AboutMethadoneand BuprenorphineRevised Second

We are the Drug PolicyAlliance and we envisiona just society in which theuse and regulation of drugsare grounded in science,compassion, health andhuman rights, in whichpeople are no longer punishedfor what they put into theirown bodies but only forcrimes committed againstothers, and in which thefears, prejudices and punitiveprohibitions of today areno more.Please join us.About Methadone and Buprenorphine

AboutMethadoneand BuprenorphineRevised Second EditionCopyright 2006 Drug Policy Alliance. All rights reserved.“Drug Policy Alliance” and the “A Drug Policy Alliance Release” logo areregistered trademarks of the Drug Policy Alliance.Printed in the United States of AmericaISBN: 1-930517-27-0No dedicated funds were or will be received from any individual,foundation or corporation in the writing or publishing of this booklet.

Table of ledgmentsIntroductionDependencyWhat is Methadone?BuprenorphineMaintenanceAfter MethadoneMyths & FactsDrug InteractionsYour Other DoctorsMethadone & WomenStoring MethadoneConcerns about OverdoseIn Case of OverdoseDetoxificationMethadone & PainDrivingTraveling with MethadoneState Substance Abuse AgenciesOther Resources2About Methadone and Buprenorphine

AcknowledgmentsThis is the third printing of thisbooklet. The first 300,000 copieswere distributed, across the U.S.and internationally, primarily byadvocates. We are deeply gratefulto all who helped get the bookletout to patients, families, treatmentproviders and program staff,policymakers and other interestedmembers of the community. AboutMethadone and Buprenorphine hasalso been translated into Italian,Russian and Spanish.This second edition has beenrevised to include information aboutbuprenorphine, an important treatment option that has emerged as anadditional opioid addiction treatmentto methadone. Future editions ofAbout Methadone and Buprenorphinewill provide readers with morecomprehensive information aboutopioid addiction treatment usingbuprenorphine.www.drugpolicy.orgMany thanks to my collaborators,Corinne Carey, JD, Travis Jordan,Michael McAllister, Sharon Stancliff,MD, Ellen Tuchman, PhD, and PeterVanderkloot for their invaluablecontributions to the research andwriting of this booklet.Thanks also to Matthew Briggs,Paul Cherashore, Amanda Davila,Chris Ford, MD, Ethan Nadelmann,JD, PhD, Robert Newman, MD,J.Thomas Payte, MD, ShaynaSamuels, and Isaac Skelton for theirsuggestions for improvements.And special thanks to all the methadone patients, advocates, and theirloved ones that I have met andworked with. You are the inspirationfor this.Holly Catania, JDBaron Edmond de RothschildChemical Dependency Institute3

IntroductionYou may be reading this bookbecause you are taking methadoneor because you are thinking abouttaking methadone – or because youcare about somebody who is. People dependent on street opioidswho receive methadone treatment arehealthier and safer than those who donot. They live longer, spend less timein jail and in the hospital, are lessoften infected with HIV, and commitfewer crimes.People usually enter methadonetreatment because they feel overwhelmed by their dependence on Longer periods of methadoneheroin or other opioids. But notmaintenance are better than shortereveryone who comes into methaperiods. The longer you stay ondone maintenance has the samemethadone maintenance, the bettergoals. Some people want to stopthe overall outcome. Indefinite treattaking street opioids for good. Somement often means life-long extensionwant to temporarily stop taking streetof good health, HIV seronegativity,opioids. And some want to reduce orand freedom from their use of street opioids. Methadone maintenance is treatmentSome people begin methadonefor people who are dependent onwith the belief that they will needopioid drugs. It is not a treatmentmedication indefinitely. Others feelfor people whose major problemsthat they will only need it for a shortare with other drugs – such astime. Regardless of what you hopecocaine, alcohol, benzodiazepines,to get from methadone maintenance,or cigarettes.however, all the evidence agrees onthese several points:Opioid drugs include all the drugsthat come fully or partially from opiumand synthetic drugs that have similareffects. Morphine, heroin, codeine,methadone, dilaudid, buprenorphine,LAAM, OxyContin, and fentanylare opioids.4About Methadone and Buprenorphine

People dependenton street opioidswho receivemethadone treatmentare healthier andsafer than thosewho do not.www.drugpolicy.org7

