Thursday, August 22, 2013

Methadone "Carries"

In Methadone Maintenance Programs the true evidence of good recovery comes with the patient being assessed as appropriate for "Carries".
Normally in the Methadone Maintenance Program a patient goes to a pharmacy or clinic where thaey receive their methadone personally, The usual methadone prescription contains the words "DWI" which means "Daily Witnessed Ingestion." The methadone usually comes in tang or some other flavoured liquid. The standard methdone dosage is usually under 100 mg but due to differences in rate of methadone metabolism may be in the range of 300 mg. Methadone Maintenance Programs are providing the right amount of methadone to counteract the withdrawal from opiates. The amount of methadone given is not aimed at causing a 'high' or interfering in a person's capacity to work and have a normal full and social human life.

Methadone is a pain medication that is given as an "unwitnessed" prescription to patients with pain disorders who do not have addiction. The operative word in 'addiction' is 'more' in that the patient wants increasing amounts of medication where by contrast pain patients commonly want the least amount of pain medication as they would rather have some pain and full life than lose the capacity to work and socialize due to the effects of their pain medications.

"Carries" are simply 'unwitnessed' prescriptions. For a doctor to write that an addict can have a 'carry' is for him to take responsibility that the addict will not sell, exchange or misuse the prescription, such as by stockpiling to take a larger dose for a 'high' . The program requires that the person be emotionally and cognitively 'stable' showing good judgement and being trustworthy. They have to be able to have a safe place to store the medication and know that the medication can cause the death of another, especially a child, in the event that it's stolen or misused. Pain patients are required to do the same just as heart patients with potentially lethal heart medications are advised of the cautions associated with 'safe storage' of medication.

In addition to this the British Columbia Methadone Program requires that a person have urine tests on a random basis that are free of 'illicit mood altering drugs' for a minimum of 3 months. Note that this is a minimum requirement but because of the equally important requirements mental and emotional stability and safe storage a person may not 'automatically' receive methadone 'carries' because their 'urine is clean'. Alot of the decision by the individual doctor to grant this 'priviledge' and 'reward' is the 'attitude' of the patient which is good indication of 'emotional stability'.

Some patients are 'rapid metabolizers', a condition which can be assessed by laboratories which measure the peak and trough of the methadone level in the urine and/or blood. Polymorphism of the CYP3A5 gene is one factor in this area. To assess this it is necessary to have the pharmacy give the medication at two separate times and for the lab to draw fluids at two separate times to measure how much is active metabolite is available for it's actual work.

If a person is a 'rapid metabolizer' then the pharmacy for an additional fee with provide the DWI twice daily. The 'second' dose is indeed a 'carry' and as such comes under the classification of 'unwitnessed' medication.

Unfortunately a central feature of the disease of addiction is 'dishonesty'. Denial of disease long after everyone else has recognised the problem simply refers to the 'self - dishonesty' that is part of the hi jacking of the brain circuitry that results in essentially the 'parasite' taking over the 'host' and achieving the parasitic end of essentially 'overdose' . Drugs ,especially, the opiates directly affect the 'pleasure centre' of the brain. Research with monkeys where they were able to press a lever to obtain direct stimulation of the pleasure centre resulted in the monkeys continuing to press the lever to death or until the researcher un hooked them from the direct stimulation device. Freud explained psychiatric process by postulating a 'death wish' or 'thanatos' as opposed to the 'life wish' or 'eros'. A researcher at UBC whose name I forget though often quote postulated that the addict by the chemical trauma to their brain 'dissociated' into two people. This certainly is consistent with observations of clinicians and the research that shows addiction removes the higher brain function with the result that addiction is a 'devolution' or regression to a more primal state .

If a person has progressed in the methadone program to having carries then this is a pretty good indication that they are indeed doing a solid recovery program and are being treated essentially like patients requiring methadone for pain. The only difference is that methadone patients on programs are required to have a random drug test usually monthly while on carries. Indeed given the increasing evidence of substance abuse with prescription medication and diversion of prescription medication no one considers monthly random urine testing an issue. Indeed it's considered that random urine testing might well be beneficial for all patients being established on chronic opiate therapy for any reason. This is significant with the recent finding that deaths on narcotics are commonly associated with benzodiazepine usage. The drug testing for Methadone Maintenance Programs includes assessing benzodiazepine, a pharmaceutical drug commonly sold on the street and because of it's respiratory depression long associated with overdose and suicide.

- Posted using BlogPress from my iPad

No comments: