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After more than 100 overdose deaths over two months, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) has alerted the addiction treatment community about a deadly combination of heroin and fentanyl, USA Today reported June 9.

“There’s starting to be some increased awareness at the higher levels of government,” said Robert Lubran, director of SAMHSA’s division of pharmacologic therapies.

The U.S. Drug Enforcement Administration (DEA) issued a warning last month about the heroin-fentanyl mix, a potent blend that has been traced to scores of overdoses and deaths in cities from Chicago to Philadelphia to St. Louis.

A recent raid on a drug lab in Mexico was touted as dealing a blow to the source of the fentanyl, and some city officials say that the crisis appears to have peaked.

What Is Fentanyl?

Fentanyl, a schedule II prescription narcotic analgesic, is roughly 50 to 80 times more potent than morphine. This medication is used to manage pain during surgery. In clandestine laboratories, fentanyl can be produced in powder form and mixed with or substituted for heroin.

Preventing Overdoses

Persons using heroin or cocaine, or in treatment/recovery from such use, need to know that:

• The potency of street-sold heroin or cocaine is amplified by fentanyl.
• There is no way to tell that heroin or cocaine is “cut” with fentanyl.
• Because the potency of the drug purchased on the street is not known, any use—even a reduced dose—can result in overdose or death.
• The effects of an overdose occur rapidly.

Fentanyl-related overdoses can result in sudden death through respiratory arrest, cardiac arrest, severe respiratory depression, cardiovascular collapse or severe anaphylactic reaction. Furthermore, routine toxicology screens for opiates will not detect fentanyl.

Although the U.S. Food and Drug Administration (FDA) approved buprenorphine to treat heroin and other opiate addiction in 2002, few doctors are using the drug as an alternative to methadone, Newsday reported May 6.

While methadone requires patients to make daily trips to a methadone clinic, buprenorphine is available through a doctor’s prescription and can be taken at home. And unlike methadone, buprenorphine does not have a high potential for misuse or fatal overdose.

The FDA approved the drug’s use for addiction to heroin, morphine, and prescription opiates such as OxyContin. However, only 1,000 doctors have prescribed buprenorphine since it became available in pharmacies last spring.

Addiction experts said restrictions attached to buprenorphine have discouraged its use. For instance, doctors who prescribe buprenorphine are required to take a daylong class to learn about the drug, and request a special license from the Drug Enforcement Agency before they can write prescriptions. In addition, doctors are not allowed to have more than 30 patients at one time on the medicine.

“There is no other medical treatment that demands this,” said Dr. Herbert Kleber, a professor of psychiatry at Columbia Presbyterian Medical Center in Manhattan, N.Y.

Some doctors, like Dr. Ron Brady, medical director of Bridge Plaza, a methadone program in New York, also are skeptical about the drug’s effectiveness. “I want to see that it works before I start using it,” said Brady. “I have learned that some patients should never be alone when taking their medicine.”

Source: www.jointogether.org

Millions of people have used and continue to use methadone as a treatment medication for opiate addiction. Methadone will sometimes cause side effects. The overwhelming majority of people who are involved in methadone maintenance treatment find the side effects to be mild and bearable, and the hundreds of thousands that continue to use methadone on a daily basis are a testament to how well most people tolerate the medication.

Although methadone has been administered on a wide scale and quite safely for decades within the United States, it remains a polarizing and controversial treatment for opiate addiction – but much that is widely believed about methadone side effects is not true.

Read below to find:

1. A list of the common side effects caused by methadone treatment
2. A list of side effects experienced during the first week of methadone maintenance treatment only
3. A list of methadone myths – side effects falsely attributed to the use of methadone.

The Side Effects of Methadone

Few medications have been studied as intensively or for as long as methadone. When used as directed, methadone does not damage the heart, kidney, lungs, brain, liver or any other major organ or system. It won’t affect your intelligence, it won’t get you high, and it won’t interrupt or impair your ability to work, drive a car, feel pleasure and pain, and generally live a normal life.

Some people tolerate the medication very well and feel no appreciable side effects. Some people experience mild side effects, and a very small percentage of people in methadone maintenance treatment experience intolerable side effects. Although methadone is dangerous if abused, it is quite safe when taken as directed as part of a medically supervised addiction treatment program.

