Heroin vs. Methadone

Can someone explain the advantages of Methadone over heroin? My understanding is that both get you high (maybe Methadone less so?), both are addictive, and Methadone withdrawal can apparently kill you, whereas I don’t think that’s the case with heroin.

So:

  1. What are the advantages of Methadone over heroin for treatment?
  2. Can Methadone withdrawal kill you?
  3. Can heroin withdrawal?
  4. Does Methadone get you high? Not as high as heroin?

When I ask about dying from withdrawal, I mean as a direct effect of the withdrawal (stoppage of breathing, for example) not as a side effect (for example, maybe it’s possible to die from heroin withdrawal if you do it alone and lose so much fluid from vomiting that you die of dehydration).

I can’t shake the idea that Methadone is considered OK because it’s produced by a pharmaceutical company whereas heroin is just bad because it’s an illegal substance.

I’m hoping Qadgop the Mercotan can opine, since he’s probably got lots of experience with all kinds of withdrawal situations.

From here: http://www.drugs.com/methadone.html

  1. Heroin is illegal to prescribe, methadone is not. Due to that, it is much easier to administer a regulated dose of methadone as compared to heroin.
  2. No, not that I’m aware of.
  3. No.
  4. Yes. Your brain basically converts both into the same substance. Methadone is longer lasting and less intense, while heroin is more intense and shorter acting.
  1. Methadone is taken orally, so you avoid all the blood-borne nastiness that heroin addicts are at high risk for.

  2. Many drugs produced by pharmaceutical companies are illegal without a prescription. If the government provided heroin to addicts under safe controlled conditions, it would also have to be made by a pharmaceutical company.

earlier thread

http://boards.straightdope.com/sdmb/showthread.php?t=508053&highlight=methadone

This brilliant post from the above thread highlights the comparisons and contrasts. :wink:

Still struggling with the humilty bit, Qadgop?

I went travelling in the late sixties (of the last century) and disappeared from my neighbourhood for about 5 years before returning. When I came back I found that many friends had, in the intervening years, become heroin addicts, and then gone on some healing program or other and were receiving methadone by prescription.

When I hung out with them they looked like stoned zombies. Just like heroin addicts.

Yes, methadone does cause some sort of high or buzz, especially in non-tolerant users (once a persons been on a steady dose for a long time it will likely just make them feel “well” and not any sort of buzz).

However, they are not converted into ‘basically’ the same substance. They are two different drugs that are both opioid agonists, but are chemically/structurally dissimilar. The rest of what you say is correct - methadone takes longer to peak and lasts longer than heroin (the slower peak is part of what gives methadone less of a high then heroin, which both has a quick peak and also usually administered in a way to make it peak even quicker, ie injecting).

There is another difference between methadone and heroin (and, in fact, AFAIK, all other opiates). Specifically, unlike morphine et al, methadone is effective for the treatment of neuropathic pain (e.g. pain from various cancers, diabetic neuropathy, post-herpetic neuralgia, etc.).

The mechanism for methadone’s unique efficacy in this regard seems to reside in the fact that methadone, uniquely among opiates, down-regulates the NMDA receptor (with such receptors up-regulated in painful neuropathy and thereby interfering with the action of opiates in the spinal cord). In other words, methadone, by virtue of its antagonism at the NMDA receptor, restores sensitivity to the analgesic effect of opiates. Moreover, since methadone is, of course, itself an opiate, it can be used as a single agent to treat neuropathic pain (exploiting its dual effects, i.e. its NMDA antagonism and endorphin receptor agonism).

My wife has been on methadone for a number of years as treatment of chronic neuropathic pain. She doesn’t get any high at all from it and is much more functional on it than off it. It also has the advantage of long term release so that a single dose will last about 5 hours. When she has gone through withdrawal her main symptom was increased pain and irritability. But it is hard to say how much of this was due to withdrawal and how much was due to not being medicated for her pain.

Read Deborah Spunden’s book “And I Don’t Want to Live This Life” about her daughter, the infamous Nancy of Sid & Nancy fame. She states that on heroin Nancy was the stereotypical spaced out junkie; on methodone she was able to work and take care of herself.

Deborah always knew when Nancy was back on heroin.

Thanks everyone for these very informative responses! Just what I was looking for.

