Methadone, HIV Infection and
Immune Function by Herman Joseph
Studies undertaken over the past two decades, primarily by Dr. Mary Jeanne Kreek of The Rockefeller University, and corroborated by other scientists throughout the world have established the long-term medical safety of methadone maintenance treatment (Kreek, 1992; Kreek, 1987; Kreek, 1986; Kreek, 1978; Kreek, 1973; Kreek et al, 1972; Novick, Richman, Friedman et al, 1993). There are no toxic effects, somatic damage or functional deficits associated with or attributable to methadone for patients who are stabilized at appropriate doses including those receiving over 100 mgs/day, who are not heavily abusing other drugs (e.g., alcohol and cocaine), and who have remained in continuous treatment for up to 18 years.
There are minimal non-toxic side effects, such as constipation, that can be treated; excessive sweating that in most cases subsides over time; and decreased libido and, in some males, delayed orgasm that normalizes within the first few months of treatment or with dose adjustment (Kreek, 1978; Kreek, 1973).
Methadone does not get into or rot the bones. Patients complaining of muscular aches are usually experiencing the initial symptoms of the abstinence syndrome and probably need a dose adjustment. Another common myth about methadone and health is that it rots the teeth. However, the dental problems experienced by the majority of methadone patients is a result of their years of using heroin and poor health. Most heroin addicts do not make visits to their dentist every 6 months as one should and eventually the lack of care will catch up with them. No other medication has received the scrutiny and evaluations that methadone has which continue up to this day. The major impact of methadone treatment on the health of addicts is that it brings them from poor to good health (Novick, Joseph & Croxson et al, 1990).
The pharmacology of methadone, a long acting synthetic opiate of 24 to 36 hours, at adequate doses results in a daily steady state of blood plasma levels, as compared to the interrupted on-off effects of short acting narcotics such as heroin. Heroin, a short acting opiate of four to six hours, can produce a deranged physiology impairing the endocrine and immune systems, gastrointestinal functioning, reproduction, homeostasis and the general biology (Dole, 1988; Himmelsbach, 1968; Martin, Wilker & Eades, 1963). The steady state of blood plasma levels produced by an adequate daily dose of methadone normalizes the deranged physiological functioning of the endocrine and immune systems induced by heroin addiction (Dole, 1988).
Immune Functioning and Methadone
Many physicians or medical professionals incorrectly believe that methadone inhibits the immune system and functioning. While this is true of all opioids, and especially the short acting opiates it is not true of methadone. And in fact, methadone is the only opioid that does not inhibit the immune system or functioning. This is an important characteristic of methadone when considering its impact on HIV+ methadone patients. But methadone does not only not inhibit the immune system--it restores immune functioning.
The potential for normalization of endocrine and immune functioning is especially crucial when treating HIV positive methadone patients. The evidence of immune restoration from HIV negative methadone patients hints that there may be a partial restoration of immune functioning for HIV positive methadone patients (Kreek, 1988). While this is not proven, there are many other advantages for HIV positive heroin users to be placed and maintained on methadone.
In Switzerland a three-year prospective study followed a group of HIV-infected methadone maintenance patients and a contrast group of HIV-infected heroin users who did not enter methadone maintenance treatment (Weber, Ledergerber, Opravil & Luthy, 1990). The results showed that a significantly lower proportion ofmethadone maintenance patients progressed to AIDS as compared with the untreated heroin users, 24 percent versus 41 percent, almost a-2 fold increase within the period of the study.
Methadone when prescribed as a maintenance medication functions as a normalizer for a deranged physiology and not as a mood altering narcotic substitute (Dole, Nyswander & Kreek, 1966; Joseph & Dole, 1970). Methadone maintenance, is therefore corrective but not curative.
Illicit Heroin Use and Immune Function
The continued use of heroin impacts negatively on the health of the user in many ways. Certainly, a primary effect is the unstable life of the heroin addict who does not eat properly or sleep normal. However, it must be emphasized that even the piercing of the skin, as during injection will effect the immune system. In addition the act of injecting illicit drugs are dirty and will adversely impact on the immune system. Injecting pills is no better because they contain buffers to hold the pill together and dies to color the pill--neither should be injected. Only sterile water should be used which can be purchased in a large drug store or medical supply store. Tap water contains bacteria which will also impact on the immune system and boiling water for short periods will not completely sterilize the water. If you cannot get sterile water then you could use distilled water which can be purchased at a drug store or boil tap water for a full 15 minutes. However, injecting will weaken the immune system and even if one only injects once in awhile each injection will begin to impact negatively on the immune system.
The Potential Mandate of Methadone Programs on HIV Infection
Methadone programs are placed in a unique position to monitor HIV and other infectious diseases and provide clinical prevention and intervention. For example, AZT can be administered as well as medications for drug-resistant TB. Most importantly, clinics can offer AIDS prevention, counseling and referrals for services that exist in the community. Special methadone clinics and programs can be developed that serve patients infected with HIV (e.g., St. Claire's MMTP, Beth Israel AIDS program on 125th Street). Unfortunately, most programs do not have the funding to provide these services to their patients and it is up to us to let our legislators know that these services are not only necessary in methadone programs, but it would be more efficacious to the health care system for methadone patients to be treated for conditions other than their addiction in methadone programs.
References
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