Frequently Asked Questions (FAQs) - and Answers

If you have repeated problems accessing any links, copy and paste the URL into your web browser. If problems persist, please notify the web site administrator at feedback@atforum.com

Disclaimer

Responses to Frequently Asked Questions (FAQs) were developed by the editorial staff of Addiction Treatment Forum and made possible by an educational grant from Mallinckrodt Inc., a manufacturer of methadone and naltrexone.

The contents of these FAQs are for informational purposes only and should not be used to diagnose or treat a health problem or disease. The contents are not intended to be nor should they be used in any way as a substitute for professional diagnosis or treatment.

Any information you find here or on websites that we link to should be verified with your professional healthcare provider, who should also be consulted regarding any specific medical questions or problems you may have. If you think you may have a medical emergency or any condition requiring immediate attention, call your doctor or 911 immediately.

Addiction Treatment Forum does not specifically recommend or endorse any specific tests, products, procedures, opinions, or other information mentioned in these FAQs. Reliance on any information appearing here is solely at your own risk. The users of this site shall indemnify and hold Addiction Treatment Forum, its employees, agents, and sponsors harmless from and against any and all damages, liabilities, losses, costs, and expenses, including reasonable attorney’s fees, arising out of or related to use of information, services, or products mentioned at this website.

MMT & Lifestyle

Can MMT patients participate in 12-Step programs?

Through many decades, 12-Step programs following the basic principles of Alcoholics Anonymous (AA) have helped millions of persons in recovery from addiction. Yet, at one time, the notion of someone on methadone maintenance attending 12-Step meetings was unthinkable. There are perhaps as many myths and misunderstandings surrounding 12-Step programs as there are methadone maintenance treatment (MMT).

mmt and lifestyle The continuing use of methadone is sometimes unacceptable among many AA members, because the person is erroneously considered as continuing to take an “addictive drug.” For the same reason, some Narcotics Anonymous (NA) groups have shunned persons on methadone. They do not understand, or care to acknowledge, the use of methadone as a legitimately prescribed medication and they fail to observe the unwritten tradition that, “No AA (or NA) member should play doctor.” Part of the problem might have come from an insistence by MMT patients on openly acknowledging their taking methadone and expecting approval from the group, even though discussions of one’s medical treatments have no place at AA or NA meetings.

Today, many AA and NA meetings are more hospitable to MMT patients, especially if they do not make a big issue of their taking methadone or other medicines. In 1991, special groups were started for MMT patients, called “Methadone Anonymous” (MA), and these have spread around the U.S. to some extent, with MMT clinics often providing meeting space. MA was founded on the accurate belief that methadone is a therapeutic tool of recovery that may or may not be discontinued in time, depending on the needs of the individual.

Persons in recovery who regularly participate in 12-Step meetings of any sort enjoy many benefits, including building a network of sober friends and a program of ongoing personal development.

For more information, see: Methadone Anonymous Comes of Age. Addiction Treatment Forum. 2001 (Summer);10(3). Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/summer2001.shtml#anchor1222388

Also, visit the MA Web site at: http://www.afirmfwc.org/methadone_anonymous.html

Revised November 2004

< Back to Contents >

Is it safe for a methadone-maintained patient to drive a vehicle?

The public has been greatly concerned about persons using alcohol or any drugs that might impair mental function when they drive motor vehicles. However, it is clear that methadone itself does not in any way hinder persons stabilized in MMT from driving safely.

An important exception might be during the early days while starting on methadone, before the dose is stabilized. Like all opioids, methadone may impair the mental and/or physical abilities required for performing potentially hazardous tasks, such as driving or operating machinery. Patients should be cautioned accordingly.

Once stabilized on methadone maintenance, various research studies have examined important skills in MMT patients required for safe driving, such as the ability to pay close attention, reaction time, eye-hand coordination, and accurate responses in emergency situations. In some cases, driving simulators were used to test these skills. In all studies, persons maintained on adequate and appropriate methadone doses had normal functioning.

To examine “real world” driving performance, some researchers looked at reported traffic violations and accidents among methadone-maintained patients compared with others having no history of drug addiction. MMT patients did not differ in any way from other drivers of the same age.

