Methadone Clinic Proposal Approved

[Nadia]

In order to avoid confusion and misunderstanding I feel it is important to post the following information. I apologize for it's length but it is difficult to explain without using examples:

Oxycodone and Oxycontin, although similar are two different drugs.

Oxycodone is an opioid narcotic analgesic used to relieve moderate to severe pain. It is an immediate release drug and does not contain any Acetomenophen or Ibuprofen. When you combine Oxycodone with Acetomenophen you get the drug Percocet. Percocet is a trade name. It is sold under the generic names: Roxicodone, Endocet, or Oxycodone w/APAP. When you combine Oxycodone with Ibuprofen you get the drug Combunox. This again is a trade name. This is a fairly new drug and I am unsure of the generic names. When you combine Oxycodone with Aspirin the drug Percodan is made. All formulations typically have a 4-6 hour window of "relief" in the body, and all formulations of this drug are considered "short" term pain releivers.

Oxycontin is an opioid narcotic analgesic used to releive severe pain. It is a time released version of Oxycodone. It does not contain any Acetomenophen or Ibuprofen. There are no generic versions of Oxycontin. This drug is considered a "long" term pain reliever and typically has a window of 12 hours of releif in the body. Oxycontin has a very high potential for abuse as we all know. The problem occurs when users crush the pill, and then inject, inhale or swallow the crushed pill. The immediate release feature of the drug is destroyed and a copious amount of medication is released into the blood stream immediately.

Hydrocodone w/APAP is a generic version of Vicodin. It is a combination of Hydrocodone Bitartrate and Acetomenophen. When Hydrocodone Bitartrate is combined with Ibuprofen, the drug Vicoprofen is made. I do not believe there is a generic version of Vicoprofen. There are other formulations of Hydrocodone Bitartrate and Acetomenophen known as Lortab and Zydone. A lower dose of Acetomenophen is used. Vicodin ES is also a controlled release version of Hydrocodone w/APAP. All formulations are narcotic opioid analgesics used for releif of "short" term pain and typically have a window of 4-6 hours, with the exception of Vicodin ES which is typically used 2-4 times per day.

All of these drugs can be compared to heroin in one form or another because they are all derivatives of opium, hence the term "opioid". Heroin is also derived from opium and is closest in form to the drug Morphine. All of these drugs have similar side effects and can cause a certain degree of impairment, although there are many circumstances to consider. Tolerance is the main circumstance to consider. After taking these drugs for a certain amount of time the body becomes dependant and must use more of the drug to get the same amount of pain releif. Physical addiction occurs regardless of whether the drug is taken as prescribed, or is taken in double or triple doses. However, tolerance builds much faster when the dose is doubled or tripled (abused), or the drug is delivered by methods other then orally (inhaled/snorted, injected, chewed).

An individual on daily Methadone Maintenence has built a tolerance to their dosage. The same goes for a person taking pain medication. They may have experienced side effects at first, however once tolerance is built, side effects tend to diminish. Judgement is rarely impaired by those who are tolerant to their doses. During the first two weeks when they are being stabilized, withdrawal may be present and may slightly impair judgement, but not the Methadone itself. This can be very tricky to understand. Put it this way. Let's say someone is abusing Oxycontin. They are taking 4, 80 mg tablets per day via inhalation or "snorting". They have done this for a year, every day. What they have done is built themselves an enormous tolerance. If they do not use Oxycontin within 12 hours they rapidly become ill. A manifestation of numerous physical and emotional symptoms crop up like SA Meredith said, make you wish you were dead. They decide to go to get help and get on Methadone. Methadone clinics must abide by certain laws. They cannot give someone a dose larger then 35 mg on their first day, or increase doses in increments larger then 10 mg every two days. The persons physical symptoms are evaluated and they are given a dose of 20 mg's of Methadone. They are only permitted to raise their dose every two days, by ten milligrams. To stop the symptoms of withdrawal for a person with that habit I would make an educated guess that 120 mg's of Methadone would just barely cut it. You can imagine how long it will take for them to get to that level. During this time period I would suggest that they may be slightly impaired due to withdrawal, not the Methadone itself. The person already has a high tolerance and would not become impaired until the dose of Methadone got high enough to overpower the amount of Oxycontin they were abusing prior. I know this is difficult to follow, but I hope that explains things a bit. Now, if one of us were to walk into the clinic and get a dose of 120 mgs, if we didn't die first, our judgement would be so impaired we would not even know where we were.

[sa meredith]

Originally Posted by Nadia

In order to avoid confusion and misunderstanding I feel it is important to post the following information. I apologize for it's length but it is difficult to explain without using examples:

Oxycodone and Oxycontin, although similar are two different drugs.

Oxycodone is an opioid narcotic analgesic used to relieve moderate to severe pain. It is an immediate release drug and does not contain any Acetomenophen or Ibuprofen. When you combine Oxycodone with Acetomenophen you get the drug Percocet. Percocet is a trade name. It is sold under the generic names: Roxicodone, Endocet, or Oxycodone w/APAP. When you combine Oxycodone with Ibuprofen you get the drug Combunox. This again is a trade name. This is a fairly new drug and I am unsure of the generic names. When you combine Oxycodone with Aspirin the drug Percodan is made. All formulations typically have a 4-6 hour window of "relief" in the body, and all formulations of this drug are considered "short" term pain releivers.

Oxycontin is an opioid narcotic analgesic used to releive severe pain. It is a time released version of Oxycodone. It does not contain any Acetomenophen or Ibuprofen. There are no generic versions of Oxycontin. This drug is considered a "long" term pain reliever and typically has a window of 12 hours of releif in the body. Oxycontin has a very high potential for abuse as we all know. The problem occurs when users crush the pill, and then inject, inhale or swallow the crushed pill. The immediate release feature of the drug is destroyed and a copious amount of medication is released into the blood stream immediately.

