Sustitución de la heroína por metadona

¿Qué es la adicción a la heroína?

If you are addicted to heroin it means that you develop withdrawal symptoms within a day or so of the last dose. These symptoms are listed in the separate leaflet called Medicines for Drug Dependence. If you are addicted to heroin, you need a regular dose to feel 'normal'.

Selección de pacientes Información sobre medicamentos

Tratamiento y medicación

Should you worry about steroids and their side effects?

Steroids have had a bad press over the years - a combination of their side effects and misuse of anabolic steroids by bodybuilders. But we actually make steroids in our own bodies - and used as your doctor recommends, they can be effective and safe.

por la Dra. Sarah Jarvis MBE, FRCGP

Tratamiento y medicación

Recetas gratuitas o a precio reducido

Some people automatically get free prescriptions. Certain people can get an exemption certificate to obtain free prescriptions. Also, anyone needing regular prescriptions may save money by buying a Prescription Prepayment Certificate. Note: this leaflet only applies to England because prescriptions are free to all in Northern Ireland, Scotland and Wales. It also only gives a brief summary of free or reduced cost prescriptions and is for guidance only. It is not a full statement of the law and a source of further, more detailed information is given at the end under Further Reading.

por la Dra. Philippa Vincent, MRCGP

What is methadone?

Methadone is a drug that is similar to heroin, although it lasts a lot longer in the body. It can be prescribed. If you take methadone, you are unlikely to develop withdrawal symptoms if you stop heroin (or the withdrawal symptoms are much less severe). If you take methadone under supervision from a doctor instead of street heroin, you are:

• Más posibilidades de alejarse de la "escena de la droga" callejera.

• Es probable que te sientas mejor contigo mismo.

• Más probabilidades de dejar las drogas para siempre.

Who prescribes methadone, and when?

A typical plan

Most GPs will refer you to a community drug team to be assessed. Following assessment, a member of the community drug team will usually contact your GP quite quickly to recommend a dose of methadone and a plan for follow-up. Some GPs who are specially trained may assess some cases and prescribe without the need for referral.

Evaluación

This usually includes:

• Tomar datos sobre su salud y su situación social.

• Taking details of your past and current drug taking and whether methadone is needed or appropriate.

• Un examen.

• Un análisis de orina (o un frotis bucal) para confirmar las drogas que está tomando.

• Una evaluación de lo que cree que necesita en este momento.

Si te has inyectado drogas como la heroína, también es frecuente que te lo aconsejen:

• Un análisis de sangre que incluye la detección del VIH, el control de la salud del hígado (pruebas de la función hepática) y la detección de la hepatitis B y la hepatitis C.

• Vacunación contra la hepatitis A, la hepatitis B y el tétanos (si no se ha vacunado previamente).

• Si procede, inmunización contra la hepatitis B para su pareja y sus hijos.

• Sobre los peligros de inyectarse, sobre los peligros de utilizar agujas y jeringuillas compartidas y sobre otras formas de reducir los daños para uno mismo.

Starting off with methadone

Methadone is usually started some time after assessment when the results of the urine test are back. An initial dose is chosen. The aim is to prevent withdrawal symptoms. However, methadone can cause serious harm, or death, in overdose. Therefore, at first your doctor will prescribe a low-ish dose to 'play safe' and see you frequently to adjust the dose. Be patient, this early stage is very important. The initial dose is usually gradually increased to a regular maintenance dose. But note:

• Methadone takes 2-4 hours to reach its peak effect level in the blood. However, the time it takes to produce its maximum effect can vary from person to person.

• Methadone accumulates in your body. So, you will feel a greater effect of the drug over a few days even without increasing the dose.

• It may take a few weeks to get to the correct dose which prevents all withdrawal symptoms.

Try to accept that you may have some, or partial, withdrawal symptoms until the correct dose is found. The correct dose varies from person to person, depending on how much heroin you were using and how your body deals with (metabolises) the methadone. You should not take any street drugs or much alcohol when you are on methadone.

Mantenimiento y desintoxicación

Once established on a regular dose, most people stay on methadone for a long time or even long-term. This is called maintenance and helps you to keep off street drugs. Some people gradually reduce the dose and come off it. This is called detoxification, or 'detox'. However, it usually takes months and sometimes years before most people are ready to consider 'detox'. It is often safer to stay on methadone than to 'detox' before you are ready.

Taking methadone

Methadone is usually prescribed as a once-daily dose in liquid form. You will usually be asked to take it under the supervision of the pharmacist who dispenses the methadone to you. This means there can be no doubt about how much methadone you take at each dose. This supervision may be relaxed after a few months of you taking a regular maintenance dose.

Important note: it is essential that you take the methadone regularly. If you miss three or more daily doses your body may lose its ability to break down the drug (tolerance). You can still continue with the withdrawal programme but you may need to start again with a lower dose.

Some other points about taking methadone

• You are more likely to succeed in staying off heroin if you have support and counselling during this difficult time. This may be from a local drug community team (or similar). Self-help groups or other agencies may also be of help. It is much harder to 'do it alone' - so do go for counselling and help if it is available in your area.

• Some prescribed medicines may interfere with methadone - for example, some used to treat tuberculosis (TB) and epilepsy. Tell the doctor who prescribes methadone if you are taking any other medicines. However, most prescribed medicines can be taken in the normal way.

• Other street drugs, such as benzodiazepines ('benzos'), and alcohol, can affect methadone. It is best not to take any other drugs and not to drink too much alcohol.

• You will be asked to give a urine sample from time to time by your doctor.

• Driving. If you use heroin, methadone or similar drugs, you should tell the DVLA. You are likely to be banned from driving. However, if you are on a supervised methadone programme, you may be allowed to drive again subject to an annual medical review.

• Pregnancy. If you become pregnant you should not suddenly stop your methadone withdrawal programme. It is riskier to stop methadone suddenly in the first three months of pregnancy than to continue on your regular dose. Many women choose to withdraw from methadone during pregnancy and this is best done during the third to sixth month of pregnancy (the 'second trimester'). Your doctor will advise.

• Keep methadone and any other drugs out of reach of children.