Basic Pharmacology: How Methadone Works

By
J.T.
Payte, Jeffrey Smith and Joycelyn Woods

J.
Thomas Payte, M.D. is Medical Director and Founder of Drug Dependence
Associates in San Antonio, Texas, Chair of the Maintenance Medications
Committee of the American Society of Addiction Medicine and a member of
NAMAs Advisory Board.

 

Jeffrey
Smith, Ph.D. has a degree is central nervous system pharmacology.

 

Joycelyn
Woods, M.A. is President of NAMA. Her degree is in neurological psychology
and she had done brain mapping of opiate receptors and published one of
the early papers on it.

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Part
1

• The
  Basics of Pharmacology

Part 2

• The
  Pharmacology of Opioids

Part
3

• Drugs
  and Conditions That Impact On the Action of Methadone

The
Lack of Education

Ignorance
about methadone abounds (Zweben and Sorensen, 1988). Stigma and prejudice have
kept accurate education about methadone treatment being taught in medical and
schools of higher education. The primary source of information about methadone
comes from the sensationalized media. Thus, professionals working in the
field, supportive services to methadone treatment, law enforcement, health
professionals, employers and the public know very little about methadone at
all, and what they do know is probably wrong. Even worse is the fact that they


dont know that they dont know. And, at the bottom of this is the
methadone patient who must bear the brunt of the prejudice and stigma and with
no where to turn to. Methadone patients read the denigrating newspaper
articles and television reports that disparage methadone maintenance treatment
and malign methadone patients — and they believe it. There is no one to
reinforce the many accomplishments of methadone patients or to celebrate the
many contributions that methadone patients make to their communities.
Methadone patients do it alone, frightened and in spite of the opposition
against them.

Academia

Professionals
working in the field receive very little, or no training at all about the very
medication that they will be administering. The only training that physicians
receive while in medical school consists of about one hour spent on the topic
of addiction, which includes alcoholism. The disease model of opiate addiction
is not presented or discussed and therefore physicians do not see opiate
addiction as a condition under the domain of medicine. Their education
regarding methadone is usually on its use in withdrawing an individual from
opiates while its best properties, that of maintenance, are neglected.

And
the few interns who do some into contact with methadone patients are usually
on the detox wards with the dysfunctional patients. They have never seen or
come into contact, at least that they know about, with the typical working
methadone patients. Knowing this it is not wonder that methadone patients are
treated so badly by the health and medical professions.

Counselors,
social workers and psychologists know even less than the medical professions.
They usually receive very little education in basic science and even less
about the biology of behavior, or the functioning of the brain. Very often
their graduate training is anti-medication as just a substitute. 
Thus, both medical and counseling professionals have been taught to
approach addiction as a character disorder with very little understanding
about the biology of addiction.

With
such a deficiency within higher education added to the public’s
misunderstanding about addiction it is not surprising that myths about
methadone thrive. For thirty years there has been a conspiracy of silence
about methadone maintenance treatment. Accurate and scientific information
about methadone is rarely presented. The basic education about methadone
treatment that professionals receive comes from the same source that the
average citizen receive it — the media which has distorted and
sensationalized the majority of methadone information.

 

Therapeutic
Communities

Of
course, there is an additional source in this equation of misinformation about
methadone and that from therapeutic communities. They were the first to attack
methadone because they know the initial successful outcome reports which when
compared to their outcome data would be impossible for them to achieve. They
were fearful of a loss of funding and mounted an attack against methadone
maintenance treatment almost from the very beginning. The primary impact of
these attacks had been to hard the esteem and well being of methadone
patients. Throughout methadones thirty year existence several therapeutic
communities have launched attacks at methadone treatment. Although today these
attacks are more subdued they remain.

Clients
of drug free modalities receive a propaganda campaign against methadone which
is unfortunate since the majority will relapse to heroin use and would
probably be excellent candidates for methadone maintenance. 
Many states agencies which oversee drug treatment funding are
controlled by abstinence oriented modalities. Only New York State, which has a
large methadone system that treats about one-fifth of all methadone patients
in the United States has a state agency that is supportive of methadone.

