonce an addict, always an addictÕ. The studies
indicated that contrary to popular belief these
soldiers were able to stop their heroin use and
stay off it when they returned to the USA.
What is methadone?
Methadone is a narcotic pain reliever, similar to morphine. Methadone also reduces
withdrawal symptoms in people addicted to heroin or other narcotic drugs without
causing the "high" associated with the drug addiction.
Methadone is used as a pain reliever and as part of drug addiction detoxification and
maintenance programs.
Important information about methadone
Taking methadone improperly will increase your risk of serious side effects or death.
Even if you have used other narcotic medications, you may still have serious side
effects from methadone. Follow all dosing instructions carefully.
Like other narcotic medicines, methadone can slow your breathing, even long after
the pain-relieving effects of the medication wear off. Death may occur if breathing
becomes too weak.
Never use more methadone than your doctor has prescribed.
Call your doctor if you think the medicine is not working.
Do not stop using methadone suddenly, or you could have unpleasant withdrawal
symptoms.
Talk to your doctor about how to avoid withdrawal symptoms when stopping the
medication.
Do not drink alcohol while you are taking methadone. Dangerous side effects or death
can occur when alcohol is combined with methadone.
Check your food and medicine labels to be sure these products do not contain alcohol.
Methadone can cause side effects that may impair your thinking or reactions.
Be careful if you drive or do anything that requires you to be awake and alert.
Before using methadone
Taking methadone improperly will increase your risk of serious side effects or death.
Even if you have used other narcotic medications, you may still have serious side
effects from methadone. Follow all dosing instructions carefully. Methadone may be
habit-forming and should be used only by the person it was prescribed for. Methadone
should never be given to another person, especially someone who has a history of drug
abuse or addiction. Keep the medication in a secure place where others cannot get to
it. Do not use this medication if you have ever had an allergic reaction to a narcotic
medicine (examples include codeine, morphine, Oxycontin, Darvocet, Percocet,
Vicodin, Lortab, and many others). You should also not take methadone if you are
having an asthma attack or if you have a bowel obstruction called paralytic ileus.
Before taking methadone, talk to your doctor if you have:

a personal or family history of "Long QT syndrome";

asthma, COPD, sleep apnea, or other breathing disorders;

liver or kidney disease;

underactive thyroid;

curvature of the spine;

a history of head injury or brain tumor;

epilepsy or other seizure disorder;

low blood pressure;

gallbladder disease;

Addison's disease or other adrenal gland disorders;

enlarged prostate, urination problems;

mental illness; or

a history of drug or alcohol addiction.
FDA pregnancy category C. This medication may be harmful to an unborn baby. It
could also cause addiction or withdrawal symptoms in a newborn if the mother takes
methadone during pregnancy. Tell your doctor if you are pregnant or plan to become
pregnant during treatment. Methadone can pass into breast milk and may harm a
nursing baby. Do not use this medication without telling your doctor if you are breastfeeding a baby.
Older adults and people with debilitating conditions may be more sensitive to the
effects of this medication.
What happens if I miss a dose?
Use the medication as soon as you remember. If it is almost time for the next dose,
skip the missed dose and wait until your next regularly scheduled dose. Do not use
extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this
medicine. An overdose of methadone can be fatal, especially if you take it with
alcohol or other narcotic medications.
Overdose symptoms may include extreme drowsiness, pinpoint pupils, confusion, cold
and clammy skin, weak pulse, shallow breathing, fainting, or breathing that stops.
What should I avoid while using methadone?
Do not drink alcohol while you are taking methadone. Dangerous side effects or death
can occur when alcohol is combined with methadone. Check your food and medicine
labels to be sure these products do not contain alcohol. Methadone can cause side
effects that may impair your thinking or reactions. Be careful if you drive or do
anything that requires you to be awake and alert.
Methadone side effects
Get emergency medical help if you have any of these signs of an allergic reaction:
hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your
doctor at once if you have any of these serious side effects:

shallow breathing;

hallucinations or confusion; or

fast or pounding heartbeats, chest pain, trouble breathing, feeling lightheaded, fainting.
Other, less serious side effects may be more likely to occur, such as:

feeling anxious, nervous, or restless;

sleep problems (insomnia);

dizziness, drowsiness, or weakness;

dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite; or

decreased sex drive, impotence, or difficulty having an orgasm.
This list is not complete and other side effects may occur. Tell your doctor about any
unusual or bothersome side effect.
What other drugs will affect methadone?
Do not use methadone with other narcotic pain medications, sedatives, tranquilizers,
muscle relaxers, or other medicines that can make you sleepy or slow your breathing.
Dangerous side effects may result. Do not use methadone with any of the following
drugs without first talking to your doctor:

a diuretic (water pill);