People that experience side effects during methadone maintenance treatment tend to feel them worst during the first weeks and months of treatment. Over time, dosage adjustments and the development of a tolerance to the medication tend to reduce the severity of experienced side effects.

Common side effects of methadone use include the following:

• Constipation
• Drowsiness
• Skin Rash
• Sweating
• Water retention
• Flushing
• Changes in sex drive or erectile dysfunction
• Dizziness (especially in the beginning of treatment and especially as a person in methadone maintenance treatment rises from a lying position)
• Dry mouth

Constipation and Sweating

Constipation and sweating are two of the most commonly experienced side effects of methadone maintenance treatment. Methadone users can reduce the severity of constipation by eating a high-fiber diet, getting regular exercise, and making a concerted effort to avoid dehydration. Those who experience excessive sweating while on methadone seem to sweat heavily regardless of the dose taken, and do not develop a tolerance to the effect.

Sexual Dysfunction

Methadone has been associated with the following types of sexual dysfunction in some men:

• Impotence
• Loss of libido
• Delayed ejaculation

A recent study showed that 40 percent of men over the age of 40 will experience moderate to severe erectile dysfunction (ED) while on methadone. For men under the age of 40, the percentage that experience ED falls to only 12 percent. The use of heroin and the illicit use of prescription opiates are also associated with erectile dysfunction.

Methadone is associated with the loss of menstruation in a very small percentage of women. More women seem to regain regular menstruation than lose it after beginning methadone maintenance treatment.

Sedation (drowsiness)

People tend to experience drowsiness most severely during the first weeks of methadone maintenance treatment, and most people will develop a tolerance to the sedating effects of methadone a few weeks after dose stabilization. Sedation can be a sign of an overly high dosage, and methadone maintenance treatment patients who feel drowsy after the first couple of months may want to discuss a dose reduction.

Itchiness, Hives, and Seizures

Itchiness, hives, and seizures are indications of a dangerous allergic response to methadone. These are not normal side effects, and the presence of any one of these reactions should prompt an immediate call to a doctor.

First Week Side Effects?

Methadone works very well, and an appropriate dosage of methadone will eliminate all feelings of opiate withdrawal, but it takes about a week of methadone maintenance treatment before the medication will provide sufficient 24-hour relief of withdrawal symptoms.

During their first week of treatment, most methadone maintenance treatment patients will experience some mild side effects.

Why Does it Take a Week?

Methadone works in the bloodstream, but it also gets stored in the liver and in certain tissues. The stored methadone gets secreted out into the body very gradually, which creates a very stable level of methadone activation over a 24-hour period, but it takes between five and seven days of methadone use for the body to store a sufficient level of the medication.

Until your body has stored enough methadone to provide for steady methadone activation (called a “methadone steady state”), you will feel some mild symptoms of withdrawal during times during the day when the level of methadone in your body is low.

Mild withdrawal symptoms that you may experience during methadone maintenance treatment include the following:

• Anxiety or depression
• Fatigue
• Insomnia
• Hot flashes
• Muscle pains
• Nausea
• Restlessness
• Cravings for drugs

If these symptoms of withdrawal continue beyond the first seven days of treatment, your methadone dosage may be too low.

Methadone Side Effect Myths

Because methadone maintenance treatment has long been a controversial and polarizing process, a lot of untruths pervade popular beliefs about methadone.

Myth #1 – Methadone Causes Weight Gain

This is a tricky one. A lot of people gain weight while on methadone, but it’s not the methadone that’s causing the weight gain. People on methadone feel normal levels of hunger and experience a normal enjoyment of food — healthy appetites that had previously been suppressed by their abuse of heroin or other opiates. People on methadone often begin methadone maintenance treatment at a low weight and gain weight as they eat with a normal and healthy appetite and enjoyment of food.

Myth #2 – Methadone Rots Your Teeth

Methadone does not, in itself, have any affect on the teeth or bones

Methadone sometimes causes a dry mouth, and since saliva protects the teeth from decay, methadone users may be more vulnerable to dental problems. Additionally, methadone users tend to begin methadone maintenance treatment after a long period of dental neglect.

Methadone users can avoid dental problems by visiting their dentist regularly, avoiding sugary foods and drinks, and brushing and flossing regularly. Also, sugar-free gum increases the amount of saliva in the mouth and can counteract the dryness that is sometimes caused by methadone.

