|Own your ow legal marijuana business||
Your guide to making money in the multi-billion dollar marijuana industry
|Heroin, Morphine, and the Opiates|
Thanks to all of these fine doctors for participating . . .
Dr. Column 11/98-7/99
Should You Tell Your Dentist You Are Taking Methadone? - September 1999, Vol IV, No. IX
Different Formulations of Methadone-
August 1999, Vol. IV, No. VIII
Many patients have varying side effects and/or "feel" different formulations of methadone differently (e.g.: clear liquid methadone, cherry methadose, wafers, etc.); some patients say one kind will "hold" longer than another, or one is "better" than another. What is your opinion/experience with this? Does your clinic offer patients a choice as to what formulations the prefer? - Donna B.
We offer the orange Disket ®, white 5 and 10 mg. Tablets, clear liquid and OrLAAM [Note: OrLAAM is not methadone, it is another medication, with somewhat similar properties to methadone, used for maintenance therapy]. We have tried flavored liquids, but the patients did not like them. I do not obsess about why patients prefer one thing or another. We just try to make treatment as desirable as possible.
Marc Shinderman, M.D.
There are always some patients who cannot tolerate certain formulations so alternatives should be available. Just as children sometimes need a 'spoonful of sugar', so adults also need to have a preparation which is tolerable. All formulations of methadone that I have heard of taste disgusting. Some people are driven to vomit just from the smell! We offer an alternative to the usual gluggy syrup as a pure solution without sugar, preservatives, alcohol, coloring or flavoring. About 10% of our patients cannot tolerate the usual solution and about half of these are happy with the pure solution (methadone powder dissolves easily in water). Tablets are not permitted by most State laws and are not feasible for doses over about 50mg anyway. Our average is now 90mg and maximum 400mg.
The more formulations we offer, the greater the patient acceptability and the higher the retention rates will be. Some side effects are due to the formulation while others may be due to the methadone itself. Hence in a perfect world we need to offer LAAM, buprenorphine, long acting morphine or other drugs for difficult cases. Some would even add prescribed heroin to the list as happens now in Switzerland.
I hope this information is useful.
--Dr. Andrew Byrne
The Following are some common formulations of methadone:Methadone powder (to be mixed with water), white tablets (5 mg and 10 mg, also 40 mg), orange Diskettes (40 mg), cherry or other-flavored methadose, and clear liquid methadone. Another patient wrote in to our "Dear Doctor" column asking about a "methadone patch"; we're waiting for the responses from our physicians and will print the information in a future issue.
Editor's Note: Regarding different formulations of methadone, the following quote is from the federal regulations -- FDA Regulations, §291.505, under (6)(iii) Form:"Methadone may be administered or dispensed in oral form only when used in a treatment program. Hospitalized patients under care for a medical or surgical condition are permitted to receive methadone in parenteral form when the attending physician judges it advisable. Although tablet, syrup concentrate, or other formulations may be distributed to the program, all oral medication is required to be administered or dispensed in a liquid formulation. The oral dosage form is required to be formulated in such a way as to reduce its potential for parenteral abuse. Take-home medication is required to be labeled with the treatment center's name, address, and telephone number and must be packaged in special packaging as required by 16 CFR 1700.14 in accordance with the Poison Prevention Packaging Act . . .to reduce the chances of accidental ingestion. Exceptions may be granted when these provisions conflict with State law with regard to the administering or dispensing of drugs."
Be aware that regulations may differ State to State. For example, the following is written in Michigan's state regs:
Under R325.14415, Take-home medication, 415(1):"Take-home medication shall be formulated in such a way as to minimize parenteral abuse and shall be packaged pursuant to section 3 of the poison prevention packaging act, 15 U.S.C. §1472."
Under R325.14416, Take-home methadone, 416(1):"...take-home methadone shall only be dispensed in an oral, liquid form so as to minimize its potential for abuse."
And, in 416(2):"It is recommended practice that this liquid vehicle be non-sweetened and contain a preservative so that a client can be instructed to keep take-home methadone out of the refrigerator in an attempt to minimize the likelihood of accidental overdoses by children and fermentation of the vehicle.
I'd like to know if you think it's absolutely necessary to tell a dentist or oral surgeon that a patient is on methadone. In my experience over the years, I find the doctor AND dentists are super reluctant to give me any kind of pain medication once I've told them I'm a methadone patient. I plan on going to a new dentist, and I don't see any reason to tell this lady about the methadone, do you? -MG
If there is any chance of the dentist or doctor giving "systemic" drugs (e.g. tablets or injections but not "local" anesthetics) then you should certainly reveal your other medications, including methadone. Certain pain killers contain partial opioid antagonists—pentazocine is an example—and these will cause immediate severe withdrawals in patients on methadone.
So you have to make another balanced decision, as elsewhere in
life. Do you risk the potential problems knowing that there may also
be adverse consequences in revealing that you are on methadone?
Top of Page
Schaffer Library of Drug Policy
Major Studies of Drug and Drug Policy
Marihuana, A Signal of Misunderstanding - The Report of the US National Commission on Marihuana and Drug Abuse
Licit and Illicit Drugs
Short History of the Marijuana Laws
The Drug Hang-Up
Congressional Transcripts of the Hearings for the Marihuana Tax Act of 1937
Frequently Asked Questions About Drugs
Basic Facts About the Drug War
Charts and Graphs about Drugs
Information on Alcohol
Guide to Heroin - Frequently Asked Questions About Heroin
LSD, Mescaline, and Psychedelics
Drugs and Driving
Children and Drugs
Drug Abuse Treatment Resource List
American Society for Action on Pain
Let Us Pay Taxes
Marijuana Business News
Reefer Madness Collection
Medical Marijuana Throughout History
Drug Legalization Debate
Legal History of American Marijuana Prohibition
Marijuana, the First 12,000 Years
DEA Ruling on Medical Marijuana
Legal References on Drugs
GAO Documents on Drugs
Response to the Drug Enforcement Agency
|Drug Information Articles|
Taking a drug test:
How To Pass A Drug Test
Beat Drug Test
Pass Drug Test
Drug Screening Tests
Drug Addiction Treatment