Hydrocodone w/APAP is a generic version of Vicodin. It is a combination of Hydrocodone Bitartrate and Acetomenophen. When Hydrocodone Bitartrate is combined with Ibuprofen, the drug Vicoprofen is made. I do not believe there is a generic version of Vicoprofen. There are other formulations of Hydrocodone Bitartrate and Acetomenophen known as Lortab and Zydone. A lower dose of Acetomenophen is used. Vicodin ES is also a controlled release version of Hydrocodone w/APAP. All formulations are narcotic opioid analgesics used for releif of "short" term pain and typically have a window of 4-6 hours, with the exception of Vicodin ES which is typically used 2-4 times per day.

All of these drugs can be compared to heroin in one form or another because they are all derivatives of opium, hence the term "opioid". Heroin is also derived from opium and is closest in form to the drug Morphine. All of these drugs have similar side effects and can cause a certain degree of impairment, although there are many circumstances to consider. Tolerance is the main circumstance to consider. After taking these drugs for a certain amount of time the body becomes dependant and must use more of the drug to get the same amount of pain releif. Physical addiction occurs regardless of whether the drug is taken as prescribed, or is taken in double or triple doses. However, tolerance builds much faster when the dose is doubled or tripled (abused), or the drug is delivered by methods other then orally (inhaled/snorted, injected, chewed).

An individual on daily Methadone Maintenence has built a tolerance to their dosage. The same goes for a person taking pain medication. They may have experienced side effects at first, however once tolerance is built, side effects tend to diminish. Judgement is rarely impaired by those who are tolerant to their doses. During the first two weeks when they are being stabilized, withdrawal may be present and may slightly impair judgement, but not the Methadone itself. This can be very tricky to understand. Put it this way. Let's say someone is abusing Oxycontin. They are taking 4, 80 mg tablets per day via inhalation or "snorting". They have done this for a year, every day. What they have done is built themselves an enormous tolerance. If they do not use Oxycontin within 12 hours they rapidly become ill. A manifestation of numerous physical and emotional symptoms crop up like SA Meredith said, make you wish you were dead. They decide to go to get help and get on Methadone. Methadone clinics must abide by certain laws. They cannot give someone a dose larger then 35 mg on their first day, or increase doses in increments larger then 10 mg every two days. The persons physical symptoms are evaluated and they are given a dose of 20 mg's of Methadone. They are only permitted to raise their dose every two days, by ten milligrams. To stop the symptoms of withdrawal for a person with that habit I would make an educated guess that 120 mg's of Methadone would just barely cut it. You can imagine how long it will take for them to get to that level. During this time period I would suggest that they may be slightly impaired due to withdrawal, not the Methadone itself. The person already has a high tolerance and would not become impaired until the dose of Methadone got high enough to overpower the amount of Oxycontin they were abusing prior. I know this is difficult to follow, but I hope that explains things a bit. Now, if one of us were to walk into the clinic and get a dose of 120 mgs, if we didn't die first, our judgement would be so impaired we would not even know where we were.

good explanation here....although I cringe at your example...."4, 80's per day for a year". Whew! Now that's a problem. And an expensive one. ($1200/$1500 plus, per week, street price)
Remember also, just about all abusers remove (or crush) the "time release" part of the oxy tablet, making the "buzz" instant and potent.
Awful, awful stuff...

[Nadia]

Originally Posted by sa meredith

good explanation here....although I cringe at your example...."4, 80's per day for a year". Whew! Now that's a problem. And an expensive one.($1200/$1500 plus, per week, street price)
Remember also, just about all abusers remove (or crush) the "time release" part of the oxy tablet, making the "buzz" instant and potent.
Awful, awful stuff...

Ha ha I hear you. That was a pricey example, but we both know it happens. Especially when the medication is prescribed. Like I've said before, I work as a Pharmacy Technician part-time, monthly prescriptions for 120, 80mg Oxycontin's are not uncommon. Furthermore, with the exception of one of my Uncle's, I have never met anyone who uses their Oxycontin as prescribed. It's always abused or diverted. People with prescriptions like the one I mentioned above who are on Medicaid for example, pay $2.00 for that prescription. It has a potential street value of nearly $10,000!!! That's living the high life!!

When my Mother first purchased an 8 unit apartment building in downtown Laconia, I moved into one of the units with my husband and managed the building for her. The former landlord warned her that some of the tenants were problematic and disruptive. Come to find out one of the tenants was selling her prescribed Oxycontin. I started to catch on after living there for less than a week. At about 4 pm the traffic would start, up and down the stairs, in and out. Doors slamming, wheels squealing, people yelling. She was not quiet about it either. She did not realize I was outside one day when she opened the window and yelled out to a customer I presume..."I only have two left dude". Her rent was always paid, even ahead sometimes. Her apartment was furnished beautifully, she wore designer clothing, and drove a fairly new Nissan Maxima. Hard to imagine considering she was unemployed? Sooner or later she was evicted, and from over-hearing conversations on the porch I found out who her Doctor was. I placed a call to her as well. This girl was making a better living then I do off a bottle of pills...

[Nadia]

Thank you Ironhorsetim for creating the poll on whether or not the Laconia Methadone Clinic should be allowed to operate in O'Shea Industrial Park. Here are the results:

There were a total of 69 voters

26.09% of people voted yes to the question (18 people)
73.91% of people voted no to the question (51 people)

Thank you IHT and to all of those who voted