DependencyOpioids have been used for thousandsof years, and it has long been knownthat many people who have becomedependent on opioids have extremedifficulty permanently ending theiruse of them.people with a long history of opioidproblems have experienced changesto the part of their brains that allows aperson to feel and function normally.This part of the brain makes and usesits own natural opioids.Suffering through the withdrawalsickness is only part of the problem.The real difficulty has always beenstaying off the drugs once the periodof withdrawal is over.The best known of these naturalopioids are the chemicals knownas endorphins. The word endorphinliterally means “the morphine within.”Indeed, these chemicals are functionally identical to morphine or heroin.Just as in the case of those who areunable to stop smoking, it is difficultto explain why it is so hard not toreturn to the use of opioids. Reasonsinclude long-term depression, lack ofenergy, drug cravings, and suddenattacks of physical withdrawal sickness. Some people find that theseproblems diminish over time andeventually disappear altogether –but others continue to suffer thesesymptoms indefinitely, and manyof them eventually relapse to theirregular use of opioids.We don’t yet understand everythingthat these natural opioids do in thebody, but evidence suggests thatthey are involved with pain control,learning, regulating body temperature, and many other functions.It is possible that people who developa dependency on opioids wereborn with an endorphin system thatmakes them particularly vulnerable.For example, we know that addictionappears to run in some families.Relapse often has nothing to do withlack of will power or other personalityproblems. Instead, it appears that6About Methadone and Buprenorphine

Addiction might also be related tochanges in the brain caused by theoveruse of heroin or other opioids.Or it may be the result of a complexrelationship between genetics andthe environment. We do not yet knowexactly how this malfunctioningoccurs, or even whether all peoplewho feel unable to stop using opioidshave this damage. There is, however,an increasing amount of evidencethat many people who find it difficult to end their use of opioids haveexperienced these physical changes– which are likely to be permanent.Relapse oftenhas nothing todo with lack ofwill power orother personalityproblems.There is not yet any test that candetermine how much damage aperson may have to his or her naturalopioid system, or how hard it maybe for that person to stay away fromopioids. All that we know for sureright now is that relapse is a majorfeature of opioid dependency.Methadone is not a cure for theproblem of opioid dependency.It is a treatment – and one that iseffective for only as long as a personcontinues to take it appropriately.www.drugpolicy.org7

What is Methadone?Methadone is a long-acting,synthetic drug that was first used inthe maintenance treatment of drugaddiction in the United States inthe 1960s. It is an opioid “agonist,”which means that it acts in a waythat is similar to morphine and othernarcotic medications.When used in proper doses inmaintenance treatment, methadonedoes not create euphoria, sedation,or an analgesic effect. Dosesmust be individually determined.The proper maintenance doseis the one at which the cravingsstop, without creating the effectsof euphoria or sedation.Although methadone is not a singleproduct from a single manufacturer,the active ingredient is always thesame: methadone hydrochloride.8About Methadone and Buprenorphine

All manufacturers add inactiveingredients, such as fillers, preservatives and flavorings. Methadone isdispensed orally in different forms,which include: Tablets, also called diskettes.Each one contains 40 milligrams ofmethadone, is dissolved in water, andthen is administered in an oral dose. Powder is also dissolved in water. Liquid methadone can be dispensedwith an automated measuring pump.Dosages can be adjusted to as smallas a single milligram.Patients have different opinions aboutthe various types of methadone.Each methadone provider usuallyoffers a single type of the drug andobtains its supply from one source,which means that patients generallydo not get to choose which form ofmethadone they get.For most people, a single dose ofmethadone lasts 24 to 36 hours.www.drugpolicy.orgHow is methadone different fromheroin and other opioids (forexample, morphine or dilaudid)?Methadone lasts longer. The bodymetabolizes methadone differentlythan it does heroin or morphine.When a person takes methadoneregularly, it builds up and is stored inthe body, so it lasts even longer whenused for maintenance. Most peoplefind that once they’re stabilized ona dose of methadone that’s right forthem, a single oral dose will “hold”them for at least a full 24-hour day.For some, the effect lasts longer; forothers it lasts a shorter time.Stability is easier on oralmethadone. Most people who areon a stable, appropriate dose ofmethadone for several weeks will notfeel any significant sense of being“high” or “dopesick.” Some patientsmay feel a “transition” – or temporary,mild glow – for a short time severalhours after being medicated,however. Others may feel slightly“dopesick” prior to taking the day’sdose but most will feel very little orno effect from the proper dose ofmethadone once they have stabilized.9