Education
Empowers Methadone Patients

With
such misunderstanding about methadone the only way for methadone patients to
deal with it and to insure adequate health care and supportive services is to
educate themselves. In this way methadone patients can educate others — the
providers, supportive services and health care professionals who should know
about heroin addiction and methadone treatment, but dont. That is the
purpose of this paper and although some of the topics are very technical it is
not important that you understand every word. Do not allow the fact that this
is science to scare you off. Instead try to get just a basic understanding of
everything and keep this paper for future reference. When you must go
somewhere where you will probably have to divulge your status as a methadone
patients review this paper and then go over in your head what ;you will say to
the doctor, social worker or counselor. 
If you present yourself as a methadone patient then you must behave as
a role model — no matter how badly they behave or mistreat you, and we all
know how difficult this can be. Your behavior should demand respect and if you
are not treated with dignity then go to their supervisor and demand that
adequate training about methadone be given to the institutions employees.
Write a letter to the president of the hospital, the director of the program,
the person in charge and demand a change in the way that methadone patients
are treated. 
Griping for thirty years and expecting others to do it has done nothing
more than to make the problem worst. We must it for our dignity — to receive
the adequate health care we deserve from hospitals, clinics and physicians and
to be treated with respect from all the helping professions.

The
purpose of this paper is to provide accurate information about the
pharmacology of methadone and to debunk the any myths that flourish about
methadone. 
The next time you hear something “crazy” about methadone ask
that person for the scientific proof. Ask for references and publications. You
will discover that usually they have none. Myths and misinformation rely on
the everybody knows method of science! Challenge and question and you
cannot go wrong.

Methadone
Patients as Health Consumers

Methadone
patients must learn to be health care consumers when it comes to their medical
care.  New
medications are being placed on the market every day and many doctors may not
realize that it can effect your
methadone. 
Pain medications are the search for one with a low addiction potential
is one class of medication that all methadone patients should ask about to
make sure that they are not getting a mixed agonist-antagonist (see Part 2,
Agonists and Antagonists; Part 3, Narcotic Antagonists and Agonist-Antagonists
Drugs).  So
it is up to you to ask the doctor and to make sure than none of the
medications that have been prescribed for you will interact with your
methadone. 
As health care consumers, methadone patients must insure that the
health care they receive is the quality that they deserve.

Where
To Get Information

Pharmacological
information about methadone and other psychoactive drugs can be found in The
Pharmacologists Bible, or Goodman and Gillman’s The Pharmacological Basis of
Therapeutics. Goodman and Gillman is far superior to the reference book, The
Physician’s Desk Reference (PDR) that most go to for information because it
gives not only clinical information as the PDR, but pharmacology, metabolism and
the recent research findings.

NAMA
produces an Education Series and provides scientific publications. Another
source is the National Clearinghouse for Alcohol and Drug Information
(1-800-SAY-NO-TO(DRUGS)) that will do a literature search and send either a
bibliography for you to chose from or send publications directly. Sometimes the
later choice cannot be done because of the vast amount of literature. So beware
of myth-makers and “everybody knows science.” Methadone is one of the
safest and most effective procedures that I know of, yet it is constantly
denigrated by nay sayers who do not understand methadone maintenance or heroin
addiction.

 

Challenge
the nay sayers! Ask them for proof, real science!
 

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Bibliography
List 

Understanding
pharmacology can be difficult for the person without a scientific background. 
This does not mean that one should ignore this area of methadone because
it is important for patients to have some basic knowledge in order to know about
their dose.  Below
are some classic texts with information about pharmacology. 
Some are more difficult than others and you should first look through a
text prior to purchasing it to insure that you have the correct information.

Brecher, E.M.,  1972.  Licit
and Illicit Drugs.  The Consumers
Union Report on Narcotics, Stimulants, Depressants, Inhalants, Hallucinogens,
and Marijuana.  Boston:
Little, Brown and Company.

 

Cooper, J.R.; Bloom, F.E.; Roth,
R.H.,  1991. The Biochemical Basis of
Neuropharmacology (6th Edition). New York:  Oxford University Press.

Eccles, J.C.,  1977. The
Understanding of the Brain. New York: McGraw-Hill.

