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Detox Done Right (Part 2)

In the first article in this series, we discussed how to make the best use of a methadone detox program. In particular, we focused on the idea that it is best to use methadone for the shortest time possible. One of the biggest problems with using methadone programs however, is that they are highly bureaucratic and getting a clinic to make changes in its procedures can be very difficult. In this article, we discuss how it is possible to use methadone to detox without using the clinics (at least directly).

Inside the Clinic

Methadone, whether used for pain or opiate addiction, is considered a medicine. But unlike medicine for, say, a heart condition, methadone is not distributed as a prescription drug (when used for detox). Instead, the methadone patient must come to the clinic every day to ingest his dose. This is done for two reasons. First, addicts are not considered trustworthy and second, the methadone is easily sold on the street.

Patients on maintenance can earn "take home" doses--so they don't have to come into the clinic every day. This is usually done for patients who are "stable" which means drug free. Patients are periodically tested for illegal drugs. If a patient consistently tests negative for illegal drugs, the clinic will usually allow him to take home doses. The maximum number of "take home" doses that clinics will give is six--so the patient is forced to visit the clinic at least once per week.

Outside the Clinic

Many patients who get take home doses sell those doses. Sometimes, this is done just to make ends meet, but mostly it is just the methadone patient converting the 'done into heroin. Whatever the reason, it is not difficult to buy black market methadone.

The easiest way to find a methadone connection (or a heroin connection, for that matter) is to hang out at a clinic. It is easiest to do if one is somehow involved--as a detox patient, for example--but it can be done regardless. It may take a while, but eventually the right people will be met. The fact of the matter is that if a person is looking for methadone to detox, he is already addicted to heroin--he is already in the right subculture to find methadone.

Avoiding the Clinic

The average price of methadone on the street is 50¢ per milligram (mg). Prices vary of course, but it should never be more than a dollar per mg. How much methadone is necessary to detox also varies, but 200 mg should be enough for just about anyone. This means that the cost of street methadone for a detox is about $100. Compare this to the cost of a clinic detox--usually in the $200-$300 range--and a very compelling reason to avoid the clinic is clear.

An even better reason for avoiding the clinics is that they do not give the patient a lot of control over his detox. There is a tendency to think that heroin addicts are always trying to scam people and so the clinics are resistant to make any changes for their patients (even though the "junkie" is also the customer and the guy who is paying the salaries of the people at the clinic).

The best reason of all for avoiding the clinics may be that many clinics are not ethical. Many clinics use their detox programs as a way to funnel addicts into their maintenance programs. Triad in Santa Cruz, for example, gives no support meds to help the patient at the end of their detox. It is hard to justify this practice except as a way to make addicts think that maintenance is the only option.

Doing the Done

With rights come responsibilities. Once the addict has acquired the methadone, he can use it to detox himself in any way deemed fit. But this also means he can screw up the detox--no one is available to help.

In the first article of this series, we recommended people start by doing a methadone detox in a clinic and following the procedure set by the doctor. This gives the addict a baseline against which to compare. It also gives him a good idea of where to start when doing his own detox.

Starting Dose

The first thing the addict must decide is at what methadone dose to start the detox. A good rule of thumb is that if an addict is doing a gram of heroin per day, he should start his detox at about 30 mg per day. The relationship between former heroin use and beginning methadone dose should be linear. The table below shows this. The first column is the amount of heroin the addict was using each day before he started the detox. The second column is the amount of methadone the addict should take the first day of his detox.

   heroin use       methadone dose   

0.25 g10 mg
0.50 g15 mg
0.75 g22 mg
1.00 g30 mg
1.50 g45 mg
2.00 g60 mg
3.00 g90 mg

Course of the Detox

There are basically two ways to handle the methadone dose during the course of the detox. The first is simply to use the same dose each day. Although this is the easiest way to divide up and administer the methadone, it has a few problems. The first is that the same dose every day will not translate into the same amount in the body everyday. This can be seen in the graph below where a dose of 20 mg is given each day. The other problem is that the body will not respond to the abrupt change in dosage and the withdrawing addict will be less comfortable.

Total methadone in body with constant intake.

The other option is to decrease the methadone dose each day. There are various ways to do this but each is just about as good as the other. In this case, it is best to simply have the dose decrease the same amount each day. So an addict would decrease the dose each day by the starting dose divided by the length of the detox in days. So if the starting dose is 35 mg and the length of the detox is 7 days, the dose would be decreased by 35 ÷ 7 = 5. Thus the dose each day would be: 35, 30, 25, 20, 15, 10, and 5.

Length of the Detox

The last thing the addict must decide is how long to detox. This issue was dealt with in the last article. It doesn't matter whether the detox is being done at a clinic or not: between five and ten days. It is best not to go over seven days, in fact.

Conclusion

Detoxing alone has many advantages. The only real drawback is that doing so is illegal. This is an important drawback, however. While it is true that cops and courts are more likely to go lightly on an addict who is trying to get clean, possession of methadone without a prescription is just as illegal as possession of heroin and can send one to jail for years. Any person going outside the clinics to detox should be very careful and aware of potential hazards.

Another important issue to keep in mind with methadone is that it is dangerous. Children are often attracted to methadone because it is normally distributed as a brightly colored liquid. Each year, children OD on methadone because they mistake it for something like Kool-AidTM. Keep methadone away from kids! And the addict must not forget to be careful when dosing himself.

Next Time: Our next article will discuss how methadone can be acquired outside of the clinic system.

by Dr. H © 2001
Last Modified: 12 January 2004


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