Myth #3 Methadone Rots the Bones

Methadone does nothing to the bones.

People sometimes feel “bone ache” during the first week of methadone maintenance treatment — but what they are actually feeling is some level of opiate withdrawal symptoms, which they are misattributing to the methadone.

Dealing with Side Effects

Most people find the side effects of methadone quite manageable. People who are unable to tolerate certain side effects, but who want to continue with medication management of an opiate addiction, have the option to switch from methadone to Suboxone. Suboxone is also a very well tolerated medication, although people on high doses of methadone will need to taper down to a low daily dose before making the switch to Suboxone.

Methadone Facts and Statistics

The topic of methadone maintenance treatment elicits a wide range of opinions, but not everything that you hear about this type of treatment is based in facts.

Methadone is neither good nor evil; it is simply a proven, effective medication for the treatment of opiate addiction. Methadone probably won’t solve your problems overnight, but it might allow you the peace and stability you need to get your life back on the right track.

One thing you might have heard about methadone is that while in methadone maintenance treatment, you’re just “trading one addiction for another.”

This is false. Once you have been stabilized on methadone, you trade addiction to a  dangerous opiate (heroin) for a dependence on a medically supervised and safe drug (methadone). While you are in methadone maintenance treatment, you will need to take methadone at regular intervals to avoid withdrawal symptoms, just as a diabetic is dependent on insulin, but you do not experience the compulsive thoughts and behaviors that define addiction.

When you were addicted to heroin, heroin defined your life and ended your ability to make good healthy choices — but once you enter methadone maintenance treatment, you are back in the driver’s seat.

Methadone Facts

• People who use methadone for longer-term maintenance have better outcomes than people who use methadone as a part of a shorter term detox protocol.

• The National Institute on Drug Abuse (NIDA) recommends a minimum of one year in methadone maintenance treatment for best outcomes.

• People on higher doses of methadone stay in treatment for longer periods of time, and have better outcomes, than do people on minimal doses of methadone. A recent medical study compared the treatment outcomes of people on 40 mgs of methadone a day and those who were taking 75 mgs of methadone a day. They found that higher doses of methadone are associated with significantly higher treatment retention (in this case a doubling between those who take 40 mgs and day and those who take 75mgs a day).

• Every person has unique dosage needs. People can metabolize methadone quite differently, and thus dosages should not be capped by maximum recommendations. Instead, the healthcare provider who is supervising the methadone maintenance treatment should evaluate the reduction of withdrawal symptoms reduction the cessation of drug cravings in order to determine the ideal methadone dosage.

• If people stay on methadone for longer than two weeks, there is an 80 percent chance that they will stay with their methadone maintenance treatment for six months or longer.

• Studies show that methadone maintenance treatment dramatically reduces illicit opiate use, criminal behavior, risky sexual practices, and the transmission of HIV.

• In 2005, more than 4,000 people fatally overdosed on methadone or methadone and other drugs together. Many of these people were using high doses of methadone in an unsupervised effort to treat pain, or were illicitly using methadone for recreational purposes.

• Unlike Suboxone or Subutex,  methadone has no ceiling of effect. Even people with very heavy heroin habits can get full withdrawal symptom relief from methadone.

• Methadone does not harm any major organs, even if taken for decades.

• People in methadone maintenance treatment programs have 30 percent the mortality rate of opiate users who are not in methadone maintenance treatment

Methadone Works Well, but It’s Not an Overnight Solution

Although methadone is sometimes used in a short-term detoxification protocol, methadone has shown its best results when used as a long-term maintenance medication for opiate addiction.

Methadone withdrawal can be difficult, but the medication works very well to keep you stable, free from pain, and free from drug cravings as you rebuild the infrastructure of a broken life.

Eventually, most people feel stronger and ready to slowly taper down off of methadone, but some people continue to use the drug for many years, or even for life. Methadone maintenance treatment is not a “quick fix,” but it does offer the opportunity to heal the scars of previous addiction and build a sober life.

A series of opiate clinics in five Danish city councils are scheduled to have already opened and begun providing treatment services (including, in some cases, free heroin) to local addicts.