 

 

Gilman, A.G., Rail, T.W., Niles,
A.S. and Taylor, P. (eds),  1990. 
Goodman
and Gilman’s The Pharmacological Basis of Therapeutics (8th
Edition). New York: Pergamon Press.

 

 

Goldstein, A.  1994.  Addiction. 
From Biology to Drug Policy. 
New York:  W.H. Freeman
& Company.

 

 

Lowinson, J.H., Ruiz, P.,
Millman, R.B. and Langrod, J.G.  (eds)
1992.  Substance
Abuse: A Comprehensive Textbook. 
Ed.  Baltimore: Williams
and Wilkens.

 

 

Pratt, W.B.; Taylor, P. (eds) ,
1990.  The Principles of Drug Action. The Basis
of Pharmacology (3rd Edition). New York:  Churchill Livingstone.

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References

 

Barchas, J.D., Berger, P.A.,
Ciaranello, R.D. and Elliot, G.R. (1977). Psychopharmacology.
From Theory to Practice. New York: Oxford University Press.

 

Cooper, J.R., Bloom, F.E. and
Roth, R.H. (1991). The
Biochemical Basis of Neuropharmacology (6th Edition). New York: 
Oxford University Press.

 

Goldstein, A.  (1994).  Addiction. 
From Biology to Drug Policy. 
New York:  W.H. Freeman
& Company.

Gilman,
A.G., Rail, T.W., Niles, A.S. and Taylor, P. (eds) (1990). Goodman
and Gilman’s The Pharmacological Basis of Therapeutics (8th
Edition). New York: Pergamon Press.

 

Spence, A.P. and Mason, E.B.
(1979). Human
Anatomy and Physiology. Menlo Park, California: The
Benjamin/Cummings Publishing Company.

 

Zweben,
J.E. and Sorensen, J.L. (Jul-Sep 1988). Misunderstandings about methadone. Journal
of Psychoactive Drugs 20(3): 275-281.

Education
Series

Cost
per each $2

 

Number 1.
Methadone Maintenance and Patient Self Advocacy by Arlene Ford. (March,
1991).

 

Number
2. Drug Policy in the Age of AIDS:  The
Philosophy of Harm Reduction by Rod Sorge (April, 1991).

 

Number
3. Myths About Methadone by Emmett Velten 
(March, 1992).

 

Number
4. Methadone, HIV Infection and Immune Function by Herman Joseph (August,
1994).

 

Number
5.1. The Basics of Pharmacology, Basic Pharmacology:  How Methadone Works? by J.T. Payte, Jeffrey Smith and
Joycelyn Woods (February, 2001 Revised).

           

Number
5.2.  The Pharmacology of
Opioids, Basic Pharmacology:  How
Methadone Works? by J.T. Payte, Jeffrey Smith and Joycelyn Woods (February,
2001 Revised).

 

Number
5.3. Drugs and Conditions That Impact On the Action of Methadone, Basic
Pharmacology:  How Methadone
Works? by J.T. Payte, Jeffrey Smith and Joycelyn Woods (February, 2001
Revised).

 

Number
6. Starting A Patient Run Program (Not available in revision).

 

Number
7. Managed Care, Medicaid, Medicare and Private Insurance: Who Will Pay?
(Not available in revision).

 

Number
8. Methadone Does Not Work Bibliography (October, 1995).

 

Number 9. The Methadone Maintained Patient and the
Treatment of Pain by J. Thomas Payte, Elizabeth Khuri, Herman
Joseph and Joycelyn
Woods (January, 1999).

 

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NAMA
Manuals

Cost per each $8

 

Number 1
Starting a Methadone Advocacy Group (NAMA Chapter or Affiliate). The basics
of starting a methadone advocacy group including history of methadone
advocacy, forming a Board of Directors, meeting planning, first projects,  politics
of methadone, listing of state agencies and other resources.

 

Setting Up a 12 Step Group. A manual to help patients
and professionals start a 12 step group. Includes organizing the group,
meeting planning, the basics of starting a 12 step group, a generic version
of 12 steps and other resources.

 

The price of the Education Series and Manuals are to
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