Methadone, HIV Infection and
Studies undertaken over the past two decades, primarily by Dr. Mary Jeanne Kreek of The Rockefeller University, and corroborated by other scientists throughout the world have established the long-term medical safety of methadone maintenance treatment (Kreek, 1992; Kreek, 1987; Kreek, 1986; Kreek, 1978; Kreek, 1973; Kreek et al, 1972; Novick, Richman, Friedman et al, 1993). There are no toxic effects, somatic damage or functional deficits associated with or attributable to methadone for patients who are stabilized at appropriate doses including those receiving over 100 mgs/day, who are not heavily abusing other drugs (e.g., alcohol and cocaine), and who have remained in continuous treatment for up to 18 years.
There are minimal non-toxic side effects, such as constipation, that can be treated; excessive sweating that in most cases subsides over time; and decreased libido and, in some males, delayed orgasm that normalizes within the first few months of treatment or with dose adjustment (Kreek, 1978; Kreek, 1973).
Methadone does not get into or rot the bones. Patients complaining of muscular aches are usually experiencing the initial symptoms of the abstinence syndrome and probably need a dose adjustment. Another common myth about methadone and health is that it rots the teeth. However, the dental problems experienced by the majority of methadone patients is a result of their years of using heroin and poor health. Most heroin addicts do not make visits to their dentist every 6 months as one should and eventually the lack of care will catch up with them. No other medication has received the scrutiny and evaluations that methadone has which continue up to this day. The major impact of methadone treatment on the health of addicts is that it brings them from poor to good health (Novick, Joseph & Croxson et al, 1990).
The pharmacology of methadone, a long acting synthetic opiate of 24 to 36 hours, at adequate doses results in a daily steady state of blood plasma levels, as compared to the interrupted on-off effects of short acting narcotics such as heroin. Heroin, a short acting opiate of four to six hours, can produce a deranged physiology impairing the endocrine and immune systems, gastrointestinal functioning, reproduction, homeostasis and the general biology (Dole, 1988; Himmelsbach, 1968; Martin, Wilker & Eades, 1963). The steady state of blood plasma levels produced by an adequate daily dose of methadone normalizes the deranged physiological functioning of the endocrine and immune systems induced by heroin addiction (Dole, 1988).
Immune Functioning and Methadone
The potential for normalization of endocrine and immune functioning is especially crucial when treating HIV positive methadone patients. The evidence of immune restoration from HIV negative methadone patients hints that there may be a partial restoration of immune functioning for HIV positive methadone patients (Kreek, 1988). While this is not proven, there are many other advantages for HIV positive heroin users to be placed and maintained on methadone.
In Switzerland a three-year prospective study followed a group of HIV-infected methadone maintenance patients and a contrast group of HIV-infected heroin users who did not enter methadone maintenance treatment (Weber, Ledergerber, Opravil & Luthy, 1990). The results showed that a significantly lower proportion ofmethadone maintenance patients progressed to AIDS as compared with the untreated heroin users, 24 percent versus 41 percent, almost a-2 fold increase within the period of the study.
Methadone when prescribed as a maintenance medication functions as a normalizer for a deranged physiology and not as a mood altering narcotic substitute (Dole, Nyswander & Kreek, 1966; Joseph & Dole, 1970). Methadone maintenance, is therefore corrective but not curative.
Illicit Heroin Use and Immune Function
The Potential Mandate of Methadone Programs on HIV Infection
Dole, V.P., Nyswander, M.E. and Kreek, M.J. Narcotic blockade. Archives of Internal Medicine 1966 (October) 118:304-309.
Himmelsbach, C. Clinical studies of morphine addictions. Nathan B. Eddy Memorial Award Lecture. In: Harris, L.S. (ed), Proceedings of the 49th Annual Scientific Meeting of the Committee on Problems of Drug Dependence. National Institute on Drug Abuse, Research Monograph Series 81. Rockville: U.S. Dept. of Health and Human Services, 1968.
Kreek, M.J. The addict as patient. In: Lowenson, J.H.; Ruiz, P.; Millman, R.B. and Langrod, J.G. (eds), Substance Abuse A Comprehensive Textbook. Baltimore: Williams and Wilkins, 1992.
Kreek, M.J. Summary of Presentation at 1988 meeting of the Committee for the Problems of Drug Dependence. NIDA Notes 1988 Fall: 12, 25.
Kreek, M.J. Multiple drug abuse patterns and medical consequences. In: Meltzer, H.Y. (ed), Psychopharmacology: The Third Generation of Progress (Chapter 172), p 1597-1604. New York: Raven Press, 1987.
Kreek, M.J. Tolerance and dependence: Implications for the pharmacological treatment of addiction. In: Harris, L.S. (ed), Problems of Drug Dependence. Proceedings o the 48th Scientific Meeting of the Committee of the Problems of Drug Dependence, 1986. DHHS No. (ADM)87-1508. Rockville, MD: National Institute on Drug Abuse.
Kreek, M.J. Medical complications in methadone patients. Annals of the New York Academy of Sciences 1978 311: 110-134.
Kreek, M.J. Medical safety and side effects of methadone in tolerant individuals. Journal of the American Medical Association 1973 (February 5) 223(6): 665-668.
Kreek, M.J.; Dodes, L.; Kane, S.; Knobler, J. and Martin, R. Long-term methadone maintenance therapy: Effects on liver function. Annals of Internal Medicine 1972 (October) 77(4): 598-602.
Hartel, D.; Selwyn, P.A.; Schoenbaum, E.E. et al. Methadone maintenance treatment and reduced risk of AIDS and AID-specific mortality in intravenous drug users. No. 8546. Stockholm, Sweden: IV International Conference on AIDS, 1988.
Joseph, H. and Dole, V.P. Methadone patients on probation and parole. Federal Probation 1970 June: 42-48.
Martin, W.R.; Wilker, A.; Eades, C.G. et al. Tolerance and physical dependence on morphine in rats. Psychopharmacology 1963 4: 247-260.
Novick, D.M.; Joseph, H.; Croxson, T.S. et al. Absence of antibody to human immunodeficiency virus in long-term, socially rehabilitated methadone maintenance patients. Archives of Internal Medicine 1990 (January) 150: 97-99.
Novick, D.M.; Richman, B.L.; Friedman, J.M.; Friedman, J.E.; Fried, C.; Wilson, J.P.; Townley, A. and Kreek, M.J. The medical status of methadone maintenance patients in treatment for 11-18 years. Drug and Alcohol Dependence 1993 33: 235-245.
Weber, R.; Ledergerber, B.; Opravil, M. and Luthy, R. Cessation of intravenous drug use reduces progression of HIV infection in HIV+ drug users. Presented at the VI International Conference on AIDS. San Francisco: 1990.
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