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.

Health & Nutrition During MMT

Are there any long-term harmful effects of methadone?

As the “gold standard” therapy for opioid addiction, MMT has provided strong benefits in reducing addiction-related physical illnesses, communicable diseases, and deaths. Typically, deaths due to any causes in methadone-treated patients are 3 to 4 times less than in untreated opioid addicts. Also, severe adverse reactions have been relatively rare in the millions of patients treated with methadone in MMT since 1964 worldwide, with many patients remaining on methadone more than 20 years.

The effects of methadone on the health of patients in MMT has probably been studied more thoroughly than for any other medication in all of medicine. Mary Jeanne Kreek, MD, one of the best known and leading researchers in the field of methadone maintenance treatment has summed-up the findings:

“The most important medical consequence of [ongoing] methadone treatment, in fact, is the marked improvement in general health and nutritional status observed in patients as compared with their status at time of admission to treatment. Most medical complications observed in methadone maintenance patients are either related to ongoing preexisting chronic disease, especially chronic liver disease, the onset of which occurred prior to entry into methadone treatment, or to coexisting new diseases or illnesses or to ongoing polydrug or alcohol use.”

In short, patients grow healthier during methadone maintenance treatment. Just how healthy depends on their condition before treatment and how they take care of themselves during treatment.

Long-term, prospective studies have demonstrated that MMT is medically safe and generally without toxic reactions requiring hospitalization. Methadone side effects are generally mild, most common during early days of therapy, and can be minimized. Maintenance on adequate methadone does not affect a person’s mental abilities to function normally during intellectual activities, driving motor vehicles, or performing work tasks. Clinical evidence suggests that most physical complaints associated with methadone therapy can be attributed to: 1) patients’ abuse of other substances while in treatment; 2) normal opioid withdrawal symptoms, possibly associated with inadequate methadone dose; 3) acclimation to methadone dose changes; and/or 4) the influence of pre-existing or new medical problems.

Sources :

Bell J, Zador D. A risk-benefit analysis of methadone maintenance treatment. Drug Saf. 2000;22(3)179-190.

COMPA (New York State Committee of Methadone Program Administrators). Regarding Methadone Treatment and Other Pharmacotherapies: A Review. New York, NY: COMPA; revised 1999. See also: http:www.compa-ny.org

Humeniuk R, Ali R, White J, Hall W, Farrell M. Proceedings of Expert Workshop on the Induction and Stabilisation of Patients Onto Methadone. Monograph Series No. 39. Commonwealth Department of Health and Aged Care: Adelaide, South Australia; 2000. Available at: http://www.health.gov.au/pubhlth/publicat/document/mono39.pdf

Kreek, MJ. Health consequences associated with the use of methadone. In: Cooper JR, Altman F, Brown BS, Czechowicz D (eds). Research on the Treatment of Narcotic Addiction: State of the Art (NIDA Research Monograph 83-1201). Rockville, MD: National Institute on Drug Abuse; 1983.]

Kreek MJ. Medical safety and side effects of methadone tolerant individuals. JAMA. 1973;223(6):665-668.

Novick DM, Richman BL, Friedman JM, et al. The medical status of methadone maintenance patients in treatment for 11-18 years. Drug Alcohol Dep. 1993;33:235-245.

Rettig RA, Yarmolinsky A, eds. Institute of Medicine: Federal regulation of methadone treatment. Washington, DC: National Academy Press; 1995.

Torrens M. Methadone and quality of life. Lancet. 1999;353:1101.

Added November 2004

< Back to Contents >

Since I’m on methadone, and it’s also a painkiller, what happens if I need pain medication?

When methadone was originally discovered in the late 1930s it was found to be an effective opioid agent to treat pain. So it is sometimes believed that persons taking the drug daily as part of a methadone maintenance treatment program for addiction do not feel physical pain like everybody else.

This is untrue – patients stabilized on methadone feel pain just like anybody else would. And, when it comes to treating pain, you will have the same needs as other people for adequate pain medication.

