Methadonia: myths about methadone

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Today a patient told me that he couldn't go on methadone because it "rots bones", which I later learned is a common belief among people addicted to heroin. I suppose that's something I should know considering where I work, but it'd never come up before. (For the record, methadone doesn't do anything to bones directly, though it does have abuse potential and people hooked on any random thing tend not to eat very well. That messes up bones).

After a while in a crowded hospital, addicts lose their their tragic glamour. Addicts, recovering or not, come in all flavors. Some of them are easy enough to treat, even pleasant, and others can make an entire medical team contemplate taking some chemicals themselves. Just like any other old patient cycling through a hospital.

I wish I could say there's no stigma attached to addiction in hospitals, but that would be an absurd lie. It's just that the stigma gets routine, no different than the groaning that goes on whenever a hypochondriac refuses to leave the hospital after their medical condition has more-or-less resolved. We're only human, after all. There's only so many times you can argue with a endocarditis patient who wants to leave the hospital against medical advice to get high before you get jaded towards people who don't deserve it.

Today's drama prompted a mention of Methadonia, a documentary that follows several patients in a support group for recovering opiate addicts.
I'm not sure how I feel about this one. It didn't teach me anything that I didn't already know. There's very little support for recovering addicts. It's extremely difficult to stop taking opiates. Opiate withdrawal, while not life-threatening in most circumstances, is extremely unpleasant. People take benzodiazepines to get a better methadone high. Higher and higher doses of methadone are being prescribed. Of course, I'm in my last year of medical school, so this might not be as common knowledge as I think.

There was a point where a recovering addict was trying to go off methadone and for some reason the documentary made it sound like the man couldn't go to a hospital until he hit an arbitrary methadone dose (60 mg, if I remember correctly). I'm not sure where that particular "plot point" came from. There's no arbitrary dose that a patient must reach before they can go to a hospital. That's not to say that he would've been admitted to a hospital for management of withdrawal symptoms, especially if he didn't have insurance, but he definitely could've gone to an ER for stabilization. He most definitely would've been entitled to treatment the instant he started feeling suicidal. Though I have to admit, again, that it's not difficult to imagine why he still refused to go to a hospital. The film just did a very bad job of explaining the issue.

The film isn't particularly well-edited. I had to push through parts of it, mostly because I felt like I owed it to the patients to see their entire stories since I sat down to watch it (odd feeling, I know, but there it is). I'm not sure why the director picked the exact same clips he picked. This might sound callous, but I've heard all the patients' stories before, more than once. Perhaps that's the point. Most people might be surprised to hear that a sweet, elderly addict trying to kick the habit in his golden years got kicked out of the program because he came in high one day and pulled out a knife on another patient.

On a more positive note, this documentary offered a few tidbits about addiction . . . culture, for lack of a better word, that I didn't know before. I didn't know that some many addicts believe that methadone is no better than heroin itself, and that some consider it worse. I'd never heard the word "methadonian" before, or the phrase "liquid shackles". That's a useful bit of info to have.