Therefore, the research consistently shows that methadone itself is not a source of concern when it comes to driving motor vehicles. However, it should be noted, that the patients tested were well-established in MMT, receiving adequate methadone doses, and not abusing illicit drugs or alcohol. Patients going through opioid withdrawal due to insufficient methadone doses, or experiencing methadone overmedication effects, such as sleepiness or fatigue, might not perform as well.

For further discussion and references, see: Gordon NB. The Functional Potential of the Methadone Maintained Person. In: Compendium for methadone maintenance treatment by the Chemical Dependency Research Working Group of New York State OASAS (Monograph 2, 1994: page 39). Available from AT Forum at: http://www.atforum.com/SiteRoot/pages/addiction_resources/CDRWG%20Mono%202.PDF

Also: Lenné MG, Dietze P, Rumbold G, Redman JR, Triggs TJ. Opioid dependence and driving ability: a review in the context of proposed legislative change in Victoria. Drugs and Alcohol Review. 2000;19(4):427-439.

Revised November 2004

< Back to Contents >

Can methadone be taken along during travel to other countries?

Many countries around the world do not have methadone treatment of any sort, and even those that do may not allow persons from outside to bring methadone into the country. Attempting to carry unauthorized methadone into any country might be considered drug trafficking and result in severe legal consequences, even though it was legitimately prescribed as a medication in the U.S.

In general, the U.S. State Department advises that persons traveling abroad with preexisting medical conditions should carry a letter from their doctor describing the condition, including information on prescription medicines that are to be taken. Medicines should be in their original, labeled containers. However, a doctor’s certification may not suffice as authorization to transport prescriptions drugs to all foreign countries. Consulates or embassies of the respective countries to which travel is contemplated should be contacted and, ideally, an official document obtained authorizing bringing prescribed medications (including methadone) into the region.

For a list of travel regulations regarding methadone in 194 different countries, see: http://www.indro-online.de/travel.htm
This site is produced and maintained by INDRO e.V.; Bremer Platz 18-20; 48155 Münster, Germany. Phone: +49 (0)251-6 01 23; Fax: +49 (0)251-66 65 80; e-mail: INDROeV@t-online.de. (Access verified September 2004.)

Also see: the U.S. State Department’s site for travelers, at: http://travel.state.gov/
and the site for travelers’ health at the U.S. Centers for Disease Control, at: http://www.cdc.gov/travel/

Added November 2004

< Back to Contents >

Could methadone be causing my sexual problems?

methadone sex concerns Some surveys have found that as many as 9 out of 10 men and women entering MMT programs have sexual difficulties of one sort or another. But such problems are not caused directly by methadone, and, in almost all cases, these persons can be helped to experience intimate relationships with a partner and enjoy sex.

There are many causes of possible sexual and reproductive problems in MMT patients. Past use of illicit drugs and alcohol could have upset hormonal balance in the body, which often returns to normal over time. Some prescribed medications, such as certain antidepressants, may cause impotence (trouble getting an erection) or lack of orgasm as a side effect. Then, there are many psychological issues that could have left sexual problems in their wake, such as previous sexual abuse or long-lasting anxiety and guilt from a drug-addicted lifestyle.

Males engaged in MMT have been reported to have higher levels of sexual dysfunction than the general population. However, the prevalent types of and potential causes for sexual dysfunction in this population are still unclear. One study of MMT patients found that erectile and sex-drive (libido) dysfunction that increased with increasing age of the patient, as might be expected. Duration of methadone treatment was not associated with increasing levels of dysfunction. Depression was significantly associated with increased erectile and orgasm dysfunction. In general, the prevalence of sexual dysfunction in this MMT population appeared similar to that which occurs in the general population.

Another research study, in women, noted that menstrual disruptions caused by past heroin abuse were very common in these patients. However, with increasing tenure in MMT, menstrual cycle irregularities improved in most of the women; some resumed menstruating again for the first time in years.