RS

I sincerely hope that this response will help at least one person. I am entirely aware that any person in this world can become addicted to drugs, and I understand that many people who are addicted, as well as their families, wish that their lives were not like this. Unfortunately, my father is a drug addict and I would do absolutely anything in the world for his life, as well as mine, not to be like this. About eleven years ago, when I was eight years old, my father suffered from a work related injury. This injury resulted in him having up to thirteen surgeries over the course of five years, which eventually lead to him becoming hooked on pain killers. With my dad being out of work, my mom was only able to take a certain amount of time off from work, but I stuck to my dads side like glue and tried to take the best care of him as I possible could. Being an only child, my dad had always owned the most significant place in my heart (and always will), but while he was out of work, dad and I spent every waking second together. He was my best friend in the world and I would grow depressed if I went even three hours without him. I was young so I didn’t realize my parents fighting, but as I grew older I grew aware of the tension in my household. My mom and dad were constantly fighting, which they had never done before, and my dad started acting so strange. Things were not the same around my house and when I reached the age of twelve the dad I had always known was no longer the best friend I knew my entire life, he was aggressive, irritable and I was frightened by him at times. My mom was constantly upset which upset me to the point where I was sick and could not attend school. At the age of thirteen my mom revealed that my father was suffering from a drug addiction to heroin. One week later my dad moved out and went away to drug rehab. When I received the goodbye phone call from my dad he was crying, this was the only time I have, and still to this day, ever heard my dad cry and I pray that it is the last. He was away for three months and was released from treatment, but the second he came home things acted up again. He was soon prescribed methadone, which was supposed to relieve the withdrawals he was suffering from at the time. Soon after he was prescribed he was using both heroin and methadone leading to another seven trips to rehab. I no longer knew the best friend I had once possessed. My dad was soon stealing from my mom for money to get drugs which lead her to filing for divorce (after being together since the age of fourteen). My father was extremely uncooperative as well as aggressive which lead to a restraining order, forbidding him from seeing her as well as myself. This absolutely killed me. I was not able to see, nor was I able to talk to my dad for months all because of drugs. My mom did everything in her power to help him get off of these drugs, but at this point it was nearly impossible. I am now nineteen years old and still suffering from this pain. The methadone completely rotted his teeth and he looks about ten years older than he should be. When he runs out of this medicine for the month he is an angry, hostile person that I do not want to associate myself with. He calls me mean names and tells me that he wishes I was never born, but I know and hope these comments are just the drugs speaking. For the past two years there have been nights when my dad calls me 100% drugged out and the only thing I can think about is if my dad is going to make it through the night or not. Lately he has been worse than ever, my dad is no longer the person I knew in the least bit. He looks old, pale, and worn. Every night I worry that I won’t be able to speak to him the following morning, no matter how many mean comments he makes to me. I don’t think my dad has said one nice word to me in over three months, he learned how to text message so he can express his anger when I do not pick up his phone calls. I am currently an economics major at UNH and this has completely distracted me from my studies, I can truly say that I do not care about school right now because my main focus is my dad getting better. Every time I try to talk to him about being addicted and going to rehab, he grows extremely angry and aggressive. It’s to the point where I’m not sure what to do anymore, my mom tells me to ignore him because he only upsets me, but I know deep down he will always be the nice, caring, best friend that I once knew. I genuinely do not wish this upon any family, I would like everyone to know how much this drug prescribed by doctors, methadone, can ruin your life, as well as your family’s life. I hate pity stories more than anything in this world, I just wanted to share my story in hope that it will stop someone from doing either of these drugs. Not a day goes by when I don’t wonder what my life would be like right now if my dad wasn’t addicted.

Heroin used to be legal, and was a commercial pharmaceutical.

http://en.wikipedia.org/wiki/File:Bayer_Heroin_bottle.jpg

As methadone is longer-acting than heroin, one dose a day is adequate to stave off withdrawal pains whereas heroin would require multiple doses. Others have touched on other aspects of the perceived advantages of methadone, as well as some of the drawbacks (like a much longer time to detox).

Methadone maintenance is a tool - like all tools, it is not appropriate for all jobs and circumstances, and it can also be abused and misused. It’s not a one-size-fits-all pancea for opiate addiction.

No. It can make you feel like shit for weeks at a time, but no, it can’t directly kill you.

No. It feels awful, and people may think they’re dying or want to die, but no, it’s not deadly.

Yes, methadone can get you high if you take enough. The high of methadone vs. that of heroin has already been addressed by people who are much more conversant in the nuances of different drug highs than I am.

Truthfully, a LOT of people most certainly do NOT think methadone is OK. It’s legal, yes, but if the government changed the relevant laws heroin could be used for drug treatment, and is in some countries in Europe.

I sincerely hope you will read my responses and get some help FOR YOU, because, frankly, you need it.

That’s a noble sentiment on one level, however, this is not YOUR responsibility. It is not up to you to “save” your father, it is up to HIM to do it.

You were what? Eight? Thirteen? You should not have been put in the role of care-giver to your father! I mean, it’s great if you help out, and I certainly understand the dynamics what with my own mother’s health problems when I was around that age, but you make it sound like you were his primary nurse or something which an inappropriate role for a child. Was there any attempt to find an adult for that role?

Actually, this is NOT a healthy relationship.

Why was your mom upset with YOU? Did you drop out of school entirely? I’m sorry, hon, but this does not sound like a healthy family environment at all. I realize that such unhealthy environments are a hallmark of drug addiction, but really, you could probably use some counseling.

OK, mixing heroin and methadone is forbidden in any legitimate treatment program. Do you know what that means? It means that at that point your dad didn’t REALLY want to get off drugs, he was in treatment because of some other reason (legal, family pressure, whatever) rather than a sincere desire to get clean. This probably doesn’t mesh well with the notion of your dad as a wonderful person, but it’s probably the truth.

