About Methadone and Buprenorphine - Drug Policy Alliance

AboutMethadoneand BuprenorphineRevised Second EditionCopyright ©2006 Drug Policy Alliance. All rights reserved.“Drug Policy Alliance” and the “A Drug Policy Alliance Release” logo areregistered trademarks of the Drug Policy Alliance.Printed in the United States of AmericaISBN: 1-930517-27-0No dedicated funds were or will be received from any individual,foundation or corporation in the writing or publishing of this booklet.

Table of Contents3 Acknowledgments4 Introduction6 Dependency8 What is Methadone?10 Buprenorphine11 Maintenance13 After Methadone14 Myths & Facts16 Drug Interactions18 Your Other Doctors19 Methadone & Women21 Storing Methadone22 Concerns about Overdose25 In Case of Overdose26 Detoxification28 Methadone & Pain29 Driving30 Traveling with Methadone32 State Substance Abuse Agencies33 Other Resources2About Methadone and Buprenorphine

IntroductionYou may be reading this bookbecause you are taking methadoneor because you are thinking abouttaking methadone – or because youcare about somebody who is.People usually enter methadonetreatment because they feel overwhelmedby their dependence onheroin or other opioids. But noteveryone who comes into methadonemaintenance has the samegoals. Some people want to stoptaking street opioids for good. Somewant to temporarily stop taking streetopioids. And some want to reduce orre-regulate their use of street opioids.Some people begin methadonewith the belief that they will needmedication indefinitely. Others feelthat they will only need it for a shorttime. Regardless of what you hopeto get from methadone maintenance,however, all the evidence agrees onthese several points:• People dependent on street opioidswho receive methadone treatment arehealthier and safer than those who donot. They live longer, spend less timein jail and in the hospital, are lessoften infected with HIV, and commitfewer crimes.• Longer periods of methadonemaintenance are better than shorterperiods. The longer you stay onmethadone maintenance, the betterthe overall outcome. Indefinite treatmentoften means life-long extensionof good health, HIV seronegativity,and freedom from incarceration.• Methadone maintenance is treatmentfor people who are dependent onopioid drugs. It is not a treatmentfor people whose major problemsare with other drugs – such ascocaine, alcohol, benzodiazepines,or cigarettes.Opioid drugs include all the drugsthat come fully or partially from opiumand synthetic drugs that have similareffects. Morphine, heroin, codeine,methadone, dilaudid, buprenorphine,LAAM, OxyContin, and fentanylare opioids.4About Methadone and Buprenorphine

People dependenton street opioidswho receivemethadone treatmentare healthier andsafer than thosewho do not.www.drugpolicy.org 7

DependencyOpioids have been used for thousandsof years, and it has long been knownthat many people who have becomedependent on opioids have extremedifficulty permanently ending theiruse of them.Suffering through the withdrawalsickness is only part of the problem.The real difficulty has always beenstaying off the drugs once the periodof withdrawal is over.Just as in the case of those who areunable to stop smoking, it is difficultto explain why it is so hard not toreturn to the use of opioids. Reasonsinclude long-term depression, lack ofenergy, drug cravings, and suddenattacks of physical withdrawal sickness.Some people find that theseproblems diminish over time andeventually disappear altogether –but others continue to suffer thesesymptoms indefinitely, and manyof them eventually relapse to theirregular use of opioids.people with a long history of opioidproblems have experienced changesto the part of their brains that allows aperson to feel and function normally.This part of the brain makes and usesits own natural opioids.The best known of these naturalopioids are the chemicals knownas endorphins. The word endorphinliterally means “the morphine within.”Indeed, these chemicals are functionallyidentical to morphine or heroin.We don’t yet understand everythingthat these natural opioids do in thebody, but evidence suggests thatthey are involved with pain control,learning, regulating body temperature,and many other functions.It is possible that people who developa dependency on opioids wereborn with an endorphin system thatmakes them particularly vulnerable.For example, we know that addictionappears to run in some families.Relapse often has nothing to do withlack of will power or other personalityproblems. Instead, it appears that6About Methadone and Buprenorphine

