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Chapter 5 - Methadone and other drugs

From: Methadone Maintenance Treatment: Client Handbook

In this chapter:

  • Methadone and pain relief
    • Double doctoring 
  • Mixing methadone with other drugs
    • Alcohol and Valium 
    • Is there a safe level of drinking? 
    • Other opioids 
    • Drugs that will cause withdrawal 
    • Cocaine and crack 
    • Marijuana 
    • Other drugs / vitamins / herbal remedies 
  • Safe injection

Methadone and pain relief

Methadone can provide effective pain relief, but when it is used for pain, the dosage is different from the dosage used to treat opioid dependence. Pain in methadone clients is sometimes under-medicated because medical staff may assume that the methadone you take provides pain relief. The truth is, once you are on a stable dose of methadone, you may be tolerant to its pain-relieving effects. This means that if you are in pain, you need pain medication just as much as anyone else in a similar situation.

For example, if you have a headache, menstrual cramps or any other low-level pain, you should get relief with a normal dose of aspirin or Tylenol without codeine. If you require surgery, or are in an accident, you should continue to take your normal dose of methadone, and receive pain medication for the same length of time as anyone else in a similar condition.

In some cases, if you are tolerant to the pain-relieving effects of methadone, you may also be tolerant to the pain-relieving effects of other opioids. Some clients run into trouble with this because the medical staff who are treating them may suspect they are complaining of pain in order to get more drugs to get high.

If you are booked for surgery or dental work, ask your methadone doctor to provide you with a letter that says you are on methadone and how that affects your needs for pain relief. A better option is to ask the doctor or dentist who is treating you to talk to your methadone doctor.

When you are struggling to overcome drug dependence, you may question whether or not you want or need to take medication for pain relief. Some may fear that even taking an aspirin might lead them back into taking other drugs. Others may feel that their history of opioid use makes it even more difficult for them to cope with pain. If pain is a problem for you, talk to your doctor.

Double doctoring

Any time you are given a prescription for "narcotic" drugs by more than one doctor, you must report it to the other doctor. In Canada, narcotic drugs such as Tylenol 3, Percocet or methadone are "controlled substances." It is against the law for you to receive a prescription for these drugs from more than one doctor, without them both knowing. It's your responsibility to let your doctor know. If you don't, you could be accused of "double doctoring," which is against the law.

Mixing methadone with other drugs

Methadone is a potent drug, and can interact with other drugs to have undesirable or dangerous effects. Your doctor knows not to prescribe drugs that will interact or interfere with methadone, but it's up to you to know the potential impact of any recreational drugs you might take.

Dangerous combinations include:

Alcohol and Valium

Mixing methadone with alcohol or Valium can kill you. The danger is particularly high when you first start treatment. Most methadone-related deaths involve alcohol and other drugs, and occur early in treatment.

Alcohol, Valium (or other benzodiazepine drugs, such as Ativan, Xanax, Restoril and clonazepam) and methadone are all central nervous system (CNS) depressants. If you take too much of any CNS depressant, it slows down your breathing, which can lead to heart failure and even death.

When you mix CNS depressants together, they intensify each other's effects. This means they can make you feel more drunk or stoned than you might expect. It also means that the effect on your breathing is intensified. Combining these drugs is extremely dangerous.

If you show up at your clinic or pharmacy, and it's clear that you've been drinking or using other drugs, you won't be given your methadone dose until the pharmacist is convinced that it's safe. Some pharmacists might ask you to do a breathalyzer test if they suspect you've been drinking. It's their job to medicate you safely. They're on your side.

When you're under the influence of alcohol or Valium, your judgment is clouded. It's easier to get into a situation where you might think you can use your drug of choice "just one more time," or, just as serious, you might think the person who's offering it to you is a friend who's doing you a favour. If you want to keep control of your actions, and protect yourself from people you can't trust, make it easier for yourself: keep your head clear.

Alcohol can also have the effect of speeding up the metabolism of methadone in your body. This means that the methadone will wear off quicker, and you might end up feeling sick before it's time to get your next dose.

Is there a safe level of drinking?