BuprenorphineBy Sharon Stancliff, MDBuprenorphine, when appropriatelyprescribed and taken, is an effective,safe medication approved by theFDA for use in the treatment of opioidaddiction. Buprenorphine relieveswithdrawal, reduces craving andblocks the effects of heroin in wayssimilar to methadone. Maintenancedoses are generally between 12 and32 milligrams but (like methadone)should be individualized.Unlike methadone, buprenorphinemay be prescribed for treatment ofopioid addiction by any doctor whohas received training (available viathe Internet or as a one-day course)and a waiver from the DEA. This is itsprincipal advantage over methadonefor most doctors and patients. Misuseof buprenorphine is less likely thanmethadone to result in death.Prescribed in the U.S. as Suboxoneor Subutex, buprenorphine is usuallytaken daily as tablets to be dissolvedunder the tongue. There is littleeffect from the drug if it is swallowed.Suboxone contains not just buprenorphine but also naloxone, an opioidantagonist that may precipitatewithdrawal symptoms if injected.For people dependent on any opioid,taking the first dose of buprenorphinewhen not in withdrawal can result inacute withdrawal symptoms.Buprenorphine, like methadone,can be used as a short- or long-termdetoxification medication or indefinitely as a maintenance medication.The risks of relapse followingdetoxification appear to be similarwhether methadone or buprenorphine (or any drug-free treatmentmodality) is used.A directory of physicians approvedto prescribe buprenorphine can befound at locator/.10About Methadone and Buprenorphine

MaintenanceMethadone maintenance isintended to do three things forpatients who participate:1. Keep the patient from going intowithdrawal. The standard initialdose, as currently recommended,is 30 to 40 milligrams a day. Afterseveral days, providers adjust apatient’s dose as needed.2. Keep the patient comfortable andfree from craving street opioids.Having a craving means more thanjust having a desire to get high.It means feeling such a strong needfor opioids that people may haveregular dreams about using drugs,think about doing drugs to theexclusion of anything else, and/ordo things that they wouldn’t normallydo to get drugs.www.drugpolicy.orgMethadone won’t control a person’semotional desire to get high, but anadequate dose of methadone shouldprevent the overwhelming physicalneed to use street opioids.3. “Block” the effects of streetopioids. If the dose is high enough,methadone keeps the patient fromgetting much, if any, effect fromthe usual doses of street opioids.This result is often called the“blockade” effect.If a person’s opioid tolerance iselevated high enough withmethadone treatment, a greatdeal of heroin would be requiredto overcome it and produce asignificant high.11

Methadone won’t controla person’s desire toget high, but an adequatedose of methadoneshould prevent theoverwhelming physicalneed to use street opioids.About Methadone and Buprenorphine

After MethadoneMany people who must takemedications every day get tired ofdoing so. This is especially true ofpatients on methadone maintenancebecause, in the United States, almostall methadone patients are alsorequired to make frequent visits toa clinic to receive their medication.For many reasons, most methadonemaintenance patients decide atsome point that they want to stoptaking methadone.If you do choose to leave maintenance, your provider should reduceyour dose at the speed you feelcomfortable with. If it is slow enoughyou should not experience majorphysical withdrawal symptoms.staying opioid free over the longterm is the harder challenge. Studiesfind that people who have longhistories of trying and failing to livewithout opioids will probably not beable to stay abstinent for long.It isn’t yet possible to predict whowill be able to live life without opioids,but it doesn’t seem to depend on how“together” you are. If you are detoxingand find that you are craving opioids,or you have finished detoxing andyou are always thinking of opioids,then perhaps maintenance shouldbe part of your life.But if you have tried withdrawingfrom opioids many times and haverelapsed, then you may have foundthat detoxing is the easier part andwww.drugpolicy.org13

