Heroin addiction

The therapy has actually been tried, with disastrous results at one site. See the reference to the Chelmsford hospital scancal.

I gather another reason for not pressing easy detoxification is that which is also raised as an objection to naltrexone treatment.

Which is to say, a detox’d person loses their increased tolerance for the drug. So that if they return to it, they tend to go back to the dose they used to use in order to get the rush, which dose is now an overdose, and … you can see this ending badly.

The desire for quick fixes can sometimes lead to the exact opposite. Or as it is sometimes put, for every complex problem, there is a simple solution. And it’s wrong.

I had a good friend who was a heroin addict. Quitting wasn’t a problem for him (though he was severely sick for a week each time); indeed he had to quit for long periods for his job which featured unannounced tests; he used only on his long vacations.

The problem was the irresistible desire: “Better than sex.” He’d be driven to buy if he accidentally found himself in the same town as a connection. But when some friends bought a bag and asked him what to do with it, he replied “You don’t know what you’re getting into. If I was you, I’d flush it down the toilet right now.”

This is something of the grim truth, too – I don’t know if there’s a slang term for it, but yeah, putting the addict behind bars for a few days will end the physiological addiction. The whole problem with dope is that people are very likely to relapse; thats the rationale behind “maintenance” – give them something as an alternative (methadone, Suboxone), and keep an eye on them, and ideally they’ll stop using the street drug. It does work for some people; Suboxone in particular has the benefit of having a higher binding affinity (not to get too technical) to many of the same receptors that heroin does – and it has a half-life of days, not hours. This means that someone taking Suboxone who tries to inject heroin won’t get anything out of it, and ideally they’ll quit trying to do it. Of course, some will figure its better to quit the Suboxone, but thats human nature.

Also human nature is to try to override the suboxone with more heroin, and ending up dead of an OD. It may have a high binding affinity, but it doesn’t block heroin perfectly.

Even so, suboxone (aka buprenorphine) can be a handy med for harm reduction. It takes about 8 hours of training and some extra paperwork ( and $$) for a physician to be allowed to prescribe it, and tends to fill the doc’s office with more junkies than usual, so getting physicians on board to start prescribing it is a bit of a challenge.

Also, it’s isn’t so bad to get off of buprenorphine as methadone, and the addict can take it at home like any other medication. Getting to a methadone clinic every day is a hassle. If someone is really serious about getting clean–and is working or whatever–then Suboxone probably is better.

Yeah, I’ve switched a few patients from up to 90 mg of methadone a day over to suboxone, then tapered them off over a few weeks without too much jonesing.

Trouble is, out on the street, suboxone is damned expensive. At least $7.50 a pill for the 8 mg strength, and some folks have needed 16 mg twice a day.

Then why are people on methadone for years?

Here in Australia it’s because the clinics make about $50 a week per addict for providing the daily dose. An average clinic with a couple of staff can provide 300 doses in a 10 hour shift. So the doctor who runs the clinic has little interest in getting anyone off the methadone.

Back when I was working at a methadone clinic our clients could earn the privilege of taking home 2 weeks worth of methadone at a time, so it’s not always the case an addict has to go to a clinic every day. (Laws probably vary on that from place to place)

Of course the key word here is “earn”. An addict trying to prove trustworthiness is a tall order. Some of them never got to that point.

Methadone is a tool, not a cure. It’s not appropriate for everyone. I used to get very pissed at judges who handed out “methadone maintenance and AA” to every drug user that showed up before them, whether appropriate or not. The ones not suited to those modalities, but ordered on them by the courts, displaced other people coming to us before they were in legal trouble who likely would have done much better in treatment than on a 10-14 month waiting list, if only because they were coming to us of their own accord rather than under duress.

don’t ask mentioned a financial incentive, but let me tell you, the place I worked wasn’t motivated by that. 2/3 of our business was from the State of Illinois and that state has a habit of “fixing” budget problems by simply not paying its contractors. One memorable year the clinic didn’t get paid by the state for 8 months. It was a nightmare. Believe it or not, some people actually are altruistic.

We tried to get people off methadone in 2-3 years. Does that sound like a lot? In one sense it is.

