Improving Methadone Detox
Methadone is a surprisingly strong opioid—even I tend to forget this. In terms of its base strength, it is very close to morphine. So popping a 10 mg pill doesn't seem like so much. The thing is that morphine only lasts a couple of hours; it has a half-life of two to three hours, which means that it will be pretty much completely out of your body in 24 hours. Methadone, on the other hand, has a half life of 24 hours (actually, it is more like 26 hours, but 24 hours is such a convenient number that I continue to use it). This means that after one full day, you still have half of the methadone you took swimming around in your body. After about a week it will pretty much be out of your body.
Methadone's long half-life makes it excellent for detoxing. Because methadone leaves the body slowly, the detox associated with it is far more gentle than the detox from morphine or heroin. And as a result of this, methadone is my recommended detox procedure. However, the procedure could be greatly improved.
As far as I know, every methadone detox ends at 2 mg. So whether a clinic starts weening you at 50 mg or 20 mg, you always get 2 mg on your last day along with a hearty, "Fair thee well!" (Actually, some clinics stop you at 5 mg.) Now I know that 2 mg doesn't sound like a lot of methadone, but it is.
Because methadone lasts eight to twelve times as long as morphine (and by extension, heroin), the equivalent amount of morphine that you are taking per day at the end of a methadone detox is between 16 and 24 mg. This is not a trivial amount of morphine to detox cold turkey from.
Why Stop at Two
Knowing this naturally brings to mind the question of why methadone clinics stop at 2 mg. The answer is pathetic: it is the limit of their dispensing machines. In fact, clinicians freely admit that even at 2 mg, it is highly questionable how much methadone you are getting: it could be 1 mg; it could be 3 mg. But the problem isn't so much the machines themselves, but the concentration of the methadone. If the methadone were sufficiently diluted, the machines could easily dispense tenths of milligrams without problems. So why don't they?
- The bread and butter of any methadone clinic is their group of maintenance patients who are almost always at levels of 40 mgs—and often much more. It would be a real pain to have to dispense to these clients if the methadone were that watered down. Clients don't want to have to drink of quart of methadone each morning. (This isn't actually true—more in a minute.)
- Having two dispensing bottles (one high concentration and one low) would be a pain and could cause deadly mistakes. I think this is overstated, however; many clinics have different windows for detox and maintenance clients; what's more, there is always the potential for deadly mistakes at a methadone clinic.
- Methadone clinics don't take detox patients as seriously as they do maintenance patients. They know that many detox patients have no intention of staying off heroin (or whatever) and just want a break. What's more, serious detox patients who fail are excellent candidates for becoming (far more profitable) maintenance patients.
There are two obvious solutions: improve the dispensing devices or dilute the methadone. The truth is that even 40 mg of methadone is a very small volume. So it really isn't asking too much to have clinics dilute their methadone solutions. (To be honest, they couldn't actually do that. They would need a quantitative chemist to do it—I might point out that I am completely qualified to do this, but no one is going to let me near a jug of methadone.) Or the the pharmaceutical companies could just start selling low concentration methadone.) But neither of these things will happen for one reason:
If the methadone concentration were simply cut in half, the staff would have to change bottles of methadone twice as often. If it were cut to one-eighth its current concentration (what I would recommend), they would have to change bottles eight times as often!
But so what? Have you ever been to a methadone clinic? It isn't like people are running around dispensing methadone like the coffee clerks are Starbucks®. And they are doing the same thing: dispensing drugs. (And yes, Virginia, you can die from an overdose of caffeine.)
Even though I am very pro-methadone, I am very anti-methadone clinics that are with few exceptions owned by money-grubbing "entrepreneurs" who don't give a flying fuck about their patients. I would much rather have all methadone clinics run by the state. For one thing, it would remove the profit motive that sees detox clients as a pain at best and a customer they can "sell up" to maintenance at worst. And for another, despite what government-hating ranters say, state run institutions generally do an excellent job of improving the services they provide. And if it were methadone detox, I'm sure one such improvement would be to detroy the 2 mg cliff.