What is Methadone?Methadone is a long-acting,synthetic drug that was first used inthe maintenance treatment of drugaddiction in the United States inthe 1960s. It is an opioid “agonist,”which means that it acts in a waythat is similar to morphine and othernarcotic medications.When used in proper doses inmaintenance treatment, methadonedoes not create euphoria, sedation,or an analgesic effect. Dosesmust be individually determined.The proper maintenance doseis the one at which the cravingsstop, without creating the effectsof euphoria or sedation.Although methadone is not a singleproduct from a single manufacturer,the active ingredient is always thesame: methadone hydrochloride.8About Methadone and Buprenorphine

All manufacturers add inactiveingredients, such as fillers, preservativesand flavorings. Methadone isdispensed orally in different forms,which include:• Tablets, also called diskettes.Each one contains 40 milligrams ofmethadone, is dissolved in water, andthen is administered in an oral dose.• Powder is also dissolved in water.• Liquid methadone can be dispensedwith an automated measuring pump.Dosages can be adjusted to as smallas a single milligram.Patients have different opinions aboutthe various types of methadone.Each methadone provider usuallyoffers a single type of the drug andobtains its supply from one source,which means that patients generallydo not get to choose which form ofmethadone they get.For most people, a single dose ofmethadone lasts 24 to 36 hours.How is methadone different fromheroin and other opioids (forexample, morphine or dilaudid)?Methadone lasts longer. The bodymetabolizes methadone differentlythan it does heroin or morphine.When a person takes methadoneregularly, it builds up and is stored inthe body, so it lasts even longer whenused for maintenance. Most peoplefind that once they’re stabilized ona dose of methadone that’s right forthem, a single oral dose will “hold”them for at least a full 24-hour day.For some, the effect lasts longer; forothers it lasts a shorter time.Stability is easier on oralmethadone. Most people who areon a stable, appropriate dose ofmethadone for several weeks will notfeel any significant sense of being“high” or “dopesick.” Some patientsmay feel a “transition” – or temporary,mild glow – for a short time severalhours after being medicated,however. Others may feel slightly“dopesick” prior to taking the day’sdose but most will feel very little orno effect from the proper dose ofmethadone once they have stabilized.www.drugpolicy.org9

BuprenorphineBy Sharon Stancliff, MDBuprenorphine, when appropriatelyprescribed and taken, is an effective,safe medication approved by theFDA for use in the treatment of opioidaddiction. Buprenorphine relieveswithdrawal, reduces craving andblocks the effects of heroin in wayssimilar to methadone. Maintenancedoses are generally between 12 and32 milligrams but (like methadone)should be individualized.Unlike methadone, buprenorphinemay be prescribed for treatment ofopioid addiction by any doctor whohas received training (available viathe Internet or as a one-day course)and a waiver from the DEA. This is itsprincipal advantage over methadonefor most doctors and patients. Misuseof buprenorphine is less likely thanmethadone to result in death.Prescribed in the U.S. as Suboxoneor Subutex, buprenorphine is usuallytaken daily as tablets to be dissolvedunder the tongue. There is littleeffect from the drug if it is swallowed.Suboxone contains not just buprenorphinebut also naloxone, an opioidantagonist that may precipitatewithdrawal symptoms if injected.For people dependent on any opioid,taking the first dose of buprenorphinewhen not in withdrawal can result inacute withdrawal symptoms.Buprenorphine, like methadone,can be used as a short- or long-termdetoxification medication or indefinitelyas a maintenance medication.The risks of relapse followingdetoxification appear to be similarwhether methadone or buprenorphine(or any drug-free treatmentmodality) is used.A directory of physicians approvedto prescribe buprenorphine can befound at http://buprenorphine.samhsa.gov/bwns_locator/.10About Methadone and Buprenorphine

MaintenanceMethadone maintenance isintended to do three things forpatients who participate:1. Keep the patient from going intowithdrawal. The standard initialdose, as currently recommended,is 30 to 40 milligrams a day. Afterseveral days, providers adjust apatient’s dose as needed.2. Keep the patient comfortable andfree from craving street opioids.Having a craving means more thanjust having a desire to get high.It means feeling such a strong needfor opioids that people may haveregular dreams about using drugs,think about doing drugs to theexclusion of anything else, and/ordo things that they wouldn’t normallydo to get drugs.Methadone won’t control a person’semotional desire to get high, but anadequate dose of methadone shouldprevent the overwhelming physicalneed to use street opioids.3. “Block” the effects of streetopioids. If the dose is high enough,methadone keeps the patient fromgetting much, if any, effect fromthe usual doses of street opioids.This result is often called the“blockade” effect.If a person’s opioid tolerance iselevated high enough withmethadone treatment, a greatdeal of heroin would be requiredto overcome it and produce asignificant high.www.drugpolicy.org11