For average pain that doesn’t last very long – such as, a headache or muscle strain – over-the-counter painkillers (analgesics) should do the job. If pain is more severe and/or long-lasting, opioid painkillers with actions similar to morphine may need to be prescribed. Since your body is already used to an opioid drug (methadone), talk to your doctor about the various drugs available for your treatment. Additional medicines – like antidepressants or anti-seizure drugs – may be prescribed to help increase the effects of the analgesic.

Be aware that certain painkillers – such as, Buprenex ®, Dalgan ®, Nubain ®, Stadol ®, Subutex ®, Suboxone ®, Talwin ®, and Ultram ® – can block the effects of methadone and could bring on uncomfortable withdrawal symptoms. Also, Darvon ® and Demerol ® are not recommended because harmfully high doses may be needed for effective pain relief in a methadone-maintained person.

You definitely should inform the healthcare professionals treating your pain that you are on methadone maintenance. If they are unsure of how best to treat the pain, or seem reluctant to prescribe stronger medication, refer them to the medical staff at your methadone clinic. Never take non-prescribed medications or street drugs (including alcohol) along with pain medication or you could seriously harm yourself.

For further information and references, see:

Pain perspectives - addiction, pain & MMT. Addiction Treatment Forum. 2004(Winter);13(1). Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/winter2004.shtml#anchor1

Methadone patients and the perils of pain. Addiction Treatment Forum. 1998(Spring);7(2). Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/spr98.shtml#anchor1222388

Revised November 2004

< Back to Contents >

Is methadone safe during pregnancy?

methadone in pregnancy A pregnant woman who abuses opioid drugs may seriously damage both herself and her unborn child. While methadone itself does not eliminate all potential problems of pregnancy, participation in MMT greatly reduces the risks of illness or even death in mother or child.

Methadone is one of only two approved and available medications in the U.S. for treating opioid addiction during pregnancy (the second is buprenorphine). When properly used as part of an MMT program, there has been no reported evidence of harmful effects of methadone to the mother or unborn child.

A respected group of experts, gathered by the Institute of Medicine in 1995, concluded that methadone maintenance, when combined with appropriate prenatal care, can reduce the incidence of complications in the mother or fetus, the slowing of fetal growth during pregnancy, and illness or death in the newborn infant. Withdrawal from methadone treatment is rarely appropriate during pregnancy, as relapse to illicit drug use is likely to occur. Although a mild form of opioid withdrawal syndrome may occur in methadone-exposed infants, medical treatments are readily available to assist in appropriate care of the newborn child.

Methadone maintenance is considered so vital for the health of pregnant opioid-addicted women that Federal Regulations governing MMT programs require that these women are given a preference for admission and that arrangements are made for proper medical care during pregnancy. Years of experience have shown that there is no lasting harm to the child from exposure to methadone during pregnancy. And it is important to note that a baby born to a mother in MMT is always much better off both physically and mentally than if the woman had continued using heroin or other street drugs.

Pregnant patients in MMT can and do deliver healthy babies. Also, by no longer injecting drugs, these women avoid hazardous infections that could be transmitted to their infants. Moreover, participation in MMT allows the mothers to receive proper perinatal care, nutritional supplements, and parenting instructions.

It is true that the newborns sometimes experience withdrawal symptoms during the first several days after birth. However, the symptoms are routinely treated by pediatricians and do not result in any long-term damage. The neonates of women in MMT tend to have lower birth weights compared with those of drug-free women, but they do not exhibit any noteworthy developmental or neurological difficulties. Of importance, compared with babies born to mothers on heroin, MMT has demonstrated great benefits to both mothers and their infants.

Research has demonstrated that adequate methadone during pregnancy – at whatever dose that is most effective for the mother – is not harmful to the fetus in terms of the incidence and severity of postnatal withdrawal syndrome. Past research has indicated that dose increases may be required during later stages of pregnancy to maintain stability on methadone, and some clinicians recommend split doses for this purpose. At the same time, however, some of the older literature recommends that the dose during pregnancy should not exceed 20 mg/day and this potentially harmful myth still persists among some practitioners.

