If you are addicted to heroin or another opiate (opium, codeine, morphine), your doctor may recommend methadone treatment. Methadone is a prescription drug that can help you manage your addiction. Methadone takes away your craving for heroin but does not make you feel stoned or tired. It does not interfere with day-to-day activities such as driving a car or going to work.

Each dose of methadone lasts for about 24 hours so you will only need to take it once a day. Used at the appropriate dose, methadone is a safe drug that may not have difficult side effects even if you take it for 10 years or more.

Combined with behavioral therapies, counseling, and other supportive services, methadone can help you stop using heroin. Managing your addiction can lead to increased success with HIV therapy.

Because methadone is a controlled drug you must meet the requirements of the U.S. Food and Drug Administration (FDA). Federal requirements along with state laws can influence whether or not methadone treatment is available in your area.

You cannot get methadone in every pharmacy and you may have to go to the clinic to get your medicine. Currently advocates are pushing for methadone to be treated like any other prescription medication.

Methadone's common side effects are constipation and excessive sweating. However, some people on methadone also report dry mouth, trouble urinating, male impotency, skin rash, low blood pressure (which results in fatigue) and nausea.

There is street folklore that methadone rots the bones and makes teeth fall out. However, there is no scientific or medical evidence that supports those reports.

Methadone can interact with other medications. Sometimes drug interactions are minor and don’t cause any problems. Other times the wrong combination of drugs can cause serious side effects. In addition, any type of liver disease (e.g., hepatitis) may make these interactions worse.

If you are taking methadone and HIV drugs you must be carefully monitored by your doctor. In some cases methadone causes the HIV drugs to become less effective. In some cases the HIV drugs cause the methadone to become less effective. Talk to your doctor to see if you need to have the dose of your methadone or any of your other medications changed.

Here is a list of some known methadone and HIV drug interactions:

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Retrovir (AZT)

• Methadone increases Retrovir levels
• No dose adjustments necessary

Videx (ddI)

• Methadone decreases Videx levels
• A Videx dose increase may be considered

Zerit (d4T)

• Methadone decreases Zerit levels by a small amount
• No dose adjustments necessary

Ziagen (abacavir)

• Ziagen decreases methadone levels
• May need to increase methadone dose

Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Rescriptor (delavirdine)

• Rescriptor increases methadone levels
• Methadone dose adjustment may be necessary

Sustiva (efavirenz)

• Sustiva decreases methadone levels significantly
• Need to increase methadone dose

Viramune (nevirapine)

• Viramune decreases methadone levels significantly
• Need to increase methadone dose

Protease Inhibitors (PIs)

Agenerase (amprenavir)

• Taking Agenerase with methadone decreases levels of both drugs
• Taking Agenerase and methadone is not recommended

Kaletra (lopinavir/ritonavir)

• Kaletra decreases methadone levels
• May need to increase methadone dose

Norvir (ritonavir)

• Norvir decreases methadone levels
• May need to increase methadone dose

Viracept (nelfinavir)

• Viracept decreases methadone levels
• May need to increase methadone dose, but usually no dose adjustment is necessary

Some other drugs used by HIV+ people, such as the antibiotic rifampin, also interact with methadone. Talk to your HIV or methadone program physician so they can provide you with the proper medical advice.

If you cannot take methadone because of drug interactions, other recovery treatments may be used:

• Drug therapies such as LAAM (Levo-Alpha Acetyl Methadol), Naloxone, naltrexone and Buprenorphine
• Detoxification (clearing the body of drugs)
• Behavioral therapies

Methadone treatment may cause changes to and even stop your monthly menstrual period. It will not, however, prevent you from getting pregnant or from having a normal pregnancy.

Methadone does cross the placenta and your baby may be dependent on (addicted to) methadone at first and need to be weaned. Long-term studies have shown that there is no increased risk of birth defects or developmental difficulties in babies born to methadone-treated women.

If you are on methadone and become pregnant, you should not stop your treatment without first speaking to your doctor.

Methadone is an important tool for treating heroin addiction. Get the most out of your methadone and your HIV treatments by keeping your doctors informed of all the drugs you are taking so any necessary dose adjustments can be made.

1		Falkner, B. and Kosel, B. (2003). Methadone and HIV medications: drug interactions. Who needs to care? STEP Perspective: Retrieved January 2005 from http://www.thebody.com/step/winter03/methadone.html.
2		Firshein, J. (1998). The politics of methadone. Moyers on Addiction: Retrieved January 2005 from http://www.pbs.org/wnet/closetohome/policy/html/methadone.html.
3		Parrino, M. and McNicholas, L. (2004). Methadone maintenance and other pharmacotherapeutic interventions in the treatment of opioid dependence. American Association for the Treatment of Opioid Dependence: Retrieved January 2005 from http://www.aatod.org/fact_drug_court.html.