Methadone won’t controla person’s desire toget high, but an adequatedose of methadoneshould prevent theoverwhelming physicalneed to use street opioids.About Methadone and Buprenorphine

After MethadoneMany people who must takemedications every day get tired ofdoing so. This is especially true ofpatients on methadone maintenancebecause, in the United States, almostall methadone patients are alsorequired to make frequent visits toa clinic to receive their medication.For many reasons, most methadonemaintenance patients decide atsome point that they want to stoptaking methadone.If you do choose to leave maintenance,your provider should reduceyour dose at the speed you feelcomfortable with. If it is slow enoughyou should not experience majorphysical withdrawal symptoms.staying opioid free over the longterm is the harder challenge. Studiesfind that people who have longhistories of trying and failing to livewithout opioids will probably not beable to stay abstinent for long.It isn’t yet possible to predict whowill be able to live life without opioids,but it doesn’t seem to depend on how“together” you are. If you are detoxingand find that you are craving opioids,or you have finished detoxing andyou are always thinking of opioids,then perhaps maintenance shouldbe part of your life.But if you have tried withdrawingfrom opioids many times and haverelapsed, then you may have foundthat detoxing is the easier part andwww.drugpolicy.org13

Myths & FactsMyth: Methadone gets into yourbones and weakens them.Fact: Methadone does not “get intothe bones” or in any other way causeharm to the skeletal system. Althoughsome methadone patients reporthaving aches in their arms and legs,the discomfort is probably a mildwithdrawal symptom and may beeased by adjusting the doseof methadone.Also, some substances can causemore rapid metabolism of methadone(see pages 16-17 for a list of medicationsthat interact with methadone).If you are taking another substancethat is affecting the metabolism ofyour methadone, your doctor mayneed to adjust your methadone dose.Myth: It’s harder to kickmethadone than it is to kicka dope habit.Fact: Stopping methadone use isdifferent from kicking a heroin habit.Some people find it harder becausethe withdrawal lasts longer. Otherssay that although it lasts longer, it ismilder than heroin withdrawal.Myth: Taking methadone damagesyour body.Fact: People have been takingmethadone for more than 30 years,and there has been no evidence thatlong-term use causes any physicaldamage. Some people do suffersome side effects from methadone– such as constipation, increasedsweating, and dry mouth – but theseusually go away over time or withdose adjustments. Other effects,such as menstrual abnormalitiesand decreased sexual desire, havebeen reported by some patientsbut have not been clearly linked tomethadone use.Myth: Methadone is worse for yourbody than heroin.Fact: Methadone is not worse foryour body than heroin. Both heroinand methadone are nontoxic, yet bothcan be dangerous if taken in excess– but this is true of everything, fromaspirin to food. Methadone is saferthan street heroin because it is alegally prescribed medication andit is taken orally. Unregulated streetdrugs often contain many harmfuladditives that are used to “cut”the drug.14About Methadone and Buprenorphine

Drug InteractionsLike any medication, methadonecan interact with other types ofmedicines and with street drugs.The body is a complex system, andit’s possible that foods, hormones,weight changes, and stress mayeach also affect the way in whichmethadone works in your body.We know about some of thesubstances that may interact withmethadone – and some of themare listed here. Others may yetbe discovered.These medicines cause the liverto metabolize methadone morequickly and may cause a need foran increased methadone dose:• Carbamazepin (Tegretol)• Phenytoin (Dilantin)• Neverapine (Virammune)• Rifampin• Efavirenz (Sustiva)• Amprenavir (Agenerase) –methadone also significantly reducesthe level of amprenavir.• Ritonavir (Norvir) – less of an effectSome medicines slow the metabolismof methadone. Sometimes peoplewill feel the effect of methadonemore strongly when they takethese medications, and sometimesthey experience withdrawal symptomswhen they stop taking thesemedications:• Amitriptyline (Elavil)• Cimetidine (Tagamet)• Fluvoxamine (Luvox)• Ketoconazole (Nizoral)Some medications are opioidblockers and may cause withdrawal.These block the effect of methadoneand should not be taken if you aretaking methadone:• Pentazocine (Talwin)• Naltrexone (Revia)• Tramadol (Ultram), in most cases16About Methadone and Buprenorphine