Myths & FactsMyth: Methadone gets into yourbones and weakens them.Myth: Taking methadone damagesyour body.Fact: Methadone does not “get intothe bones” or in any other way causeharm to the skeletal system. Althoughsome methadone patients reporthaving aches in their arms and legs,the discomfort is probably a mildwithdrawal symptom and may beeased by adjusting the doseof methadone.Fact: People have been takingmethadone for more than 30 years,and there has been no evidence thatlong-term use causes any physicaldamage. Some people do suffersome side effects from methadone– such as constipation, increasedsweating, and dry mouth – but theseusually go away over time or withdose adjustments. Other effects,such as menstrual abnormalitiesand decreased sexual desire, havebeen reported by some patientsbut have not been clearly linked tomethadone use.Also, some substances can causemore rapid metabolism of methadone(see pages 16-17 for a list of medications that interact with methadone).If you are taking another substancethat is affecting the metabolism ofyour methadone, your doctor mayneed to adjust your methadone dose.Myth: It’s harder to kickmethadone than it is to kicka dope habit.Fact: Stopping methadone use isdifferent from kicking a heroin habit.Some people find it harder becausethe withdrawal lasts longer. Otherssay that although it lasts longer, it ismilder than heroin withdrawal.14Myth: Methadone is worse for yourbody than heroin.Fact: Methadone is not worse foryour body than heroin. Both heroinand methadone are nontoxic, yet bothcan be dangerous if taken in excess– but this is true of everything, fromaspirin to food. Methadone is saferthan street heroin because it is alegally prescribed medication andit is taken orally. Unregulated streetdrugs often contain many harmfuladditives that are used to “cut”the drug.About Methadone and Buprenorphine

Myth: Methadone harms your liver.Fact: The liver metabolizes (breaksdown and processes) methadone,but methadone does not “harm”the liver. Methadone is actually mucheasier for the liver to metabolizethan many other types of medications. People with hepatitis orwith severe liver disease can takemethadone safely.Myth: Methadone is harmfulto your immune system.Fact: Methadone does not damagethe immune system. In fact, severalstudies suggest that HIV-positivepatients who are taking methadoneare healthier and live longer thanthose drug users who are noton methadone.Myth: Methadone causes peopleto use cocaine.Fact: Methadone does not causepeople to use cocaine. Many peoplewho use cocaine started takingit before they started methadonemaintenance treatment – and manystop using cocaine while they areon maintenance.www.drugpolicy.orgMyth: The lower the doseof methadone, the better.Fact: Low doses will reducewithdrawal symptoms, but higherdoses are needed to block theeffect of heroin and – mostimportant – to cut the craving forheroin. Most patients will needbetween 60 and 120 milligramsof methadone a day to stop usingheroin. A few patients, however,will feel well with 5 to 10 milligrams;others will need hundreds ofmilligrams a day in order to feelcomfortable. Ideally, patients shoulddecide on their dose with the helpof their physician, and withoutoutside interference or limits.Myth: Methadone causesdrowsiness and sedation.Fact: All people sometimes feeldrowsy or tired. Patients on astabilized dose of methadone willnot feel any more drowsy or sedatedthan is normal.15

Drug InteractionsLike any medication, methadonecan interact with other types ofmedicines and with street drugs.The body is a complex system, andit’s possible that foods, hormones,weight changes, and stress mayeach also affect the way in whichmethadone works in your body.We know about some of thesubstances that may interact withmethadone – and some of themare listed here. Others may yetbe discovered. These medicines cause the liverto metabolize methadone morequickly and may cause a need foran increased methadone dose:Carbamazepin (Tegretol)Phenytoin (Dilantin)Neverapine (Virammune)RifampinEfavirenz (Sustiva)Amprenavir (Agenerase) –methadone also significantly reducesthe level of amprenavir.Ritonavir (Norvir) – less of an effect16 Some medicines slow the metabolismof methadone. Sometimes peoplewill feel the effect of methadonemore strongly when they takethese medications, and sometimesthey experience withdrawal symptoms when they stop taking thesemedications:Amitriptyline (Elavil)Cimetidine (Tagamet)Fluvoxamine (Luvox)Ketoconazole (Nizoral)Some medications are opioidblockers and may cause withdrawal.These block the effect of methadoneand should not be taken if you aretaking methadone: Pentazocine (Talwin) Naltrexone (Revia) Tramadol (Ultram), in most casesAbout Methadone and Buprenorphine

Some medications initiallyinteract with methadone to causesedation, but then the oppositeoccurs, and they can causewithdrawal symptoms. Thesemedications include: Benzodiazepines such asXanax and valium Alcohol BarbituratesOther medications with interactiveeffects: Cocaine can increase the dose ofmethadone required. Methadone increases the levelof AZT and desipramine inthe blood.Two things should always bekept in mind regardingmethadone interactions: Methadone is not responsiblefor every new feeling you have,and it won’t be affected by mostmedications or changes in yourlife conditions. If your methadone dosage doesn’tfeel right, it probably isn’t right. Youare the expert when it comes to howmuch methadone is enough. Talk toyour doctor about how you’re feeling.For more information about druginteractions, go under “methadone.”If your methadonedosage doesn’t feel right,it probably isn’t right.www.drugpolicy.org17

