Hepatitis c and methadone by injection

[Ove]

I'm staaf member in a institution which cooperate with addicts of different kind. One of the topics are support to our participiants who are being treated for hepatitis C. One of the participiants injects his methadone, a several year long habit which he find very difficult to quit. In realation to a forthcoming treatment for hepatitis C, we want to know if this injection habit have any influence on the treatment or if it is, in any way, a risc for his general health.



This discussion is related to Hepatitis C Your liver and Methadone.

[chemister]

It is normal to drink the methadone in Europe.
When people are in the program with regular urine test they start with treatment of hep C with no problem, and they think that is positive.
If the user inj heroine, the hep.C doctors want the user to start with methadone or Buprenofin before treatment start. Then is Ok to start with treatment of hep.C
I think the inj. is not positive to the liver.

[pjhep80]

i was on methadone for withdrawal years ago, never heard of anyone injecting it, you drink it... but i know some were on maintenance and took their's home so i guess if you are that into needles you could inject it... but alot of the addiction to heroin is the process of getting high so if he is that hooked on shooting i think he could very easily go back to using...

anyway, i think as long as he is not sharing the needle with anyone and sterilizes or uses a new one each time it wouldnt have any effect on the hep one way or the other...

[snadge]

the DR's will not start treatment as he still uses needles and risk catching the virus again during Treatment - it doesnt matter if he promises he uses clean ones only - they wont take the risk incase he relapses during treatment (gets re-infected) -

they only treat clean ex-addicts - methadone is fine as its supposed to be swallowed - methadone is not made for injecting - assuming he uses 20ml syringes and he probably on more than that he will be injecting himself probably more than two or three times per day - thats a lot of risk taking for the DR's....

[thegypsy9164]

I'm an ex addict with 25-years clean.  We used to get the methadone pills, crush, cook and inject them; so, it can be done.  However, at some point your patient MUST transition not only away from injecting methadone but away from the use of it entirely.  Regarding treatment, the patient deserves treatment and is not a throw-away even if he relapses while treating.  The hepatologist would know whether or not use of methadone is countertherapeutic.  I'd advise getting the patient to sign a release of confidential information form so that your agency can work as a team with the hepatologist treating your patient and share any and all relative information including his drug use.  This will be a motivation for your patient to follow his treatment regimine more honestly.  By the way, I'm a licensed chemical dependency counselor but this is just the opinion of me as someone in recovery who is familiar with being an addict who is treating for HCV.
Joey

[JennyPenny]

Joey, thanks for the informative post. We have been HCV education for clinicians who work in opioid treatment centers with a grant from SAMHSA for the past five years. I don't know very much about methadone but one of the things I've been told is something that you suggest shouldn't happen and I'd love to know if I have misunderstood or if there are different takes on the subject. It's about getting off methadone. I've been told that some people, I don't know the percentage, shouldn't or can't ever get off methadone because of their brain chemistry. And that should not be a necessary part of an opiate addict's goal. I see you say that a patient MUST get off. Can you explain what I am missing here? Thanks a lot.

Susie

[thegypsy9164]

This may or may not be more appropriate on a different forum.  However, it will hopefully be informative and beneficial to any interested in reading it as it came about as the result of a thread related to coexisting conditions requiring treatment, one of which is HCV.  I didn't get it out of a book, just from years of experience in my field.

Due to varying treatment approaches, ************** IS CONSIDERED AN ART BY SOME and AS A SCIENCE BY OTHERS.  As a result, you DO come across lots of varying opinions.  Some differences lie in how much money a program can make from the treatment approach they adopt and how they can manipulate information to justify what thay are doing to treat the disorder.  That is an issue that has sickened me since 1985 when I started in the ************** field.

There are differing views on recovery from drug addiction.  There are 12-step self help program based philosphies, controlled use philosophies, medication based and other philosopies.  

A FACT is that drug use changes brain chemistry significantly.  Sometimes stopping drug use can result in a return to "normalized" brain structure.  Sometimes an individual has to cope with permanently altered brain structure.  When I say brain structure I'm talking about the way neurotransmitters function ( reduction in some, elevation in others, some permanent, some temporary, etc).  These include dopamine, seretonin, epinephrine, norepinephrine and many more.  Enough education to really understand changes in brain chemistry would take lots and lots of continuing education and/or college course work.  

My opinion is that unless an addict in recovery has significant brain dysfunction and/or changes in brain chemistry significant enough to warrant medications (such as a drug abuse based bi-polar condition requiring something like Lithium), then they should learn to function completely drug free.  Of course who knows if the person already had a bi-polar condition and learned to self medicate with drug use or if it developed as a result of changes in brain chemistry caused by drug abuse.  Therein lies one of the age-old battles between mental health and substance abuse professionals.  Do we treat for mental health, substance abuse or coexisting conditions.  Although the Diagnostic and Statistical Manual (DSM) gives specific guidelines with which to diagnose mental health and psychoactive substance use disorders, a clinician must still assess variables before a final diagnosis is made.  Ideally, a team concensus is desireable.  Please note that when it come to recovery from substance abuse/dependence, if not given a chance to acquire some significant clean time, how will we know the degree to which an individual's brain chemistry has been altered and what treatment approach is truely warranted.  

I have always had issues with Methadone.  My belief is that although an opiate addict can, and in many cases should, benefit from a titered withdrawal from opiates through the use of methadone, methadone dependence can become an achilles heel just like the opiates were.  

So, without writing a thesis, there you have it.
Joey  

p.s.  Wow!  3 or 4-weeks of treatment for HCV and my brain is beginning to clear again (smiling).

[JennyPenny]

Wow! That's the best explanation I've ever heard on the subject. You made it pretty easy to understand. I should have realized that the bottom line, in some cases, is the almighty dollar. And it does make sense that unless you try to get someone off methadone, how do you know they can't live without it.

Thanks for taking the time for the explanation. I really appreciate that. Have a good weekend.

[thegypsy9164]

You are soooooooo welcome Suzie!  Drug addiction nearly killed me and I was the living dead for 17-years of full blown trying to die.  My drug addiction was the source of my HVC.  I thank God for the miracle of the 25-years clean and what I have learned and become in that time.  As a result, it is more than a passion to me, it has become my life.  The only other thing that comes close is my skydiving (speaking of addictive personalities). .
Joey

[gypsyjoey]

Hello Ove,
I was curious as to whether or not the question you had, which began this thread, was ever answered.

JennyPenny,
Have you been able to glean any additional information related to our discussion from other sources?

Please inform.

gypsyjoey