antibiotics

heart or blood pressure medication such as diltiazem

HIV medicines an MAO inhibitor

other narcotic medications such as pentazocine (Talwin), nalbuphine (Nubain),
buprenorphine (Subutex), or butorphanol (Stadol)

rifampin (Rifadin, Rimactane, Rifater); or

seizure medication such as phenobarbital (Luminal, Solfoton) or phenytoin
(Dilantin).
This list is not complete and there are many other medicines that may cause serious
medical problems if you take them together with methadone. Tell your doctor about
all the prescription and over-the-counter medications you use. This includes vitamins,
minerals, herbal products, and drugs prescribed by other doctors. Do not start using a
new medication without telling your doctor. Keep a list with you of all the medicines
you use and show this list to any doctor or other healthcare provider who treats you.
Background Information
Methadone, the mainstay of treatment for heroin addiction, was originally synthesized
by chemists in Germany after the United Nations cut of their supplies of Turkish opium
that were interrupted during World War II. It was developed as a morphine substitute
for pain-killing purposes.
Methadone was first offered commercially in the U.S. as Dolophino in 1947 by Eli Lilly
Pharmaceuticals. It was first used as a long-acting painkiller for surgical and cancer
patients. It was not until about 1950 that it was first used on a short-term basis to
treat the withdrawal symptoms in addicts being taken off of heroin or morphine.
Synthetic narcotics were first investigated at the Addiction Research Center of the
United States Public Health Hospital at Lexington, Kentucky.
Methadone is a rigorously well-tested medication that is safe and efficacious for the
treatment of narcotic withdrawal and dependence. For more than 30 years this
synthetic narcotic has been used to treat opioid addiction. Heroin releases an excess
of dopamine in the body and causes users to need an opiate continuously occupying
the opioid receptor in the brain. Methadone occupies this receptor and is the
stabilizing factor that permits addicts on methadone to change their behavior and to
discontinue heroin use. Methadone, as an opiate, is an addictive central nervous
system depressant.
Taken orally once a day, methadone suppresses narcotic withdrawal for between 24
and 36 hours. Because methadone is effective in eliminating withdrawal symptoms, it
is used in detoxifying opiate addicts.
It is, however, only effective in cases of addiction to heroin, morphine, and other
opioid drugs, and it is not an effective treatment for other drugs of abuse. Methadone
reduces the cravings associated with heroin use and blocks the high from heroin, but it
does not provide the euphoric rush. Consequently, methadone patients do not
experience the extreme highs and lows that result from the waxing and waning of
heroin in blood levels. Ultimately, the patient remains physically dependent on the
opioid, but is freed from the uncontrolled, compulsive, and disruptive behavior seen in
heroin addicts.
Tolerance (the body's ability to develop counteracting and restabilizing effects)
develops to the analgesic, nauseant, sedative, euphoric, respiratory and
cardiovascular effects. However, no tolerance develops to the drug's ability to stave
off withdrawal symptoms. Therefore, once the addict is stabilized on methadone (s)he
can function normally - physically and psychologically - without requiring larger and
larger doses in order to eliminate withdrawal symptoms and remain physiologically
"comfortable". This occurs regardless of the stabilizing dose (that which is required to
suppress withdrawal symptoms and to which the patient is equally tolerant to in illicit
opiates. In some patients, at higher doses, methadone may help decrease anxiety
although it is not effective as a potent mood elevator.
Withdrawal from methadone is much slower than that from heroin. As a result, it is
possible to maintain an addict on methadone without harsh side effects. Treatment
provides the heroin addict with individualized health care and medically prescribed
methadone to relieve withdrawal symptoms, reduces the opiate craving, and brings
about a biochemical balance in the body.
The character and severity of withdrawal symptoms that appear when narcotics are
discontinued depend on many factors, particularly: what the drug is, dose, duration of
use, interval between doses, health, personality, and expectations and motivations of
the patient.
The symptoms of abrupt withdrawal from methadone (complete discontinuation of
administration of the drug) are: insomnia, anxiety, hypertension, irritability, chills,
excessive perspiration, 'runny' nose and eyes, enlarged pupils, sore joints, sore
muscles, aching joints, muscle spasms, abdominal cramps, nausea, diarrhea, and
overall malaise. Symptoms appear 24-48 hours after the last dose and increase in
intensity for six days. They then begin to subside and most major symptoms are
minimal by the 14th day.
However, general discomfort, loss of appetite and insomnia may persist for as long as
six months. These symptoms can be drastically reduced and often eliminated by
withdrawing according to a slow, deliberate dose decrease managed by a physician.
The longer the process, the less the symptomology.
Methadone maintenance is a long-term treatment for opiate addictions of all types.
The patient must regularly visit a clinic and receive his/her medication. Many patients
lead normal, productive lives, working and caring for their families and enjoying an
active social life. According to a Federal 15-year follow-up study, methadone does not
cause any physical deterioration even after 15 years of use. Since methadone
programs are voluntary, the length of time spent in treatment depends greatly upon