Unfortunately, one of the clinics, in the town of Odesene, remains shuttered. The problem doesn’t have anything to do with politics or law and order — instead, the challenge has been finding enough affordable and potent heroin to satisfy the needs of the patient population.

The Danish government has provided 70 million Danish kroner (more than $13 million) in funding for the pilot project to provide heroin to addicts in Copenhagen, Odense, Esbjerg, and Glostrup. But The National Board of Health, the agency responsible for sourcing the heroin, is having difficulty finding a pharmaceutical manufacturer that can supply as much heroin as the agency needs at a price it can pay.

The Danish newspaper Fyens Stiftstidende has reported that the government has launched a fact-finding team to travel abroad to find out more about the heroin manufacturing process, in the hopes of finding a way to supply and store the heroin it needs at a lower cost. The Danish government did not reveal which countries the fact-finding team will visit.

A Chicago-area study found that heroin use is at epidemic proportions in the region, with emergency rooms seeing more heroin-related visits by suburban teens, the Chicago Tribune reported March 29.

The eight-month study, conducted by researchers at Roosevelt University in Chicago, found that more people visited Chicago-area emergency rooms for heroin use compared with other metropolitan areas. In 2002, federal statistics showed that the Chicago area had 12,982 heroin-related emergency-room visits, the most in the nation for the fifth consecutive year.

Kathleen Kane-Willis, a researcher at Roosevelt’s Institute for Metropolitan Affairs, said her study found that heroin users in the city are mainly minorities and older, while those in the suburbs are white and younger.

The study also showed that the number of teens from suburban Cook County entering drug-treatment facilities for heroin more than quadrupled between 1995 and 2002. On the other hand, treatment admissions among teens living in the city declined during the same time period.

“Parents need to be educated about this,” said Kane-Willis. “They need to know what the signs of use and addiction are. We need to do more research on the new heroin generation to know where their first use is occurring, where they’re buying, how they support their habits.”

Source: www.jointogether.org

It’s no secret that an addiction to heroin causes a lot of problems.

It can land you in jail – both because of the legal risks of possessing and procuring the drug, and from the things you might need to do just to fund your habit. Heroin addiction can erode relationships with family and friends and leave you unable to work, and it can kill you in a heartbeat at any time.

There is no shortage of solid reasons to quit using heroin, but in addition to the aforementioned consequences of use, chronic heroin use is also associated with a host of serious or fatal medical conditions — and the longer you use heroin, the greater your risks of medical complications from that use.

Here’s the truth: You don’t have to use heroin, and you’ve probably thought on many occasions of trying to quit. Thoughts of withdrawal can be scary, but there are medications (such as methadone or Suboxone) that help you overcome your heroin addiction without the pain of withdrawal.

Medical Conditions Associated with Heroin Use

• HIV – The infection rates for intravenous (IV) heroin users far exceed infection rates in the general population. The sharing of needles or other injection gear or unsafe sex between addicts greatly increases the likelihood of HIV exposure.

• Hepatitis C – There are few places in North America where the Hepatitis C infection rate among IV drug users is less than 50 percent — and in many locations, infection rates climb to as high as 75 percent. Hepatitis C is far more easily contracted than HIV and can lead to fatal conditions such as cirrhosis or liver cancer.

• Pneumonia – Heroin users run an increased risk of pneumonia because of heroin’s depressive effects on respiration, and the generally lower health and diminished immune systems of heroin users.

• Skin Abscesses – Unclean injection procedures can introduce bacteria under the skin. These bacteria can lead to pus- and blood-filled skin abscesses that, if left untreated, can cause gangrene, or even death.

• Endocarditis – Dirty needles can cause blood infections and heart infections. Endocarditis can lead to irregular heartbeat, heart disease and heart failure.

• Cell death in vital organs – The “filler” substances that are often added to street heroin can clog blood vessels. Clogged blood vessels can lead to cell death in vital organs of the body.

• Blood clots – The impurities that constitute most of what heroin users inject into their bodies can lead to blood clots, which can result in stroke or heart attack.

• Collapsed veins – Frequent injections lead to scarring inside the veins, which increases the risk of vein collapse.

Heroin Use Shortens Life

If you continue to use heroin the odds are high that heroin will shorten your lifespan. But you don’t have to keep using heroin. Treatments such as those that incorporate methadone or Suboxone are both affordable and effective, and can help you get back on the path toward a much more satisfying future.