Methadone & WomenIs it true that women sometimesstop getting their periods whenthey begin taking methadone?Yes, but there are also many otherreasons why women’s periodsbecome irregular or stop:• Pregnancy• Stress• Poor diet• Weight gain and loss• Menopause• Other medical problems• Other medicationsRemember:• You can still get pregnant even if youdon’t get your period.• You can conceive and have normalpregnancies and normal deliverieswhile you are receiving methadone.You may have heard that you shouldnot take methadone when pregnant.This is not true.• Methadone is not harmful to thedeveloping fetus – but detoxing is.• Methadone is the treatment of choicefor heroin and opioid dependencyduring pregnancy.• The effects of methadone onpregnancy have been widely studied.• Methadone has been usedsuccessfully during pregnancy.• When properly prescribed forpregnant women, methadoneprovides a non-stressful environmentin which the fetus can develop.• Taking methadone during pregnancymay prevent miscarriage, fetaldistress, and premature labor.• Decreasing the dose of methadoneduring the first trimester increases therisk of miscarriage.• During pregnancy, your dose shouldbe sufficient to avoid cravings, avoidstreet drugs, and prevent withdrawal.www.drugpolicy.org19

Methadone & Women (cont.)If you are pregnant, be sure totalk with your doctor, because:• When you’re pregnant, your bodymetabolism changes, so you mayneed to adjust your dosage. Youmay need to increase your dose ofmethadone, or split your dose andtake smaller amounts two or threetimes a day.You may have heard that your babywill be born addicted to methadoneor will suffer other side effects, buthere are the facts:• Methadone does not cause fetalabnormalities. No harmful effectsto a fetus have been found in thestudy of methadone’s effect onpregnancy.• Premature birth and low birth weightcan be associated with cigarettesmoking and/or poor nutrition andare not attributed to methadone.• Babies born to mothers dependenton methadone will have methadonein their systems, but studies showthat the children can be weanedsuccessfully and safely with noadverse effects.You may have heard that youshouldn’t breast-feed your baby ifyou are taking methadone, but hereare the facts:• Breast-feeding is now consideredsafe for the babies of women who aretaking methadone, but not safe forwomen who are HIV positive.• Small amounts of methadone inbreast milk can pass to the baby.• Methadone levels in breast milk arevery low.20 About Methadone and Buprenorphine

Storing MethadoneWhile at home, always keep yourmethadone in a safe place – preferablyin a locked box or cabinet – out ofthe reach of children and clearlymarked to prevent anyone else fromtaking it accidentally.Remember: Methadone is a verystrong drug. A small amount cankill a child or an adult who does nothave a tolerance to it. If anyone inyour home accidentally drinks yourmethadone, call 911 or an ambulanceimmediately.If anyone inyour homeaccidentallydrinks methadone,call 911 or anambulanceimmediately.Store your methadone away fromextreme heat or cold. The methadonethat you take home is often mixedwith water – and sometimes mixedwith other additives, depending onwhere you get your methadone.The solution typically lasts for weeks.When you are traveling or away fromhome, keep your methadone in theprescription bottles that were givento you by your methadone providerto prevent any trouble with the law.As with any prescription drug, it isillegal to possess methadone withouta prescription.www.drugpolicy.org21

ConcernsAbout OverdoseMethadone treatment reduces thechance of overdose for those who areusing or are addicted to heroin.Methadone is a pure drug and isindividually prescribed. It does notcontain the harmful “cuts” that aremixed into drugs bought on thestreet. Concerns about overdoseremain, however, especially if youcontinue to use street drugs or ifyou resume regular heroin use afterstopping your methadone treatment.If you stop taking methadone andstart using street drugs again, yourchance of overdose increasesbecause you now have a lowertolerance for the drugs. Toleranceincreases when your body hasgotten used to having the drug in itssystem – in other words, your body“tolerates” the presence of the drug.If you stop using regularly – or if youhave detoxed – it takes a smalleramount of the heroin, methadone, orother opioid to cause an overdose.Also, mixing pills such as benzodiazepines,barbiturates and/or alcoholwith methadone or heroin increasesthe risk of overdose.22About Methadone and Buprenorphine

