From: Methadone Maintenance Treatment: A Community Planning Guide (© 2009 CAMH)
Opioids are a family of drugs used to relieve pain. Some opioids, such as morphine and codeine, are made from the opium poppy plant. Other opioids are synthetically made from chemicals. Heroin is a highly addictive, illegal opioid made by adding a chemical to morphine.
Commonly misused prescription drugs include:
- oxycodone (e.g., Percodan, Percocet, OxyContin)
- hydrocodone (e.g., Tussionex)
- codeine (e.g., Tylenol 1, Tylenol 3)
- morphine
- hydromorphone (e.g., Dilaudid)
- meperidine (e.g., Demerol)
Opioids are effective painkillers. They can also create feelings of intense pleasure or euphoria. People who misuse or abuse opioids can easily become addicted to them.
QUICK FACT |
| According to CAMH’s 2007 Ontario Student Drug Use and Health Survey, 21% of students (grades 7–12) surveyed reported using prescription opioid pain relievers for non-medical purposes and almost 72% reported obtaining the drugs from home. |
Opioid dependence develops after using opioids regularly for a period of time. Opioid dependence is not just a heavy use of opioids, but a complex health condition that includes both a psychological and physical dependence on opioids. People are psychologically dependent when a drug is so central to their thoughts, emotions and activities that the need to keep using the drug becomes a craving or compulsion. With physical dependence, the body has adapted to the drug and will suffer withdrawal symptoms if use of the drug is reduced or stopped abruptly.
Many people believe that dependence on opioid drugs is self-inflicted and efforts to treat people who are dependent on opioids will inevitably fail. Not so. Opioid dependence is a brain-related medical disorder for which there are effective treatments. No single treatment is effective for all individuals with opioid dependence. Two main treatment options are available:
- addiction treatment counselling (e.g., withdrawal management, outpatient, day treatment, residential or self-help/support group settings)
- substitution drug therapies using methadone or buprenorphine1.
Treatment with methadone is safe and effective for many people who are dependent on opioids, especially when combined with counselling. To date, MMT remains the most widely used form of treatment for opioid addiction in Canada (Health Canada, 2002a).
About prescription opioids
Methadone isn’t used just to treat people who are dependent on heroin. In fact, more and more people in Canada turn to methadone after struggling with prescription painkiller dependence. Prescription painkillers have become the predominant form of opioid use in many parts of Canada. Many opioid users report that they first used prescription opioids to treat pain. Research shows that a substantial proportion of prescription opioids are obtained directly or indirectly (e.g., through friends or partners) from sources in the medical system (Brands et al., 2004; Fischer et al, 2006).
QUICK FACT |
| In 2005–06, 46.5% of the people in MMT programs in Ontario were coping with dependence related to over-the-counter codeine preparations or prescription opioids compared to 15.7% who had heroin or opium problems (Hart, 2007). |
How does someone become opioid dependent?
Opioid drugs are very effective painkillers. The strength of an opioid drug and the dose can be adjusted to address the intensity of pain, as needed. For example, if you break your arm, you might be moaning and groaning when you get to the hospital. But once your doctor gives you an injection of morphine, you can be reasonably comfortable while the doctor sets your arm and puts it in a cast. Before you go home, you are given a prescription for codeine pills so you won’t have to suffer while the arm gets better.
For most people, a situation like this would be the only time they would take opioid drugs. Once the pain of the injury becomes tolerable, people usually stop taking prescription painkillers and don’t give them a second thought.
But what if the pain doesn’t go away? What if the only thing that can bring relief is opioid drugs? Then, you might continue to take them, and since you like the way they make you feel, you get some more. After a while, if they’re not working as well as they used to, you might take more at a time or try a stronger opioid. You may think you could stop whenever you want to. But when you try to stop, you get very sick and can’t stop thinking about starting up again. Eventually much of your time, energy and interest may be absorbed in getting and taking drugs. Your body has adapted to having the drugs and now you feel like you have to have them.
Of course, this is only one example of how opioid dependence can begin. Some people start taking opioids for fun, seeking out a new experience and finding one that is pleasurable and predictable for a while. Some people may be looking for relief from poverty, emotional hardship or depression. Some may be drawn to the reckless image of the drugs, wanting to see themselves as “cool” or “hip.”
Once a person starts taking opioids, they may continue using them for a long time, even though they know opioids are dangerous and that the pleasures are short-lived and superficial. They know the drugs keep them away from people and things that matter to them. Their health, home, finances and relationships may slip into a state of chaos. They need a chance to put the struggle with the drugs aside and take time and effort to sort out the rest of their lives. This is when treatment, such as methadone maintenance treatment, can help. |
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Adapted with permission from Methadone Maintenance Treatment: Client Handbook (CAMH) 2008. |
1. Buprenorphine is an alternative treatment to methadone. Two formulations of buprenorphine hydrochloride — Subutex and Suboxone — have recently been approved by Health Canada for use in treating opioid dependence. Subutex contains only buprenorphine hydrochloride. Suboxone tablets contain buprenorphine hydrochloride and naloxone, which deters abuse of the product by causing withdrawal symptoms if the product is injected rather than taken orally as prescribed (Collège des médecins du Québec and Ordre des pharmaciens du Québec, 2008; CPSO, 2009a)
In Methadone Maintenance Treatment: A Community Planning Guide
Acknowledgements
Introduction
About methadone maintenance treatment
Getting ready
Establishing a community working group
Engaging the community
Developing a methadone maintenance treatment program
Implementing the program
Evaluating the program
Appendix: Do You Know... Methadone
References
Resources