Sources:

Berghella V, Lim PJ, Hill MK, et al. Maternal methadone dose and neonatal withdrawal. Am J Obstet Gynecol. 2003;189:312-317.

Federal Regulation of Methadone Treatment. National Institute of Medicine. 1995. Available online at: http://www.nap.edu/books/0309052408/html/

Joseph H, et al. Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues. Mt Sinai J Med. 2000;67(5-6):347-364. Available at: http://www.mssm.edu/msjournal/67/page347_364.pdf

McCann MJ, Rawson RA, Obert JL, Hasson AJ. The treatment of Opiate Addiction with Methadone. Technical Assistance Publication (TAP) 7. Rockville, MD: Center for Substance Abuse Treatment; 1994. Publication (SMA) 94-2061.

Zweben JE, Payte JT. Methadone maintenance in the treatment of opioid dependence; a current perspective. West J Med. 1990;152:588-599.

Revised November 2004

< Back to Contents >

Is methadone bad for the heart?

methadone and heart Used appropriately as part of an MMT program, methadone does not appear to directly cause heart problems, even at quite high doses.

There were some concerns during 2001 when LAAM (a long-acting cousin of methadone) was associated with disturbances of normal heartbeat, called cardiac arrhythmias. LAAM was taken off the market in Europe and manufacture of the product in American was discontinued.

To some extent, all opioids, including methadone, have an influence on heart function. Some of these effects are helpful. For example, persons having heart attacks are sometimes given morphine. Other effects, which have been demonstrated mostly in animals or test tube experiments, are less certain as being helpful or harmful. However, methadone has generally not been found to be harmful to heart health in actual patients.

A review panel of MMT medical directors consulted by Addiction Treatment Forum, and collectively representing 117 years of experience in treating more than 29,000 persons with methadone, noted that they had not seen a single heart problem that they would directly attribute to methadone. Similarly, a small study of patients receiving very high doses of methadone – from 500 to 1,400 milligrams per day – did not find any methadone-related heart problems.

This is not to say that MMT patients do not experience heart problems just like other persons. However, the health risks, heart-related and otherwise, for opioid-addicted individuals not in treatment are great and death rates are high. MMT programs, of which methadone is a central part, provide a total healthcare environment potentially contributing to better heart health.

There also is some evidence that methadone maintenance preserves heart health. Having previously observed an absence of cardiovascular disease in MMT patients, a team of New York researchers investigated whether long-term exposure to opioid agents might be associated with decreased severity of coronary artery disease that is believed to precede most myocardial infarctions (heart attacks).

The investigators compared autopsy results in persons who had methadone or opioids in their blood compared with matched decedents (controls) without such drugs present. Severe coronary artery disease (CAD) was found significantly less often in decedents with methadone in their blood than in control-group decedents. In fact, subjects with methadone in their systems were roughly 2½ times less likely to have moderate or severe CAD. Exact reasons for these possible cardioprotective effects of methadone were unclear and require further research. However, the authors concluded that long-term exposure to methadone may lessen CAD severity and its often fatal consequences.

For more information and references, see:

Practitioner Panel – methadone and heart health. Addiction Treatment Forum. 2001(Summer);10(3). Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/summer2001.shtml#anchor1221360

Leavitt SB, Krantz M. Cardiac Conditions During MMT. Addiction Treatment Forum [White Paper Report]. October 2003. Available at: http://www.atforum.com/SiteRoot/pages/rxmethadone/cardiacmmt.shtml

Also: Marmor M, Penn A, Widmer K, Levin RI, Maslansky R. Coronary artery disease and opioid use. Am J Cardiol. 2004;93:1295-1297.

Revised November 2004

< Back to Contents >

Should MMT patients have special heart-health tests?

Some patients in methadone maintenance treatment (MMT) programs may have conditions or behaviors associated with increased risks of arrhythmia (irregular heart rhythm), including: abuse of cardiotoxic substances, cardiovascular disease, electrolyte imbalances, and prescribed medications that may foster cardiac disturbances. Furthermore, recent data suggest that in some individuals methadone – alone or, more commonly, in combination with other drugs and/or cardiac risk factors – can influence the development of certain arrhythmias (called long QT syndrome and/or torsade de pointes) in susceptible patients.