Start taking better care of yourself today ,and look forward to a longer, healthier, and happier life. Any questions you may have about opiate addiction treatments in your area can be answered by treatment specialists at the National Resource Center, who are available for a free, confidential consultation at 888-471-0430.

With a lack of security and weak border patrols, drug trafficking and use is on the rise in Iraq, the Boston Globe reported Aug. 28.

According to senior officials with the United Nations drug-monitoring agency, heroin and marijuana are moving into Iraq through its eastern border with Iran. In addition, gangs are trafficking illegal drugs from Central Asia through Iraq’s Kurdish area in the north and the southern port of Umm Qasr.

Although Iraq is currently being used as a route to get the drugs to Turkey, the Balkans and Western Europe, Brian Taylor, chief of the anti-trafficking section of the United Nations office, said the availability of drugs is causing misuse problems in Iraq.

“If Iraq is increasingly used as a transit country, it’s likely there will be a spillover effect with local use,” Taylor said.

Iraqi doctors report an increase in the misuse of pills and inhalants, many of which are purchased illegally on the street.

According to Dr. Hashim H. Zainy, director of the IBN Rushd Hospital, the nation’s largest psychiatric facility, addiction cases have grown by 75 percent between February and July of this year.

“I still think it’s underreported,” he added.

Charles Heatly, senior spokesman for the Coalition Provisional Authority in Baghdad, said coalition officials are too busy with immediate needs, such as providing water, electricity and security, to focus on drug issues.

“It’s perhaps not at the top of our list of priorities at the moment,” he said.

Source: www.jointogether.org

Two women were recently charged in relation to separate methadone-related cases that resulted in the deaths of an infant in Alabama and an adult woman in Florida.

The Alabama woman, Angela Garcia, 31, is facing life in prison after the overdose death of her 13-month-old son, who ingested methadone that was left unsecured in the family home, The Floridian faces a third degree homicide charge after methadone she sold to another Floridian woman, Terry White, caused White’s overdose death.

Garcia is being held on $100,000 bail after prosecutors alleged that she left the methadone she was using for to manage her opiate addiction lying unsecured in her trailer home. According to a May 14 article by Gary McElroy of the Alabama news website al.com, Garcia’s infant son consumed methadone on more than one occasion prior to the overdose that caused his death late in 2008.

Garcia was charged with exposing a child to chemical endangerment, which carries a maximum sentence of life in prison.

As reported in a May 14 article on TampaBay.com, the Florida case involved Charlene Nadeau, 43, who sold prescribed medications (10 methadone pills and three Xanax pills) to Terry White on April 4. White was found unresponsive in her home the following day, and was pronounced dead at a local hospital upon arrival.

Nadeau was witnessed selling the medication, and was even heard wondering if she might go to jail for selling drugs. She now faces charges including third degree homicide the sale of a controlled substance.

While the keynote speaker at the annual conference of the National Association of Addiction Treatment Providers, Gen. Barry McCaffrey (a former four-star general who served as the nation’s “drug czar” under President Clinton) warned of drug-related dangers facing troops in Afghanistan.

Drug use by U.S. soldiers has doubled in the last four years, Gen. McCaffrey said, and he worries that as more soldiers move from Iraq to opium-laden Afghanistan, the rate of drug problems is going to keep rising.

Gen. McCaffrey said that Afghanistan produced 9,000 metric tons of opium each year, and that unless U.S. destroys a significant amount of that crop, increasing numbers of soldiers will become addicted — and terrorists will continue to profit.

“I’d be astonished if we don’t see soldiers who find 10 kilograms of heroin and pack it up in a birthday cake and send it home to their mother,” Gen. McCaffrey said. “The second thing is (soldiers) are going to stick it up their nose and like it.”

Talking about the state of American addiction treatment, McCaffrey lamented that although 24 million Americans are chronic substance abusers, only four million now get treatment for their problem.

Although he does not support legalizing marijuana or an end to the war on drugs, Gen. McCaffrey said that drug addiction treatment and rehabilitation, even for those in prison, is crucial. “The chamber of commerce will have you have believe is that it’s only poor people abusing drugs,” he said. It’s also anesthesiologists, ICU nurses, [and] healthcare providers.”