Talk:Methadone

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Added warning about injecting pills with talc

I just added it yesterday, I thought it should be mentioned since there are some who still try and inject the pills. They usually do a tedious filtration thinking it will remove any harmful ingredients but it WILL NOT. It will only disperse the particles at most. The same goes for any other pills containing talcum, from ritalin to oxycodone. Injecting the liquid methadone is usally safer but it's still *not* a good idea because of the high volumen of liquid required, plus the various soluble additives. There is really(or should not be) not much motivation for injection since the bioavailiability is around 60% orally. There is actually a rush yes but it disappears(or rather, is greatly reduced) after a few months of use. It is possible to get 'high' from methadone in the start but it doesn't take long before it's gone for good. Larger doses may get you feeling 'wasted' but the euphoria will be gone. The number one problem with methadone is something else: the number of deaths/suicides involving combinations of other drugs and methadone.

Besides that, methadone is a good drug for both maintance and pain relief provided it's used correctly. It's one of the few opiates that will not require endlessly higher and higher doses, possible due to its NMDA receptor antagonism. It will not completely prevent concurrent abuse of other drugs but it will *greatly* reduce it. Many junkies on methadone still do occasionally heroin as a side abuse when they have the money. But it's nothing compared to the daily hunt they used to do everyday before. Remember that there is no permanent treatment of opiate addiction so far, only harm reduction, This is what methadone does. By the way, it's not really harder to get off methadone than other opiates although it must be done in a different way. However it takes more TIME because one has to take into account the long half life of methadone. This means it takes much much longer to taper off than short acting opiates. You can only reduce the daily dose with 5-10% every month even when you're down to one pill of 20 mg. Personally I think we will have a real cure(possibly an ibogaine analog) for opiate addiction within 15-20 years. M99 87.59.103.3 (talk) —Preceding undated comment added 19:27, 25 May 2009 (UTC).

"Controversy"

I noticed the "controversy" section has some unsourced statements, particularly the first sentence. Can this be deleted, or is that a violation of protocol? —Preceding unsigned comment added by 68.80.193.90 (talk) 10:26, 31 May 2009 (UTC)

Feel free to remove it, just be sure to explain what you're doing in the edit summary box so that the users watching recent changes don't assume you're doing something malicious like blanking vandalising. I think all of that so-called "controversy" section could be removed as unsourced and unnecessary. This article is really poor, IMHO, and really needs some TLC so please feel free to work on it if you feel inclined. Sarah 11:21, 31 May 2009 (UTC)

Price clarity

The statement, "In late 2004, the cost of a one-month supply of methadone was $120" is unclear as no specific dose amount is given or associated with that time interval. Cost depends on dose and dose depends on patient need. 500 mg/day would obviously incur a greater cost per month than say 5 mg/day. —Preceding unsigned comment added by 76.180.195.34 (talk) 14:09, 3 June 2009 (UTC)

The British National Formulary (BNF 57, latest edition, online at http://www.bnf.org/bnf/bnf/current/3534.htm) gives the prices as:

• Oral solution 1 mg/mL, methadone HCl 1 mg/mL:
  • 20 mL = 29p
  • 30 mL = 60p
  • 40 mL = 58p
  • 50 mL = £1.03
  • 60 mL = 87p
  • 100 mL = £1.45
  • 500 mL = £9.60

• Oral solution 5 mg/mL, methadone HCl 5 mg/mL:
  • 20 mL = £1.47
  • 1 litre = £73.33

• Injection, methadone HCl:
  • 25 mg/mL, 2-mL amp = £2.05
  • 50 mg/mL, 1-mL amp = £2.05

• Methadose® (Rosemont) - oral concentrate, methadone HCl:
  • 10 mg/mL (blue), 150 mL = £12.01
  • 20 mg/mL (brown), 150 mL = £24.02

• Tablets, methadone HCl 5 mg:
  • 50 = £2.97

• Injection, methadone HCl, 10 mg/mL:
  • 1-mL amp = 93p
  • 2-mL amp = £1.61
  • 3.5-mL amp = £1.98
  • 5-mL amp = £2.14

Ben (talk) 14:30, 3 June 2009 (UTC)

It also varies greatly depending on what country, state, region you're talking about. I personally think it would be better to not include a price, or perhaps to include prices from several places just as examples but they would need to be from different countries and not all American at the risk of being US-centric (which all the substance abuse related articles tend to be). Sarah 03:26, 4 June 2009 (UTC)

Maybe it would be a good idea to improve the side effects section regarding acute vs. chronic use

For instance, with short term use methadone is stimulating, euphoric and invigorating(which, along with the intense euphoria, is what get people addicted). Like other opiates such as morphine it has a doping effect when used in sport. But with chronic use(say >3 months), the opposite happens with tendency to weight gain, sleepiness, chronic fatigue and possibly depression. Methadone in terms of unpleasant side effects is certainly the most physically taxing of the opiates, with the exception of LAAM. One of the most hated side effects with chronic methadone use besides the fatigue is sweating and heat intolerance. Some doctors prescribe anticholinergics to ease this side effect but it's my impression that it doesn't help much except perhaps reduce the sweating a little. It will not stop the hot flashes and the intense vasodilation that makes users sweat and suffer during the summer. When someone looks at the side effects, it may be a bit confusing since the side effect profile is very different(like most other opiates) with acute vs. chronic use. The solution could be to arrange the side effects in a table instead of a list. M99 87.59.79.24 (talk) —Preceding undated comment added 19:02, 3 June 2009 (UTC).

Origin of urban legend regarding "Dolophine" source.

William Burroughs, in his 1954 book "Junkie" states that, about 1950 whilst an inmate of the government treatment facility at Lexington Kentucky, he was given "Dolophine, a synthetic horror, appropriatly named after Adolph Hitler" . This, the first mention in literature of this common fallacy, leads me to think that Mr Burroughs is the source of this myth.

118.92.223.205 (talk) 00:41, 5 June 2009 (UTC)

Elimination Half-Life

A 22 hour mean terminal elimination half life doesn't seem right to me. Most sources/studies report longer. Some values on the web:

http://www.medscape.com/viewarticle/441934_3  : Mean = 31.8

Google Books: Principles and Practice of Anesthesiology  : Mean = approx. 35

www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2042854  : Range = 33-46 (small sample)

Some one should look up some articles and compile a good average. Right now I'm changing the mean to "approx. 32 hrs" —Preceding unsigned comment added by 24.196.111.104 (talk) 08:23, 10 June 2009 (UTC)