It is important for healthcare practitioners to be aware of medical conditions and medications that might influence the development of arrhythmia during methadone maintenance. However, these should not be used to automatically exclude patients from entering or continuing MMT. Although some factors cannot easily or quickly be corrected, others might be modified and/or closely monitored during methadone maintenance.

Current evidence, however, does not support altering routine methadone dosing practices or requiring electrocardiograms (ECGs) for all patients entering or continuing MMT. The following general steps are recommended:

All persons entering MMT should have a medical examination that includes a general assessment of cardiac health, and this information should be periodically updated.
Adequate methadone doses are essential for therapeutic success, and it does not appear necessary to alter methadone dosing practices – such as, arbitrarily lowering doses – solely due to concerns about possible cardiac effects. However, in patients with multiple pre-existing risk factors for arrhythmia, screening ECGs may be a sensible component of major dose increases.
Routine ECGs, incurring added expense and inconvenience, for all patients entering or continuing MMT are not recommended. Screening ECGs should be reserved for individual patients with established cardiovascular disease or those with clinically-significant arrhythmia-risk factors.
If an ECG is deemed necessary, results should be reviewed by a physician with experience in interpreting test results. When feasible, ECGs should be performed during peak drug concentrations.
The use of methadone in patients already known to have significant heart disease has not been thoroughly studied and expert consultation (such as with a cardiologist or internist) might be sought in these and other cases in which there are specific concerns about cardiac complications during MMT. However, this should not necessarily deter the appropriate use of methadone in these patients.

In sum, methadone remains an effective and well-tolerated therapy for the treatment of opioid addiction when prescribed appropriately. A sound understanding of its potential association with heart rhythm disturbances in the context of other heart disease factors will allow clinicians to optimize safety during MMT.

Research in this area is ongoing and future refinements of these practices may be necessary. Meanwhile, the relatively small potential risk of adverse cardiac effects that have been reported with methadone should be weighed against the more serious risks of withholding MMT; including, a high likelihood of illicit drug use and its related morbidity, mortality, and public health ramifications.

For further information and references, see: Leavitt SB, Krantz M. Cardiac Conditions During MMT. Addiction Treatment Forum [White Paper Report]. October 2003. Available at: http://www.atforum.com/SiteRoot/pages/rxmethadone/cardiacmmt.shtml

Added November 2004

< Back to Contents >

Is methadone harmful for MMT patients with HIV/AIDS?

Research in MMT patients has demonstrated that methadone does not make HIV or AIDS worse, nor does methadone interfere with treatment for this viral infection. However, there has been some confusion regarding this. Past laboratory experiments found that the HIV virus was able to more easily infect certain cells when methadone was added to the mix in a test tube. Also, when methadone was added to cells in which the HIV infection was inactive, the virus began to grow again. These cells, however, were not from MMT patients, so nothing can be said here about HIV in such patients. Of further interest, the methadone doses used in these experiments were extremely low. Similarly, other experiments had shown that very low, inadequate doses of methadone can hinder the immune system, possibly allowing infections like HIV to become worse. Other research had found that steady doses of adequate methadone actually inhibited viral activity.

hiv Studies in human subjects – MMT patients – have shown that methadone is not harmful and, in fact, may boost recovery from HIV. In one investigation (see graph), patients with HIV in MMT (MMT Patients) were compared with HIV-infected former injection drug users (Former IDUs) not in MMT and individuals still injecting illicit drugs (Current IDUs). In the methadone-maintained patients the progression of HIV disease was three times less than in the IDUs and also less than in the opioid-free former IDUs not in MMT. Importantly, over time, 10 persistent IDUs died of heroin overdoses and 2 drug-free former IDUs relapsed and died – there were no such deaths in MMT patients.

Although methadone does not appear to be damaging in persons with HIV or interfere with anti-HIV therapy, two conclusions should be noted: 1. continued use of injected illicit drugs makes HIV worse; 2. MMT patients must receive adequate doses of methadone. In fact, one small study of MMT patients being treated for HIV found that their response to drug therapy was excellent; however, they needed about a 50% increase in methadone dose (on average) due to an interaction of certain anti-HIV medications with methadone.

