Addiction Treatment Forum reports on substance abuse news of interest to opioid treatment programs and patients in methadone maintenance treatment.

FAQFrequently Asked Questions (FAQs) - and Answers

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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 Pharmaceuticals, 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.

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Medication-Assisted Treatment & Lifestyle


mmt & lifestyleCan Patients In MAT Participate In 12-Step Programs?

Through many decades, 12-Step programs following the basic principles of Alcoholics Anonymous (AA) have helped millions of people in recovery from addiction. Many AA and Narcotics Anonymous (NA) meetings are becoming more hospitable to patients in medication-assisted treatment (MAT), especially if patients do not make a big issue of taking methadone or other medicines.

In 1991, special “Methadone Anonymous” (MA) groups were started for MAT patients. These groups have spread across some areas of the U.S., with opioid treatment programs (OTPs) often providing meeting space. MA was founded based on the track record of MAT as a therapeutic tool of recovery.

People in recovery who regularly participate in any type of 12-Step meetings 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

 

Revised July 2009

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drivingIs It Safe For A Methadone-Maintained Patient To Drive A Vehicle?

The public has been greatly concerned about people who drive when using alcohol or any drugs that might impair mental function. However, it is clear that methadone itself does not in any way hinder people stabilized in medication-assisted treatment (MAT) from driving safely.

An important exception might be while starting on methadone, before the dose is stabilized. During that time methadone may impair mental or physical abilities, or both, required for performing potentially hazardous tasks, such as driving or operating machinery. Patients should be cautioned accordingly.

Various research studies in MAT patients stabilized on methadone maintenance have examined important skills required for safe driving. These include concentration, 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, people maintained on adequate and appropriate methadone doses had functioned normally.

To examine “real world” driving performance, researchers looked at reported traffic violations and accidents among methadone-maintained patients, and compared them with records from people having no history of drug addiction. MAT patients did not differ in any way from other drivers of the same age. In a more recent study, researchers examined the records of drivers stopped for traffic violations in Norway, where blood or urine samples, or both, are collected without drivers’ consent when there is a suspicion of driving under the influence. Of the 655 drivers with methadone in their blood, methadone was the only drug present in 10. A benzodiazepine was found, in addition to methadone, in 90%. There was no correlation between blood levels of methadone and the degree of driving impairment.

Thus, research consistently shows that methadone itself is not a source of concern in patients who drive motor vehicles. The patients tested were well established in MAT, receiving adequate methadone doses, and not abusing illicit drugs or alcohol. Those who might not perform as well include patients going through opioid withdrawal due to insufficient methadone doses; those experiencing methadone overmedication effects, such as sleepiness or fatigue; or those abusing other drugs or alcohol,

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.

Bernard JP, Mørland J, Krogh M, Khiabani HZ. Methadone and impairment in apprehended drivers. Addiction. 2009;104(3):457-464.

Revised July 2009

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travelCan Methadone Be Taken Along During Travel To Other Countries?

Many countries do not offer methadone treatment, and those that do may not allow people from outside to bring methadone into their country. Carrying unauthorized methadone into any country might be considered drug trafficking. This could result in severe legal consequences, even though the methadone was legitimately prescribed as a medication in the U.S.

In general, the U.S. State Department advises that people with preexisting medical conditions who are traveling abroad with medication should carry a letter from their doctor describing the condition being treated, including information on prescription medicines to be taken. Medicines should be in their original, labeled containers. But some foreign countries do not consider a doctor’s certification an authorization to transport prescription drugs into their country. Travelers should contact consulates or embassies of the countries to be visited, and, ideally, obtain an official document authorizing carrying 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 May r 2009.)

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/

Revised July 2009

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Could Methadone Be Causing My Sexual Or Reproductive Problems?

Some surveys have found that as many as 9 out of 10 men and women entering medication-assisted treatment (MAT) programs have some type of sexual difficulties. But such problems are not caused directly by methadone. And, in almost all cases, these people can be helped to enjoy intimate sexual relationships with a partner.

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

Men in MAT reportedly have higher levels of sexual dysfunction than men in the general population. But the types of sexual dysfunction in this population, and their potential causes, are still unclear. One study of MAT patients found that erectile and sex-drive (libido) dysfunction increased as patients got older, as might be expected. How long the patients had been in methadone treatment was not associated with increasing levels of dysfunction. Depression was significantly associated with increased erectile and orgasmic dysfunction. The prevalence of sexual dysfunction in this MAT population seemed to be similar to that in the general population.

A research study in women noted that menstrual disruptions caused by past heroin abuse were very common. But menstrual cycle irregularities improved in most of the women who continued in MAT. Some patients started menstruating again for the first time in years.

Staff in MAT clinics have ways to help patients overcome sexual or reproductive problems. These include prescribing special medications, changing existing medications, or providing specialized counseling. Unfortunately, many patients are embarrassed to mention their concerns about sexual matters, and instead suffer in silence. Staff can help patients overcome this discomfort or shyness, so they can ask for and accept help.

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 July 2009

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Are Sleep Problems Common During MAT?

sleep problemsSleep can be disrupted by many factors: psychological and medical disorders, effects of medications or substances of abuse, or lifestyle (eg, lack of exercise). People who abuse alcohol or other drugs are at high risk for sleep disorders. This is due to the effects of those substances, or their withdrawal, on normal sleep patterns. Normal sleep is not immediately recovered in these patients, even if they achieve drug or alcohol abstinence. In fact, months or even years may be necessary for normal sleep patterns to return.

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

Methadone may contribute to insomnia by disrupting normal sleep phases during the night, but the reasons for this are unknown. About 84% of MAT patients in one large study had serious sleep problems. These patients were receiving average methadone doses of 93 mg/day, and had been in treatment an average of 3.2 years. More than a third 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 MAT, but these conditions were not related to the level of methadone being administered. About 14% of the patients reported ongoing abuse of alcohol, heroin, sedatives, or some combination of drugs

Untreated sleep disorders may contribute to continued drug abuse or relapse in MAT by patients who are attempting to sleep better by using self-medication. The use of nonaddicting sleep medications is critical for these people. In the final analysis, because opioids, including methadone, appear to affect sleep, MAT patients may have to accept some degree of sleep disturbance as a normal part of the addiction-recovery process. However, a return to more normal sleep patterns will likely require stabilized methadone maintenance, and may take a great deal of time. For example, a person who is receiving inadequate methadone dosing could be awakened frequently during the night by opioid withdrawal symptoms, including pain associated with withdrawal.

Unfortunately, there do not appear to be any published recommendations of medications for sleep in MAT patients specifically. The choice of which nonaddicting medications might best help 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

Revised July 2009

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