What is heroin dependence?
If you are addicted to heroin it means that you develop withdrawal symptoms within a day or so of the last use. So, if you are addicted to heroin, you need a regular dose to feel ‘normal’.
Withdrawal symptoms can include: sweating; feeling hot and cold; runny eyes and nose; yawning; being off food; stomach cramps; feeling sick or vomiting; diarrhoea; tremor; poor sleep; restlessness; general aches and pains; and just feeling awful. Withdrawal symptoms tend to ease and go within five days.
However, you may then have a persistent craving for heroin, remain tired, and have poor sleep for quite some time afterwards.
What is methadone
Methadone is a drug that can be prescribed. Although similar to heroin it lasts a lot longer in the body. If you take methadone you are unlikely to get withdrawal symptoms if you stop heroin (or the withdrawal symptoms will be much less severe).
If you take methadone, instead of street heroin, under supervision from a doctor you are:
- More likely to be able to get away from the street ‘drug scene’.
- Likely to feel better in yourself.
- More likely to be able to get off drugs for good.
Methadone is usually prescribed as a once-daily dose in liquid form. You will usually be asked to take it under the supervision of the pharmacist who dispenses the methadone to you. This means there can be no doubt about how much methadone you take at each dose. Supervision arrangements will be reviewed 3 months into your treatment.
Other points to considerYou are more likely to succeed in staying off heroin if you have support and counselling from a local drug community team or from self-help groups or other agencies.
- Please tell the doctor who prescribes your methadone about any other prescribed medicines you take, as some can interfere with methadone, e.g. medicines for epilepsy, TB and some anti-depressants.
- Other street drugs, such as benzodiazepines (‘benzos’) and alcohol, can affect methadone: it is better not to take any other drugs or and to drink alcohol within the recommended guidelines with methadone.
- If you are breathalysed and your result is over 0.35mg then your prescription will not be issued.
- You will be asked to give a urine sample from time to time as part of your treatment.
- If you use heroin, methadone or similar drugs you should tell the DVLA. You are likely to be suspended from driving. However, if you are on a supervised methadone programme, you may be allowed to drive, subject to an annual medical review.
- Keep methadone and any other drugs out of reach of children. We can provide you with a locked box.
Who prescribes methadone and when?
You will need to be referred to West Kent Drug & Alcohol Wellbeing Service to be assessed: first by a drug worker and then by the prescribing doctor. Following assessment, the community drug team may prescribe methadone.
If you have been injecting drugs such as heroin it is also common to advise:
- A blood test, which includes testing for HIV, checking the health of your liver (liver function tests) and checking for Hepatitis B and C.
- Immunisation against Hepatitis B.
- If appropriate, immunisation against Hepatitis B for your partner.
You will also be advised about the dangers of injecting and using shared needles and syringes, and will learn how to reduce your risk of harm.
Following your assessment you will be given an appointment to see the prescribing doctor and your key worker. This consultation will help to determine the most appropriate treatment for you. An initial dose of methadone will be chosen to try to prevent withdrawal symptoms. The doctor will prescribe a relatively low dose at first. This is because an overdose of methadone can cause serious harm or even death. The doctor will prescribe within safe clinical guidelines and will see you regularly to adjust the dose.
Be patient: this early stage is very important. The initial dose is usually gradually increased to a stable dose.
- Methadone takes 2-4 hours to reach peak effect.
- Methadone accumulates in your body so you will feel a greater effect from the drug over a few days even without increasing the dose.
- It may take a few weeks to get to the correct dose which prevents all withdrawal symptoms.
Try to accept that you may have some, or partial, withdrawal symptoms until the correct dose is found.
The correct dose varies from person to person depending on how much heroin you were using and how your body deals with (metabolises) the methadone. You should not take any street drugs or drink alcohol within the recommended guidelines when you are on methadone to reduce the risk of overdose.
Maintenance and coming off (detox)
Once established on a regular dose, your key worker will talk about the aims of your treatment at West Kent Drug & Alcohol Wellbeing Service. Aims include stabilisation, which helps you to keep off street drugs, and detoxification (detox), which is the process of reducing and coming off.
Your key worker will discuss with you how to reduce the dose which will help you to keep off street drugs. The rate of reduction will be reviewed every 6 weeks and agreed with the prescribing doctor.