Your Other DoctorsMethadone patients aresometimes reluctant to tell theirother doctors that they are takingmethadone. They are afraid thatthese doctors – or other healthcare providers – will discriminateagainst them. Unfortunately, theyare often right.Find a primary-care provider whomyou can trust. The ideal situationis to make sure all your doctorsknow that you are taking methadone. If you choose not to tell them,however, keep these importantthings in mind: If you are having surgery for whichyou may be put to sleep, theanesthesiologist might use a typeof medication that will cause abruptmethadone withdrawal. Be sure youknow which medications interactwith methadone (see pages 16-17)– even if your doctors know that youare taking methadone. It is illegal for your methadoneprovider to communicate with yourprimary-care doctor or anyone elsewithout your written permission.(Title 42 of the Code of FederalRegulations Part 2 [42CFR part 2]protects against disclosure of drugtreatment records.)Ideally, though, open communication among all the doctors who aretreating you may assist you in gettingthe best possible health care.18About Methadone and Buprenorphine

Methadone & Women Is it true that women sometimesstop getting their periods whenthey begin taking methadone?You may have heard that you shouldnot take methadone when pregnant.This is not true.Yes, but there are also many otherreasons why women’s periodsbecome irregular or stop:PregnancyStressPoor dietWeight gain and lossMenopauseOther medical problemsOther medications Methadone is not harmful to thedeveloping fetus – but detoxing is. Methadone is the treatment of choicefor heroin and opioid dependencyduring pregnancy. The effects of methadone onpregnancy have been widely studied. Methadone has been usedsuccessfully during pregnancy. When properly prescribed forpregnant women, methadoneprovides a non-stressful environmentin which the fetus can develop. Taking methadone during pregnancymay prevent miscarriage, fetaldistress, and premature labor. Decreasing the dose of methadoneduring the first trimester increases therisk of miscarriage. During pregnancy, your dose shouldbe sufficient to avoid cravings, avoidstreet drugs, and prevent withdrawal.Remember: You can still get pregnant even if youdon’t get your period. You can conceive and have normalpregnancies and normal deliverieswhile you are receiving methadone.www.drugpolicy.org19

Methadone & Women (cont.)If you are pregnant, be sure totalk with your doctor, because: When you’re pregnant, your bodymetabolism changes, so you mayneed to adjust your dosage. Youmay need to increase your dose ofmethadone, or split your dose andtake smaller amounts two or threetimes a day.You may have heard that your babywill be born addicted to methadoneor will suffer other side effects, buthere are the facts: Methadone does not cause fetalabnormalities. No harmful effectsto a fetus have been found in thestudy of methadone’s effect onpregnancy. Premature birth and low birth weightcan be associated with cigarettesmoking and/or poor nutrition andare not attributed to methadone.20 Babies born to mothers dependenton methadone will have methadonein their systems, but studies showthat the children can be weanedsuccessfully and safely with noadverse effects.You may have heard that youshouldn’t breast-feed your baby ifyou are taking methadone, but hereare the facts: Breast-feeding is now consideredsafe for the babies of women who aretaking methadone, but not safe forwomen who are HIV positive. Small amounts of methadone inbreast milk can pass to the baby. Methadone levels in breast milk arevery low.About Methadone and Buprenorphine

Storing MethadoneWhile at home, always keep yourmethadone in a safe place – preferablyin a locked box or cabinet – out ofthe reach of children and clearlymarked to prevent anyone else fromtaking it accidentally.Remember: Methadone is a verystrong drug. A small amount cankill a child or an adult who does nothave a tolerance to it. If anyone inyour home accidentally drinks yourmethadone, call 911 or an ambulanceimmediately.If anyone inyour homeaccidentallydrinks methadone,call 911 or anambulanceimmediately.Store your methadone away fromextreme heat or cold. The methadonethat you take home is often mixedwith water – and sometimes mixedwith other additives, depending onwhere you get your methadone.The solution typically lasts for weeks.When you are traveling or away fromhome, keep your methadone in theprescription bottles that were givento you by your methadone providerto prevent any trouble with the law.As with any prescription drug, it isillegal to possess methadone withouta prescription.www.drugpolicy.org21