For further information and references, see: Methadone & the immune system. Addiction Treatment Forum. 2002(spring);11(2). Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/spring2002.shtml#anchor1221360

Also, see: Leavitt SB. Methadone-Drug Interactions. Addiction Treatment Forum [Special Report]. January 2004. Available at: http://www.atforum.com/SiteRoot/pages/rxmethadone/methadonedruginteractions.shtml

Revised November 2004

< Back to Contents >

Do I have to get off of methadone to be treated for hepatitis C?

Absolutely not. Unfortunately, MMT patients are sometimes told they must first withdraw from methadone or drastically reduce their dose to be treated for hepatitis or, if it’s needed, to receive a liver transplant operation.

There is no scientific evidence that methadone interferes in any way with treatment for hepatitis C (or for hepatitis B) or with liver transplantation. In fact, there have been clinical studies showing that MMT patients, remaining on methadone, do just as well as any other patients if properly treated.

Also, U.S. Federal Guidelines on hepatitis C treatment, as well as those developed by other organizations, have supported the continued use of methadone in MMT patients during therapy for hepatitis. For example, a guideline released in 2004 from the American Society for the Study of Liver Diseases (AASLD) clearly states:

“The use of methadone or buprenorphine is an effective means of reducing illicit drug use and its complications. …there are several studies of persons taking methadone that suggest that the drug does not significantly reduce the likelihood of an SVR [sustained response to therapy], nor does it alter dosing of interferon or ribavirin. Therefore, methadone use does not directly affect the management of HCV infection.”

For further information and references, see:

Addiction Treatment Forum. Liver Disease in MMT: Treatment & Transplant – Parts 1-4. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/Liver_ Dis_in_MMT.PDF

Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C. AASLD Practice Guideline. Hepatology. 2004;39(4):1147-1171. Available from AT Forum at: http://www.atforum.com/SiteRoot/pages/addiction_resources/AASLD_HCV_Guirader_et_al.pdf

NIDDK - Chronic Hepatitis C; Current Disease Management. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/NIDDK_HCV_Guide.PDF

NIH: Management of Hepatitis C: 2002. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/NIH_HCV_Cons_Final.pdf

Revised November 2004

< Back to Contents >

Are treatments for HCV effective in MMT patients?

hcv effective Up to 9 of every 10 injection drug users entering MMT programs may be infected with hepatitis C (HCV), so this is an important question. It is especially critical since MMT patients face many barriers to liver transplantation, which may be necessary for survival if HCV treatment is denied or ineffective.

This topic was previously discussed from an evidence-based perspective in a series of AT Forum articles during 2001-2002.[1] The bottom-line answer is that HCV treatments continue to improve and MMT patients can respond as well as any other persons.

Approximately 170 million people world-wide are chronically infected with the hepatitis C virus (HCV). While the seroprevalence in the general population ranges between 0.2 and 2%, 50-90% of injection drug users are chronically HCV-infected. However, many patients who are in methadone maintenance treatment are still excluded from therapy for HCV infection.

The authors of one review article examined clinical trials published between 1987 and 2003 that focused on the treatment of chronic HCV in patients with drug addiction or in methadone maintenance treatment.[2] They found only seven clinical trials investigating HCV treatment among current or former drug abusers.

The studies indicated that successful response to anti-HCV treatment and adherence to the treatment regimen in infected methadone patients were comparable to any other patients in the general population. However, MMT patients with persistent drug abuse seemed more likely to discontinue treatment early.

A clinical trial reported in 2004 noted that, compared with general population subjects, MMT patients had a comparable sustained viral response (SVR) to anti-HCV treatment with peginterferon alfa-2b and ribavirin.[3] Pegylated interferon (or peginterferon) is a newer, longer-acting version of interferon. SVR denotes the absence of virus 6 months after treatment, which some describe as a “cure.” In this study, more MMT patients had difficulties with compliance or requested discontinuation of treatment only during the first 2 months.