the patient. Studies show that patients are more likely to stay in treatment for
relatively long periods if they are over 30 years old, are married, have dependent
children, and have spent time in jail due to their addiction. All these factors tend to
strengthen the patient's determination to overcome his / her addiction and become a
more productive social being.
Methadone is not a cure for opiate addiction. It is a pharmacological tool which
suppresses withdrawal symptoms, lessens the craving for narcotics, and, coupled with
therapy, facilitates those interpersonal interactions involved in strengthening
motivations, changing lifestyle, and breaking the cycle of life patterns and stress
reactions underlying relapse.
Methadone is the most widely researched yet heavily regulated pharmaceutical known.
Some regulation is necessary but after a certain length of time in treatment, usually
after 1-2 years, the successful patient should be allowed to be medically maintained.
This means fewer clinic visits.
Is It Safe?
Like any controlled substance, there is a risk of abuse. When used as prescribed and
under a physician's care, research and clinical studies suggest that long-term
methadone treatment is medically safe (COMPA, 1997). When methadone is taken
under medical supervision, long-term maintenance causes no adverse effects to the
heart, lungs, liver, kidneys, bones, blood, brain, or other vital body organs. Methadone
produces no serious side effects, although some patients experience minor symptoms
such as constipation, water retention, drowsiness, skin rash, excessive sweating, and
changes in libido. Once methadone dosage is adjusted and stabilized or tolerance
increases, these symptoms usually subside.
Methadone is a legal medication produced by licensed and approved pharmaceutical
companies using quality control standards. Under a physician's supervision, it is
administered orally on a daily basis with strict program conditions and guidelines.
Methadone does not impair cognitive functions.
It has no adverse effects on mental capability, intelligence, or employability.
It is not sedating or intoxicating, nor does it interfere with ordinary activities such as
driving a car or operating machinery.
Patients are able to feel pain and experience emotional reactions.
Most importantly, methadone relieves the craving associated with opiate addiction.
For methadone patients, typical street doses of heroin are ineffective at producing
euphoria, making the use of heroin less desirable.
How long do I have to stay on methadone?
This is the most common question we're asked. Even after about 30 years of
experience with methadone, we still don't have an answer that applies to everyone.
What we can say is that most people who are successful coming off methadone show
three important characteristics:
 First, their lives have been stabilized after they've been on methadone
maintenance treatment for more than a year.
 Secondly, the decision to stop taking methadone is made with their doctor,
who gradually decreases the dose while providing support.
 Finally, they've made changes in their lives that show they're stable. For
example, they may have a stable family life, support from the non-drug-using
community, steady employment and fewer financial or legal difficulties.
It's important to understand that methadone, when taken as prescribed, is a safe and
effective medication that individuals can take for years. We encourage you to use it as
long as you feel it's working for you, and there are no medical concerns.
Does methadone have any side effects?
Once your dose is stabilized, methadone is usually a very well-tolerated medication.
As with any effective medication, unwanted side-effects may develop during
treatment with methadone. Most people experience few, if any, side-effects. While
side-effects may be distressing, they are rarely dangerous and most diminish with
time.
 Sweating. This can be due to a methadone dose that is too high or too low.
 Constipation. You can try increasing fibre (such as bran) in your diet if you
experience this problem. Regular exercise and drinking more fluids may also
help.
 Sexual difficulties. Some people experience reduced desire, while others show
an increased desire associated with a better life.
 Sleepiness or drowsiness. This is common, and may be caused by too much
methadone. You should be assessed by your doctor to see if your dose needs to
be adjusted. Don't drive a car or participate in activities that require you to be
alert while this is a problem.
 Weight change. People sometimes put on weight, but this may be because
they're now eating properly and are healthier.
Can methadone interact with other drugs?
Remember, methadone is a medication that may interact with other medications you
may be taking. Alcohol, as well as prescription, non-prescription, herbal and street
drugs may interfere with the action of methadone. Discuss all medications you are
taking with your pharmacist or doctor.
Is methadone dangerous?
When methadone is prescribed to a narcotic-dependent person at a proper dose, and is
monitored by a doctor, it is a safe medication.
However, it can be extremely dangerous if used inappropriately. Methadone should
never be taken by individuals for whom it is not prescribed. It can cause overdose and
death when a person who is not dependent on narcotics takes it. Children are
particularly at risk for overdose and death if they swallow methadone accidentally. If
this happens, seek emergency treatment immediately.
What are my responsibilities?
It is your responsibility to drink your methadone dose every day. If you have carries,
you must make sure that you store your methadone safely until you drink it. It's best to
refrigerate your carries.