Frequently Asked QuestionsCan I overdose on methadone?It is possible to overdose on methadone,but providers work to adjustdosages so that they are safe foreach individual patient. It is importantto be honest with the clinic staff abouthow much heroin or other opioidsyou are using so that they prescribe adosage that is right for you – too littlewon’t be effective; too much couldcause you to overdose. Methadoneis a strong medication, so you needto build up the dosage slowly to besure that your body is handling themedicine well.Can I overdose on buprenorphine?Misuse of buprenorphine is less likelythan methadone to result in death(see page 10).What if I use other drugs while I amtaking methadone?The correct dosage of methadoneblocks the effects of heroin. If youtake opioids while also taking methadone,you may not feel the effects ofthe opioids. You may then decide totake even more of the opioid, whichcould cause an overdose. Somedrugs also interact with methadoneand can change how your medicationsaffect you (see pages 16-17).Taking too much of a sedative ordrinking a lot of alcohol while youare taking methadone can also bedangerous because each substancemakes the other more powerful,increasing your risk of overdose.Be extremely careful if you mixthese drugs.The correct dosageof methadoneblocks the effectsof heroin.www.drugpolicy.org23

Concerns About Overdose (cont.)Can I overdose on heroin whileI am taking methadone?Yes. Even while taking methadone,if you take too much heroin –especially if the heroin is unusuallystrong – you could overdose. Youincrease the odds of overdosingon heroin while you’re takingmethadone if you mix it withsedatives, alcohol, or other drugs.What if I stop going to mymethadone program?If you stop taking your methadoneand return to using street drugs,you can overdose more easily thanwhen you last used. When you stoptaking methadone, your body willrapidly develop a lower tolerance forthe heroin. As soon as your methadonecompletely wears off (a coupleof days), your tolerance for heroinwill be lower than it was when youbegan taking methadone. So, if youdecide to use again, you need to bevery careful. Take some precautions– always be sure there are otherpeople with you when you’re using,in case you need medical attention,and test the effect of the drug onyou before you take an entire dose.What happens if I start takingmethadone again after I havestopped?If you stop taking methadoneeven for a few days, you need tobe careful when you start takingit again. Your body may have lostsome of its tolerance for themethadone, so you could overdose.You need to restart at a lower doseand work back up to the levelyou were at when you stopped.The doctor at the clinic can helpyou determine the right dosages.24 About Methadone and Buprenorphine

In Case of OverdoseIf you suspect that someonehas overdosed on methadone,lay the person on his or her sidein the recovery position and call911 immediately.If medical professionals arrivequickly, they can treat theindividual with an antagonist, suchas naloxone, that will help themcome out of the overdose. It isimportant to tell the medical professionalswhat drug the overdosevictim took so they know which drugto use to counteract the overdose.The person who overdosed willneed to be watched for a few hours.Methadone is a long-acting drug.The medications that are used totreat the overdose are short-acting.If the antagonist wears off beforethe methadone level decreasesenough, the patient may go backinto a state of overdose and requiremedical attention again.What should I do if someoneoverdoses?• Immediately call 911 and remain withthe person.• Do not force the person to vomit.• Do not make them take a coldshower.• Do not inject salt water intotheir veins.What are the signs of an opioidoverdose?• Unresponsiveness• Drowsiness• Cold, clammy, bluish skin• Reduced heart rate• Reduced body temperature• Slow or no breathingWhat might happen if an overdoseis not treated?• Brain damage• Paralysis (temporary or permanent)• Deathwww.drugpolicy.org25

DetoxificationDoctors do not advise that peoplequickly taper off of their dose ofmethadone – but there are, unfortunately,many situations where thisoccurs. For example, a methadonepatient may be in jail or in a hospitalwhere methadone is not prescribed.Or the person may be complying witha demand from family court in orderto be reunited with children who arein foster care. Public policy is slowlychanging, but some methadonepatients are still being forced todetox from their medication.If you are being “administrativelydetoxed” by your methadoneprovider, you should find anotherprovider quickly. If your provideris not helping you find another,contact a harm reduction program,needle exchange, or your state’shealth department for assistance.A directory of state alcohol anddrug abuse agencies can be foundat www.treatment.org/states/index.htmlSome people also use graduallytapering doses of methadone for ashort period of time (three to sevendays) to relieve the initial discomfortof heroin withdrawal. This methodmay be successful for people whohaven’t been dependent on heroinor other opioids for a long time.If you do start using drugs again afteryour detox, you are not a “failure.”Time that you spent away from streetdrugs was a period of reduced risk– risk of arrest, exposure to disease,and overdose. But remember, if yourelapse, the first weeks of use (again)are a time of higher risk of overdose.How it WorksMethadone patients have two options:inpatient and outpatient treatment.With inpatient treatment, the patientis admitted for overnight care to aclinic or hospital. The patient usuallymust spend several days and takemedication to relieve the withdrawalsymptoms. In outpatient detox,medication also provides relief fromwithdrawal symptoms. The medicationis administered during daily clinicvisits over a period of several weeksor longer. Often methadone is used indoses that are gradually reduced.26About Methadone and Buprenorphine