Let me tell you something - a LOT of drug addicts are very nice, wonderful people when they’re sober. The problem being, of course, that so often they’re not sober they’re drunk or high or trying to get to that state. It’s not that being a drug addict makes your dad a bad person, more likely, he’s a wonderful person with a really bad problem he doesn’t deal with very well.

It was also probably the best thing for you, despite the emotional hurt. Living with an aggressive, uncooperative thief is not a good thing, and it’s not healthy. Would you have better off with dad still around but stealing from your mom to the point you had no food to eat or no way to pay the rent or mortgage? I think not.

Until an addict wants to get off the drugs no one can “make” him get off the drugs. You need to stop assigning responsibility for your dad’s sobriety to everyone BUT your dad. It’s not YOUR job to keep him clean. It’s not your mom’s job, either. It’s up to HIM to do it.

Then YOU need help. You need counseling. Or a support group for families and friends of addicts. Or both. You need a much better understanding of what addiction is and isn’t and how you can cope with being related to an addict. You need this for YOUR pain and to make YOUR life better. You can’t wait for dad to clean up - you just don’t know when, or if, that will happen. You need to get on with YOUR life NOW.

No, the methadone did NOT “rot his teeth”. The self-neglect typical of an addict rotted his teeth. Addicts don’t take good care of themselves, that’s why so often they look like shit, lose their teeth, etc. No matter what your dad used as his poison of choice his teeth would have rotted because it’s not the drugs that do it, it’s the appalling lake of proper hygiene so often seen in addicts.

Again, you are blaming something other than the one person actually responsible for the problem.

THEN DON’T ASSOCIATE WITH HIM. Don’t be around him when he’s acting like that. Don’t reward bad behavior.

As far as “runs out of this medicine for the month” - assuming he is actually in a treatment program of some sort, he is being given a specific amount of drug to be used per day, no more and no less. If he’s running out then either he is taking more than he should, or he is selling it. Either way, it’s not indicative of a desire to either get clean, obey the law, or behave himself.

Two point here:

First, as a general rule, if a drug addict is functional enough to make a phone call and stay on the line they’re not in immediate danger of death. If he passes out during a conversation call 911, that is a serious sign, but hours of rambling, slurred speech, while disturbing, isn’t really dangerous.

Second, this constitutes either emotional abuse, harassment, or both. Why do you allow this? This is not healthy FOR YOU. You are allowing your father’s problem to because your problem - why? You need to get off the merry-go-round. See recommendation about counseling and/or support groups.

Seriously, YOU need to take responsibility FOR YOURSELF and do what you need to do FOR YOURSELF so you can have a good life despite having a messed-up dad.

Why are you sacrificing your education and your chance at a better future for your father? YOUR FATHER IS NOT YOUR RESPONSIBILITY. It is up to HIM to get better. You can NOT make him get better no matter what you do. Indeed, you may be enabling him in his addiction without realizing it.

THEN STOP BRINGING IT UP!

Seriously, you are not his mother. You are not his wife. He knows that rehab exists (having been there), he knows where help is. He doesn’t want it. You can’t make him want it. STOP TALKING ABOUT IT.

Not until he’s off the drugs.

What should you do? NOTHING. There is nothing you can do right now. You can’t make him want something he doesn’t actually want. You can’t force him. He wants and loves the drugs more than anything else in his life right now, including you. Until HE wants to get clean he won’t.

Do what you mom says - ignore him. Don’t have a relationship with him until he’s clean and sober.

Again, you blame everyone but the one party actually responsible. NO drug 'ruined" his life, or his family’s life, his addiction did that. It really doesn’t matter if it’s heroin, methadone, crack, valium, or plain old alcohol. It’s the addiction, and its associated behaviors, that fucks things up. It doesn’t even have to be drugs - gambling addicts can be just as toxic.

Alright - NOW GO GET HELP FOR YOURSELF. Seriously. A support group for relatives of addicts or counseling or both. You need it.

Unbelievable. I am so sorry to read this. I hurt myself at work, 3 surgeries and lots and lots of pain killers. Currently morphine and percocets. I pray everyday to keep it from affecting my life and the way I treat my family. Your story gives me some perspective and I will keep it in my head and try to learn from it. You went through more than any child should, God Bless.

Chelseapink9, you might try Al-Anon. It’s for people who have loved ones who have substance use disorders. Or, if you can find it, you might try Nar-Anon, which is for people who have loved ones who are drug addicts. Either way, you’ll find people who have experienced what you’re going through, and who can help you get through it.

Chelseapink9
Remember your dad the way he was. He would have been extremely proud of you doing your studies. Try to stick with it and focus on your own future. It’s such a tough thing for a young person to go through but remember that you also have an obligation to look after yourself. I hope the doctor who originally prescribed the treatment is aware of the outcomes. Good luck with the support group that the other contributor suggested. If you work with groups like this you can help raise the awareness.