Here’s the thing: we didn’t want to detox the addicts, we wanted to get them off drugs for good. As already pointed out, you can lock anyone in a room for a few days and get them “clean” - and they’ll go right back to using at the first opportunity. We wanted them to get off the street drugs, then off the methadone, and stay off drugs. The two years was (ideally - it didn’t always work out) therapy so that when they did detox, finally, they had the mental and behavioral tools to avoid going back to using. Until they were ready for that methadone kept them out of the get high/come down/withdrawal/obtain drugs/get high merry go round so they could concentrate on getting themselves straightened out sufficiently to STAY straight.

And it didn’t always work to be honest.

The craving for heroin or other opiates is “filled” by the methadone.

BTW, the usual name for the treatment the OP is asking about is “Ultra-Rapid Opiate Detox,” where they sedate you for 48-72 hours while giving you IV naltrexone, thus ridding your receptors of the opiates (though that probably wouldn’t be long enough for methadone or LAAM or some of the long-lasting opioids, though) and getting the user past the worst part of the withdrawal symptoms. But the craving still exists, and that’s what ends up causing most people to relapse.

If someone is admitted to the hospital with asthma, a broken bone or some other treatable condition, you certainly wouldn’t want to complicate things by trying to get them off of narcotics. The hospital that I work at actually puts people on alcohol infusions to keep them from going through the DT’s while they’re being treated for something else.

It’d be a whole lot easier to just use valium or librium or other benzo to manage any possible withdrawal, frankly. Safer, too. Alcohol has such a narrow therapeutic window, and a LOT of side-effects.

Actually Qadgop, so many people that go through serious DT’s and are treated with benzos end up on a ventillator and aspirate and sometimes spend a month in the icu. Better to just keep them pickled while they’re there!

I personally couldn’t say what works best. There is actually two distinct camps at my hospital. The Medical service pretty much exclusively uses benzos, while the ETOH drip is used with patients on the Surgical Services. More people should moderate/stop their regular drinking when then they know they are going in for an elective procedure. I guess that isn’t too easy for a hard-core drinker.

How does methadone fix what leads them to take drugs in the first place?

It doesn’t.

But heroin has a relatively short elimination half-life, (a few hours, if I recall) which means that it’s out of the system relatively quickly, leading to renewed craving and the need to do whatever it takes at whatever hour to scratch the itch. It is this chaotic lifestyle of chasing the rush at crazy hours with no hope of stability that is a major part of the problem for your average street addict.

Methodone is an opiate. Addicts complain that they don’t get the rush that comes with heroin, but it kind of addresses the cravings. It also has a very long elimination half life (of the order of a day) so the chaotic lifestyle has a chance of being addressed. The addict has some structure - once a day dose, at a predictable hour - and the capacity to do mainstream things for the rest of the day without having to live the mad lifestyle. Once they get control of the lifestyle they can address their fundamental issues behind the addiction and learn some skills to resist against a background of relative stability without the eternal distraction of chasing the next hit.

Then they can be weaned off the methadone once they have the coping skills learned in a more stable environment.

I’d wager the risk is higher for those very same complications with ethanol than it is for benzos.

What hospital do you work at? None of the hospitals I’ve ever been on staff at ever used ethanol IV routinely to prevent ethanol withdrawal. I’ve only seen it used for acute methanol poisoning. And that was a long time ago.

In fact, quite the opposite. Not sure what the laws were and how they changed in the USA, but even in Canada where human rights (back then) were not consitutionally guaranteed, the courts around 1970 recognized that a law that allowed someone to be locked up on a doctor’s say-so for a week or more was fundamentally at odds with a free society. (IIRC a doctor just had to certify they had examined you and you were an addict).

SO it wasn’t a particular party or philosophy or “expenses” or law-and-order issue. And of course, if addiction were made a court issue and a criminal offense - by the time someone could be processed, well a typical minor charge can take a year or more to work through the system - that’s not exactly “treatment”.

Then what’s the criminal charge? “Being addicted”? That’s on a doctor’s examination? It’s not like there’s any simple test other than a drug test (which proves use, not addiction) or holding the person and actually waiting to see if they DT. How would you get a drug test or a medical exam without a court order, and what grounds would you use to get that order, seeing as how you can’t get a order without some decent proof, which is what the court order would be for? Maybe you could do that to people caught with possession, but I imagine people caught red-handed with possession will eventually get a few months in a relatively drug-free facility anyway.

Then, as mentioned above… curing physical addiction does not cure the urge. Heck, people quit smoking over and over. Getting off nicotine for a few days or weeks doesn’t cure the urge; and I’m making a wild guess here that people adicted to using opiates are feel the “urge” much more than smokers do?