The Pros And Cons Of Methadone Abuse

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Methadone is a potent opioid agonist used for the treatment of pain, heroin and opiate withdrawal symptoms. Initially, methadone was primarily used for the treatment of drug withdrawal. Presently, it is also used for the treatment of pain related to chronic, or terminal illness. Due to the low price, availability, and effectiveness, methadone is appealing to health care providers for the treatment of chronic pain. Although methadone has its Pros, I believe the Cons outweigh them. Risk of overdose is high, due to its unpredictable pharmacokinetic properties, inadequate patient education, polysubstance abuse, and over prescribing by healthcare providers (Aschenbrenner,2009). The methadone problem is growing in the United States. In fact, methadone …show more content…
The onset of action of methadone is thirty minutes to an hour. Methadone peaks at 1.7-5 hours, its duration of action is four to eight hours, but its elimination half-life is eight to fifty-nine hours. How the drug is metabolized is dependent on genetics, and enzyme factors. The problem is after the drug has induced wanted analgesic effects, it remains in the body long after. Some patients may metabolize the drug quickly, while others may be slow metabolizers. When metabolized slowly, the risk of accumulation and toxicity is great. Patients should maintain a methadone level of less than two mcg. If blood serum levels are not monitored, patients can experience severe respiratory depression. Risk of toxicity is high in the elderly population. Due to normal physiological decline, such as deceased renal and hepatic function. In addition, elderly adults being treated with methadone for chronic pain, usually have other comorbidities, that they are taking medications for, which increases the likelihood of drug interaction …show more content…
In-fact, methadone accumulation and can lead to respiratory depression, sedation, respiratory arrest, and even death. Many of the unintentional deaths related to methadone was caused by respiratory depression, occurring in the first two weeks of methadone therapy. Patients that are under tolerant and over tolerant are most at risk for the adverse effects of methadone. Although, older patients, patients with sleep apnea, liver disease, pulmonary disease are also at risk. Patients that do not tolerate methadone well can experience respiratory depression with a small amount of the drug. While patients that are over tolerant due to frequent opiate drug use, will require a greater amount of methadone to experience therapeutic effects. The line between therapeutics and toxicity is slim and requires frequent monitoring by prescribing doctors. Also, it is difficult for doctors to determine methadone dosage, since there is no concrete way of determining how much the patient will need to be therapeutic. Individuals differ significantly in how long it takes for methadone to achieve steady state and maximum effect, and it may take seven days or longer to achieve a therapeutic level. In-fact, Doctors are not required to start at the lowest dosage of methadone, and are often tempted to titrate methadone too quickly to achieve therapeutic levels.

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