The FDA oversees drugs in the USA and in 1970 released the following schedules under the Controlled Substance Act (CSA) which organizes drugs (prescription) into five groups based on risk or harm. The drugs with highest risk and no counterbalancing benefit are banned from medical practice; these are schedule one drugs. These have no currently accepted medical use and include drugs such as heroin, LSD, marijuana, ecstasy and Quaaludes (the drug Bill Cosby is currently in the news for giving to women and then having sex with them). Schedule two drugs include narcotics like Dilaudid, Percocet, Oxycontin, oxycodone, opium, morphine, codeine and Methadone. Schedule five at the bottom of the list includes codeine cough syrup.
When used correctly, methadone, which is longer acting then heroin and short-acting narcotics (like Percocet, Oxycodone) can help someone not crave the high of heroin and can help them regain a life of sorts; it can also relieve pain as the other narcotics can. Methadone is also used for those addicted to other opioids. There are many Methadone Clinics all over the place and some are run better than others. There are some clinics that are run as pill mills though, and you already are aware that many pain clinics are not run legitimately. The practicing and prescribing patterns of physicians and the midlevel providers (physician assistants and advanced registered nurse practitioners) who work for them varies. While addiction is a disease it, unfortunately due to the issues involved, is not viewed as other medical diseases because of the problems that can be caused by illegitimate use of these medications. Methadone supposedly reduces the drug cravings and harsh withdrawal symptoms that are often associated with a patient’s relapse, without creating the sense of euphoria associated with the abuse of heroin and the other opiates. When a narcotic is used correctly for someone with pain and at the correct dosing they rarely have the side effects that drug abuser look for; the euphoria, high feeling. It is a complicated chemical pathway of receptors in the brain. Therefore, in the Methadone clinics the person addicted to heroin or other narcotics is switched from the drug that gives them a “high” to an opioid (methadone) that does not. They then can be titrated to gradually lower does over time with the goal of getting off the drug. So for the abuser who takes Methadone instead of their drug of choice the risk involves taking too much or too high a dose in an effort to get the high that they want. Because Methadone is a long acting drug when they take too much they are at real risk of overdose.
Now let’s look at three terms you need to understand: addiction, dependence and tolerance.
Addiction: characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, and continued use despite harm and craving. The user has developed physical as well as psychological dependence. They crave it and need it and do whatever they have to so the can get the drug.
Dependence: is the state of adaptation that is manifested by withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. You have to have the drug or have problems when it is taken away.
Tolerance: is the state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time. Over time taking the medication you need more to achieve the same effect.
Family member says he's getting methadone daily at a clinic but is not a heroine addict
So now to your questions and concerns about your family member and I felt it important to provide the above education in order to help you understand the problem better. You probably won’t want to hear what I am saying but it’s important for you to understand for your sake if not theirs. This person is likely getting pills from more than one source and likely not all will be “legal” sources (doctor’s offices) and it’s likely been going on for some time. Persons who are addicted do what they must to get what they want. At a minimum that involves lying.
What is the truth
If he tells you he has “tried” heroin a couple of times read that to say he uses it regularly or frequently. And since he cannot obtain it legally, I am worried how and from where he is obtaining it. Because while a person can get Methadone from a clinic (pill mill or supposed legitimate office), heroin is a street drug with all that entails. If he really is going to a Methadone Clinic daily then a physician wrote the order. Unless you have power of attorney over him, you will not be able to get medical records. I don’t know what “prescribed pills” you say he continues to take daily but in my work reviewing medical records I have often seen patients getting narcotics and going to a Methadone Clinic as well. This is particularly dangerous. The legitimate Methadone Clinics will test patients and look for issues but the “pill mill” Methadone clinics might not. Methadone will not show up in a drug screen unless specifically ordered.
I recommend educating yourself in all aspects of these drugs and their abuse potential; particularly learn about the side effects, withdrawal symptoms and how they appear when they are high. This education is too involved for this article as there are too many possible drugs and scenarios to describe. Learn more about Methadone clinics and about where you can obtain Narcan injectable which is becoming available in some areas. If you suspect he is overdosing this drug might help. Pay attention to where he is getting money from as street drugs are expensive and many user become dealers to obtain their supply “for free”.
I hope this helps and know that we are with you.
Reach Out Recovery Exclusive By Dr. Gail Dudley