Any “cross-tolerant” opioid – suchas morphine, dilaudid, methadone,heroin, or LAAM – can suppresswithdrawal. Methadone is usedbecause it is long-acting, gentle,eliminates craving, and doesnot produce a “high” when it isused properly.Other medications, includingdrugs such as buprenorphine andclonidine, are also used – and maybe used more widely in the future.The usual detox program formethadone requires that the patientuse it as a tapering dose for 21 to30 days. During induction, the doctordetermines the right dose to overcomewithdrawal. Afterward, thedose you take gradually becomessmaller, until you no longer needthe methadone. The medical andcounseling staff in your programcan help you develop a plan forfurther treatment if you need it, andwill guide you through the physicalchanges you experience during thedetox period.www.drugpolicy.org27

Methadone & PainSevere pain has long been under treated in theUnited States. This is partly because of ignoranceand prejudice, but also because of the laws thatmade drugs like heroin illegal. The government hasactively pursued and prosecuted physicians forprescribing opioids.If you are on methadone maintenance, yourregular maintenance dose of methadone willprovide little or no pain relief. You will still feelpain, just like everyone else. In fact, you may needmore pain-relief medication than people who arenot taking methadone.Greater public awareness of how many people haveneedlessly suffered because of this undertreatmentof pain is beginning to force changes. To managepain, doctors are beginning to more freely prescribeopioids – including methadone, which has beenrecognized as an effective pain medication.About Methadone and Buprenorphine

DrivingStudy after study has shown thatpeople who are maintained on acorrect dose of methadone can doanything that people who are notusing any medication can do.Researchers have conductedlaboratory and field studies since1964. They have consistently foundthat methadone – when used in thetreatment of heroin addiction – hasno adverse effects on a person’sability to think and function normally.Methadone patients still experiencea great deal of discrimination byemployers, however, especially whenthey seek to get or keep jobs thatinvolve driving.Discrimination persists, despitethe fact that people maintained onmethadone are no different from thegeneral population in their motorskills, reaction times, ability to learn,focus, and make complex judgments.Of course, your ability to think andfunction normally depends onyour having the correct dosage ofmethadone. If you feel groggy, tired,or unable to focus, you should notdrive. Be sure to consult your clinicianabout whether you are receiving acorrect amount of methadone.www.drugpolicy.org29

Traveling with MethadoneTraveling in the United StatesIt can be very stressful for methadonepatients to plan a trip. Rules vary fromplace to place throughout the UnitedStates, and many of them are unclear.If you are traveling within the UnitedStates, decide whether you want totravel with your medication or obtain itwhen you arrive at your destination.To be sure that your methadonetreatment is not interrupted, you willeither need to get enough methadonefrom your provider to cover you forthe entire time you’re away – or yourprovider/clinic will need to arrangefor you to be “guest medicated” at amethadone clinic located in the areawhere you will be staying.In either case, it is wise to make yourarrangements as early as possiblebefore you leave.Keep in mind that federal, state, andclinic regulations limit the amount ofmethadone that you can take withyou. These rules differ from place toplace, so check with your provider tofind out about the rules in the areasyou plan to visit.A comprehensive “MethadoneMaintenance Treatment Directory”listing contact information foroutpatient methadone maintenancefacilities in the United States can befound on the Internet at:www.findtreatment.samhsa.gov.If you do not have access to theInternet, see the directory of statesubstance abuse agencies onpage 32.Traveling AbroadMethadone is a prescribed medication,and most countries allowvisitors to bring whatever prescriptionmedications they need with them. Insome places, however, methadonemay be considered an exception tothis policy.In many countries, methadone isnot available, and some countriesprohibit bringing it in. Some countriesalso have laws prohibiting formeraddicts or people with criminalrecords from entering. It may bedifficult to find out which laws are ineffect in which countries – and whichlaws are actually enforced.30About Methadone and Buprenorphine