There are many ways that MMT clinic staff can help patients to overcome sexual or reproductive problems – such as, prescribing special medications, changing existing medications, or providing specialized counseling. Unfortunately, when it comes to sexual matters, many patients are embarrassed to mention their concerns and suffer in silence. It is important to overcome this discomfort or shyness and ask for the help that is available.

For further information, see: Sexual dysfunction & addiction treatment. Addiction Treatment Forum. 2000(Spring);9(2). Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/spring2000.shtml#anchor1221360

Also: Brown R, Mundt M, Plahn S. Methadone maintenance and male sexual dysfunction. ASAM Conference; Washington, DC; April 22-25, 2004. Abstract 3A.

Schmittner J, et al. Menstrual function during methadone maintenance. Paper presented at: CPDD (College on Problems of Drug Dependence) 65 th Annual Meeting; June 2004; San Juan, Puerto Rico.

Revised November 2004

< Back to Contents >

Are problems sleeping common during MMT?

sleep problems Sleep disturbances affect up to half of the American population, depending on how surveys are done, and up to 15% of those afflicted persons have underlying substance abuse problems. Of some concern, many patients in methadone maintenance treatment (MMT) appear to have serious sleep disturbances.

The need for sleep varies from one person to another, but ranges up to 10 hours during a 24-hour period. Both the quantity and quality of sleep are important, and patients may complain that they do not sleep at all, when they are actually describing a lack of deep sleep, perhaps less spontaneous dreaming, and/or frequent awakenings.

Unfortunately, sleep can be disrupted by many factors, such as: psychological and medical disorders, effects of medications or substances of abuse, or lifestyle (e.g., lack of exercise). Occasional sleep disturbances are a universal human affliction and practically every adult will experience self-described insomnia at some point in life. For many, insomnia is a passing response to life stresses. But, persistent sleep disorders may be symptomatic of more serious conditions.

Persons who abuse alcohol and other drugs are at high risk for sleep disorders. This is due to the negative effects of those substances or their withdrawal on normal sleep patterns. Sleep is not immediately recovered even if drug or alcohol abstinence is achieved and, in fact, more normal sleep may require months or even years to return.

Specifically relating to opioid drugs, some studies have found that the primary effect on sleep of short-term ( acute) opioid administration is to hasten falling asleep, but the restfulness of sleep and total sleep time are reduced. Long-term (c hronic) opioid abuse may lead to tolerance of some negative effects on sleep, although more serious insomnia may develop.

It is believed that methadone may contribute to insomnia by disrupting normal sleep phases during the night; however, the exact reasons for this are unknown. MMT patients also have a high prevalence of depression and anxiety disorders, which independently and negatively affect sleep. Small studies have indicated increased disruptions of sleep, including disturbed breathing (apnea), among methadone-maintained patients.

In one large study of MMT patients – receiving average methadone doses of 93 mg/day and an average of 3.2 years in treatment – most of the subjects (84%) had serious sleep problems. More than a third of them also had major depression and nearly half had general anxiety disorder. Depression, anxiety, nicotine dependence, body pain, and unemployment were significantly associated with poorer sleep quality during MMT; however, methadone dose was not a contributing factor in the overall analysis. Approximately 14% of the patients reported ongoing alcohol, heroin, and/or sedative abuse.

Untreated sleep disorders may influence continued drug abuse or relapse in MMT patients who are attempting to self-medicate their distress. Therefore, the use of non-addicting sleep therapies is critical in this population. In the final analysis, since opioids including methadone appear to affect sleep, MMT patients may have to accept some degree of sleep disturbance as a normal part of the addiction recovery process. However, it is vital to also consider that a return to more normal sleep patterns would require stabilized methadone maintenance and may take a great deal of time. For example, a person who is receiving inadequate methadone dosing could be frequently awakened during the night by opioid-withdrawal symptoms, including pain.

Unfortunately, there do not appear to be any published recommendations of pharmacotherapies for sleep specifically in MMT patients. The choice of which non-addicting medications might best help to resolve sleep problems and retain methadone patients in treatment needs further study.

For more information and references, see: Sleep Disorders in MMT. Addiction Treatment Forum. 2004 (Summer);13(3):1. Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/summer2004a.shtml#anchor2

Added November 2004

< Back to Contents >