Of further interest, the latest research has reported that the peginterferon-ribavirin combination also is quite effective in patients co-infected with HCV and HIV (the virus causing AIDS).[4,5] This could be important for many MMT patients; although, the studies did not specifically include any methadone-maintained subjects.

Sources:

1. Addiction Treatment Forum. Liver Disease in MMT: Treatment & Transplant – Parts 1-4. Available at: http://www.atforum.com/SiteRoot/pages/addiction_resources/Live_Dis_in_MMT.PDF

2. Schaefer M, et al. Treatment of chronic hepatitis C in patients with drug dependence: time to change the rules? Addiction. 2004;99(9):1167-1175.

3. Mauss S, Berger F, Goelz J, Jacob B, Schmutz G. A prospective controlled study of interferon-based therapy of chronic hepatitis C in patients on methadone maintenance. Hepatology. 2004;40(1):120-124.

4. Torriani FJ, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection in HIV-infected patients. NEJM. 2004;351(5):438-450.

5. Chung RT, et al. Peginterferon alfa-2a plus ribavirin versus interferon alfa-2a plus ribavirin for chronic hepatitis C in HIV-coinfected persons. NEJM. 20o4;351(5):451-459.

Revised November 2004

< Back to Contents >

Why does methadone make me put on weight?

There is actually nothing about the chemistry of methadone itself or the way if affects the body that would make a person put on weight. However, this is a common complaint of patients in MMT programs. A survey in 1984 reported that about 1 in 10 patients had gained weight, although 1 in 20 persons actually lost weight while on methadone. So, the situation is entirely opposite in different patients, which supports the view that methadone itself is not the cause.

weight in methadone treatment One common explanation for the weight gain is water retention but, in most cases, it is found that the patient is taking other medications that cause water retention or there is another reason. Many medications, such as some (but not all) antidepressants, cause weight gain as a side effect. Furthermore, there is the fact that many persons in MMT are simply taking better care of themselves, and eating much better, than they did while leading a life of substance addiction. A more healthy diet (talk to a dietitian) and some regular exercise could go a long way in helping to control weight problems.

Some persons have believed that the prepackaged liquid form of methadone is fattening, which is untrue. For example, Methadose ®* cherry oral concentrate does contain sucrose syrup (a natural sugar) to deter potential injection of the product. However, in a 100 milligram dose there are only about 15 calories (or 1.5 calories in each milliLiter of Methadose) – about the same calories as in one Life Saver candy and ten times less than in a single can of a sweetened lemonade or cola drink.

This also means that the amount of sugar in this methadone product would not be harmful for persons with diabetes. However, if there are still concerns, Methadose ®* brand of oral methadone concentrate comes in a sugarless formulation, which also is unflavored and colorless.

*Methadose® is a registered trade mark of Mallinckrodt, Inc.; St. Louis, MO.

Revised November 2004

< Back To Contents >

What is the role of diet and nutrition in addiction recovery?

nutrition in addiction recovery Some experts believe that advances in the treatment of addictions during this century will involve physiologic healing via the restoration of neurochemical balance in the brain. Diet and nutrition may play key roles in that process.

The American Dietetic Association (ADA) has officially recognized that, “Many debilitating nutritional consequences result from drug and alcohol abuse. Chronic nutrition impairment causes serious damage to the liver and brain, which reinforces the craving for more drugs and alcohol and perpetuates the psychological aspect of addiction.”

Furthermore, the ADA suggests, “Nutrition makes a difference in the rate and quality of physical recovery, which prepares individuals to function at a higher level in treatment – cognitively, mentally, and socially.”

Many persons simply do not eat enough food or the right foods when they are preoccupied with drug-taking. When they do eat, drugs of abuse and alcohol keep the body from properly absorbing and breaking down nutrients and expelling toxins.

In one clinical study, more than three-quarters of patients being treated for addiction were classified as having unsatisfactory nutritional states, with malnutrition predominating. Such patients were typically deficient in a number of vitamins, minerals, proteins, and fatty acids.

