Discontinuing Methadone While Still Occasionally using Cocaine

I have a number of patients who are still using cocaine, but are otherwise doing very well in the methadone program. Many of them do not consider the cocaine use to be of any concern, because they ‘only use it once a week,’ or ‘once in a while.’ Even though you may feel that occasional use of cocaine is not a concern, it can be, for reasons I will discuss.

There have been studies done in this area. It seems that people who have conquered their opiate (heroin, OxyContin, etc) addiction, who discontinue methadone while still using cocaine, tend to relapse back onto opiates 80% of the time within the first eight months (reference pending).

This is quite a high relapse rate. Most of the people I have spoken to about this issue have stated that ‘this won’t happen to me.’ Although some of these patients will be correct, 80% will not.

I’m not sure why this relapse onto opiates occurs. The study does not address this. It is possible that if someone is still using cocaine it means that the person is still associating with people using hard drugs. This association in itself is a risk factor for relapse.

Another possibility it that people who still use cocaine occasionally may at some point be presented with an alternative that is not cocaine. They may feel, at the time, that ‘just once’ would be safe. This can then lead to kindling of a prior addiction, and can result in full-blown relapse.

If you fall into this category, and have conquered your opiate addiction, then congratulations. That is fantastic. If you are still using cocaine or crack, and feel that this is not a problem for you, please re-examine your point of view. If you relapse, think of all the hard work that you’ve already done that you will have to do again.

That being said, if you do relapse, don’t wait too long before coming back to the methadone program. You should come in the day after you used, before it turns into a full-blown relapse. Better yet, come in if your are just thinking of using. If you come in early enough, you may not need to go back onto methadone. Simply attending the clinic, and talking with your doctor, can prevent a full-blown relapse.

 

UPDATE

I have come across some information that may explain what I am saying above.

Some people have said that when they use cocaine, they get anxious or jittery.  They use some sort of opiate (like a perc) to get rid of this.  Some people even say that is how they started with opiates and then ended up on the methadone program.  It seems, on methadone, they do not need the extra opiate, since the methadone “does the job.”  So, it makes sense that if you stop methadone but continue to use cocaine, the jitters will return, and the temptation will be to use an opiate to get rid of it.  Then it is only a matter of time before you get back onto methadone again.  Does this make sense to you?

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