If you want to drink, this is a question you should ask your doctor. Whether or not it's safe for you to have a drink or two now and then depends on a number of factors. For example, anyone who is hepatitis C positive should avoid drinking altogether because of the stress alcohol puts on the liver. Another consideration is how alcohol might interact with any other medications you might be taking besides methadone.

Even though alcohol is everywhere and it's cheap and it's legal, when you're on methadone, drinking can cause more problems than it's worth.

Other opioids

Methadone is an opioid drug, and will block the high of other opioid drugs, such as heroin, codeine, OxyContin and Percocet. That means that if you're on methadone, and, for example, you take some heroin, you might not feel much of anything. If you take more heroin, you could be in trouble. Just because you don't feel the high doesn't mean the drug is not affecting your body. You can still overdose.

"Since I started on methadone, I've stopped using other opiates. Now I can keep friends." — Don, 39, on methadone four months.

Drugs that will cause withdrawal

Drugs that reverse the effects of opioids and cause you to go into withdrawal are called "opioid antagonists."

The opioid antagonist you'd be given if you overdosed, and got to the hospital in time, is called naloxone. Another one you may hear of is naltrexone, which is prescribed for the treatment of opioid or alcohol dependence.

While you're not likely to take either of those drugs if you're looking to get high, there are some drugs whose effects are similar to an opioid high, but will also cause withdrawal. An example of this is Talwin, which is what pharmacists call an opioid agonist/antagonist. That means it produces some of the same effects as opioids, such as pain relief, but will also cause you to go into withdrawal if you have opioids, such as methadone, in your system. On the street Talwin is a main ingredient of "Ts and Rs." Don't take it. You'll get sick.

Cocaine and crack

Coke is a highly addictive drug that can make you anxious and paranoid, even violent and deluded. Too many people who get on methadone start using coke or crack to replace opioids. If you do that, you'll have a new set of problems, and methadone can't help you to deal with a cocaine addiction.


Having a few tokes may be safer than having a few drinks, or smoking crack, but like any drug, marijuana can have negative effects, and it can be misused. Some people dismiss the risks of using grass, saying it helps them to relax or improves their appetite. While marijuana may have these effects, it can also distort your senses and make it harder to think clearly. In some people, THC can induce anxiety and depression.

It may seem obvious, but the reality is, marijuana is illegal, it's habit forming, and if you smoke too much, it can reduce your motivation. Keep in mind too that if your methadone provider has a low tolerance for drug use, and you smoke marijuana, it could show up in your urine tests for up to a month, depending on how much you smoke.

Other drugs / vitamins / herbal remedies

Some other drugs, including those you get from your pharmacist, can be dangerous if taken in combination with methadone. Others may alter or interfere with the effectiveness of methadone. To be safe, and to be sure you're comfortable, let your pharmacist know about all other drugs you take.

"A part of me wishes I hadn't gone on meth because it has an intense withdrawal and is just as hard to get off of as junk. On the other hand, meth has saved my life, I think, because if I hadn't gone on, I'd probably be dead by now. Since I started on meth I've stopped using drugs and I've got my life on track in a good way.

"For meth to work you've got to be strong. You can't let yourself take a little something if you're feeling sick. You've got to keep busy. Stay away from the people you used to get high with. Stay away from the places that bring back memories, and make you want to get high again. You've really got to want to get off drugs." — Harvey, 37, on methadone five years

Safe injection

Everybody's hoping that once you're on methadone, you'll never touch another needle in your life. Sometimes, though, it takes longer to get clear of drugs than it does to begin methadone treatment. Always avoid injecting, but if you do, please follow this advice:

Always use a new needle. Even cleaning with bleach may not protect you from becoming infected with hepatitis C (HCV). Many, maybe even most, injection drug users are infected with HCV. Sharing needles also puts you at high risk of becoming infected with HIV, or of passing it on to someone else. Needles are one thing you should never share. Besides, they are only meant to be used once. After that they are dull, and could damage your veins. Dispose of used needles safely so no one gets sick or hurt. Needles are available through needle exchanges, pharmacies and public health departments.