ConcernsAbout OverdoseMethadone treatment reduces thechance of overdose for those who areusing or are addicted to heroin.Methadone is a pure drug and isindividually prescribed. It does notcontain the harmful “cuts” that aremixed into drugs bought on thestreet. Concerns about overdoseremain, however, especially if youcontinue to use street drugs or ifyou resume regular heroin use afterstopping your methadone treatment.If you stop taking methadone andstart using street drugs again, yourchance of overdose increasesbecause you now have a lowertolerance for the drugs. Toleranceincreases when your body hasgotten used to having the drug in itssystem – in other words, your body“tolerates” the presence of the drug.If you stop using regularly – or if youhave detoxed – it takes a smalleramount of the heroin, methadone, orother opioid to cause an overdose.Also, mixing pills such as benzodiazepines, barbiturates and/or alcoholwith methadone or heroin increasesthe risk of overdose.22About Methadone and Buprenorphine

Frequently Asked QuestionsCan I overdose on methadone?It is possible to overdose on methadone, but providers work to adjustdosages so that they are safe foreach individual patient. It is importantto be honest with the clinic staff abouthow much heroin or other opioidsyou are using so that they prescribe adosage that is right for you – too littlewon’t be effective; too much couldcause you to overdose. Methadoneis a strong medication, so you needto build up the dosage slowly to besure that your body is handling themedicine well.Can I overdose on buprenorphine?Misuse of buprenorphine is less likelythan methadone to result in death(see page 10).What if I use other drugs while I amtaking methadone?The correct dosage of methadoneblocks the effects of heroin. If youtake opioids while also taking methadone, you may not feel the effects ofthe opioids. You may then decide totake even more of the opioid, whichcould cause an overdose. Somedrugs also interact with methadoneand can change how your medications affect you (see pages 16-17).Taking too much of a sedative ordrinking a lot of alcohol while youare taking methadone can also bedangerous because each substancemakes the other more powerful,increasing your risk of overdose.Be extremely careful if you mixthese drugs.The correct dosageof methadoneblocks the effectsof heroin.www.drugpolicy.org23

Concerns About Overdose (cont.)Can I overdose on heroin whileI am taking methadone?Yes. Even while taking methadone,if you take too much heroin –especially if the heroin is unusuallystrong – you could overdose. Youincrease the odds of overdosingon heroin while you’re takingmethadone if you mix it withsedatives, alcohol, or other drugs.What if I stop going to mymethadone program?If you stop taking your methadoneand return to using street drugs,you can overdose more easily thanwhen you last used. When you stoptaking methadone, your body willrapidly develop a lower tolerance forthe heroin. As soon as your methadone completely wears off (a coupleof days), your tolerance for heroinwill be lower than it was when youbegan taking methadone. So, if youdecide to use again, you need to be24very careful. Take some precautions– always be sure there are otherpeople with you when you’re using,in case you need medical attention,and test the effect of the drug onyou before you take an entire dose.What happens if I start takingmethadone again after I havestopped?If you stop taking methadoneeven for a few days, you need tobe careful when you start takingit again. Your body may have lostsome of its tolerance for themethadone, so you could overdose.You need to restart at a lower doseand work back up to the levelyou were at when you stopped.The doctor at the clinic can helpyou determine the right dosages.About Methadone and Buprenorphine

In Case of OverdoseIf you suspect that someonehas overdosed on methadone,lay the person on his or her sidein the recovery position and call911 immediately.If medical professionals arrivequickly, they can treat theindividual with an antagonist, suchas naloxone, that will help themcome out of the overdose. It isimportant to tell the medical professionals what drug the overdosevictim took so they know which drugto use to counteract the overdose.The person who overdosed willneed to be watched for a few hours.Methadone is a long-acting drug.The medications that are used totreat the overdose are short-acting.If the antagonist wears off beforethe methadone level decreasesenough, the patient may go backinto a state of overdose and requiremedical attention What should I do if someoneoverdoses?Immediately call 911 and remain withthe person.Do not force the person to vomit.Do not make them take a coldshower.Do not inject salt water intotheir veins.What are the signs of an opioidoverdose?UnresponsivenessDrowsinessCold, clammy, bluish skinReduced heart rateReduced body temperatureSlow or no breathingWhat might happen if an overdoseis not treated? Brain damage Paralysis (temporary or permanent) Death25

DetoxificationDoctors do not advise that peoplequickly taper off of their d

Methadone and Buprenorphine has also been translated into Italian, Russian and Spanish. This second edition has been revised to include information about buprenorphine, an important treat-ment option that has emerged as an additional opioid addiction treatment to methadone. Future editions of About Methadone and Buprenorphine