There are some resources thatpatients can check to determine thelaws that apply to methadone at theirdestinations. Ultimately, however,patients are responsible for determiningwhether it is legal and/or safeto bring methadone with them whenthey travel.• An excellent place to start is theINDRO Web site at:www.indro-online.de/travel.htm• For more information about Europeanmethadone providers, go to:www.q4q.nl/methwork2/home.htm• You can also check with theconsulate of the country that youare traveling to – although not allconsulates will be well informedabout methadone.Whichever country you travel to,you will need to decide whetheryou will carry your own methadone(where permitted) or find a methadoneprovider there who will treat you(if one is available).Whichever option you choose, youwill need to bring your prescription formethadone, and, if you are guestmedicating,a letter from your homeprovider, explaining your prescription/dosage. Make these arrangements asearly as possible before your trip.What should you do if methadoneimportation is prohibited at yourdestination?Knowing that their medication islegal, most simply do not declare it atcustoms unless they are specificallyasked to do so. There are, however,severe penalties for importation ofeven small, prescribed amountsof medications in some countries(for example, the death penalty inSingapore!).Each patient will have to weighthis decision very carefully. Manymethadone patients have traveledto various parts of the world withoutexperiencing any problems.www.drugpolicy.org31

State SubstanceAbuse AgenciesAlabama 334.242.3961Alaska 907.465.2071Arizona 602.542.1000Arkansas 501.686.9866California 800.879.2772Colorado 303.866.7480Connecticut 860.418.7000Delaware 302.255.9399District ofColumbia 202.727.8857Florida 850.487.2920Georgia 404.657.2331Hawaii 808.692.7506Idaho 208.334.5935Illinois 800.843.6154Indiana 317.232.7800Iowa 515.281.4417Kansas 785.296.6807Kentucky 502.564.2880Louisiana 225.342.6717Maine 800.499.0027Maryland 410.402.8600Massachusetts 617.624.5111Michigan 517.335.0278Minnesota 651.582.1832Mississippi 877.210.8513Missouri 573.751.4942Montana 406.444.3964Nebraska 402.471.7818Nevada 775.684.4190New Hampshire 603.271.6110New Jersey 609.292.5760New Mexico 505.827.2601New York 518.473.3460North Carolina 919.733.4670North Dakota 701.328.8920Ohio 614.466.3445Oklahoma 405.522.3619Oregon 503.945.5763Pennsylvania 717.783.8200Puerto Rico 787.764.3795Rhode Island 401.462.4680South Carolina 803.896.5555South Dakota 605.773.3123Tennessee 615.741.1921Texas 512.206.5000Utah 801.538.3939Vermont 802.651.1550Virginia 804.786.3906Washington 877.301.4557West Virginia 304.558.2276Wisconsin 608.266.2717Wyoming 307.777.649432About Methadone and Buprenorphine

The Drug Policy Alliancepublished About Methadone andBuprenorphine to help patients makehealthy and informed treatmentdecisions with their doctors. As partof our broader mission, we also seekto end the prejudices and policiesthat cause discrimination against allpeople in maintenance therapies.By educating hundreds of thousandsof readers, About Methadoneand Buprenorphine has helpedadvance both of these goals, so we’repleased to offer it for just the cost ofproduction. As a private, nonprofitorganization, however, the DrugPolicy Alliance relies solely on ourmembers and contributors for financialsupport – both to advance drugpolicies based on science, health,compassion and human rights, andto aid in the distribution of AboutMethadone and Buprenorphine andpublications like it.Please join our fight for the rightsand dignity of methadone patientsand the millions of others whosuffer the consequences of thefailed war on drugs. Join theDrug Policy Alliance today.To become a member and help endthe war on drugs, please contact:MembershipDrug Policy Alliance70 West 36th Street16th floorNew York, NY 10018212.613.8020 voice212.613.8021 faxmembership@drugpolicy.orgwww.drugpolicy.org/joinFor additional copies of AboutMethadone and Buprenorphine,please contact the above address,email us at:methadone@drugpolicy.orgor call: 212.613.8020DPA AM 0710About Methadone and Buprenorphine