Addictive substances – such as heroin, cocaine, alcohol, and marijuana – affect food and liquid intake, taste preference, and body weight. Opioids can alter cholesterol, calcium, and potassium levels. Potassium is especially important because an imbalance in this electrolyte can influence cardiac problems.

Nutritional supplements – e.g., vitamins, amino acids, herbal products – and other nutrients are believed capable of restoring proper neurochemical balance in the brain. Also, eliminating or reducing certain substances (sugars, simple starches, caffeine) and increasing protein intake may help rebalance brain chemistry.

During recovery, improved nutrition also can help heal physical damage to the body caused by nutrient depletion. However, nutrition is often neglected by patients and it might be unlikely to take top priority in addiction treatment programs.

Scientists seem to agree that substances of abuse may cause nutritional deficiencies; however, a direct link between these and addiction has not been fully accepted. Also, the notion that special diets and/or nutritional supplements may be viable adjunctive or stand-alone treatments for addiction requires further research. Nevertheless, given an appreciation of the possible importance of diet during recovery and an interest in better nutrition, there are some obstacles and concerns to overcome, such as:

The nutritional component of addiction recovery does not appear to be an exact science and it must be individualized for meeting particular patient needs.
Patients must be motivated to change their eating habits and have access to recommended nutritional items. They also need to know how to shop for and prepare nutritious foods.
Some patients may not have the financial resources to purchase appropriate foods and/or supplements.
Some foods and nutritional supplements may negatively interact with prescribed medicines, such as methadone, antidepressants, and other drugs.
The prescription of multiple pills and tablets (e.g., vitamins, herbal products, others) in persons already known to have a preference for using chemicals to control their mental states may pose problems.
Dietary supplements are available at health food stores everywhere and via the Internet, which may promote inappropriate consumption. Patients need to understand that they should not take any products without the approval of clinic staff.
Clinic medical staff must become familiar with the many nutritional supplements available, their applications, and potential for harmful interactions. This can be a daunting task.

Some specialists recommend that treatment providers should assess patients for malnutrition and provide appropriate diet and nutrition education. And, they should look to qualified nutritionists or dietitians for guidance as appropriate. However, relatively little is known for certain in this area based on sound clinical research, so appropriate caution is advised.

Source: Feeding recovery. Addiction Treatment Forum. 2004(Spring);13(2):1. Available at: http://www.atforum.com/SiteRoot/pages/current_pastissues/spring2004.shtml#anchor2

Added November 2004

< Back to Contents >

Are nutritional supplements, like herbal products, safe to use with methadone?

So-called “nutritional supplements” – including certain herbs, plants, and other “natural” substances (that is, found in nature) – have been used since ancient times to treat almost every human ailment. However, for several reasons, their use is not always safe or recommended.

Such products are not regulated by the US Food & Drug Administration (FDA), which means there is no control over the purity and quantity of ingredients in any product.
Some products can interact with methadone to make the usual dose feel stronger or weaker, or interact harmfully with other prescribed medicines.
The effectiveness and safety of some supplements are still in question.

For example, in June 2002 the government issued a warning about herbal products containing ephedra, also called ephedrine. The Ephedra species of herbs (also known by the Chinese name “ma huang”) was found in many products, such as those promoting weight loss, increased energy, or better sexual performance. However, in some people, the products can have powerful stimulant effects on the nervous system and heart that may cause serious harm. The interaction of ephedra-containing products with methadone is unpredictable.

Similarly, St. John’s wort, widely advertised to help overcome depression can interact harmfully with prescribed antidepressant medications and other drugs. It may reduce methadone’s effects and bring about withdrawal symptoms.

Therefore, at the least, anyone on methadone maintenance should let MMT clinic medical staff know what non-prescribed products they are using. It also is advisable to let staff know before taking any new supplement or drugstore product, even vitamins.

The government has formed an organization – the National Center for Complementary and Alternative Medicine – to more closely examine nutritional supplements and other therapies, such as acupuncture. For further information, their website is at http://www.nccam.nih.gov/

Revised November 2004

< Back to Contents >