Methadone maintenance is better than alternative

Q: Do you think methadone is safe for staying off of heroin or other narcotics? I have a friend who has been on it for a long time, has never gone back to using street drugs and has been successful in staying off all other drugs.

A: Methadone is a synthetic narcotic that has been used for more than 30 years as a treatment for heroin addiction. It works by "pre-empting" the effects of heroin, blocking its euphoric qualities while eliminating withdrawal symptoms and relieving the craving for the drug. Methadone works only for those addicted to heroin or other opiates - it won't help those hooked on cocaine or other drugs.

Over time, long-term use of methadone has proven more effective than short-term use. (Once they complete a short course of methadone, addicts tend to go back to heroin.) Although your friend is now addicted to methadone, long-term use of this drug is relatively safe, with no serious or long-term adverse side effects to the heart, lungs, liver, kidneys, bones, blood, brain or other vital organs. However, in November 2006, the FDA warned of serious, potentially fatal, side effects when methadone is taken too often, in too high doses or with certain other medications or supplements. Among those side effects: difficulty breathing; extreme drowsiness; fast, slow, pounding or irregular heartbeat; faintness; severe dizziness; or confusion. These dangers tend to occur among patients new to methadone treatment.

Taken in the correct doses, as instructed, the side effects of methadone are relatively minor and don't occur in everyone - these include constipation, water retention, drowsiness, skin rash, excessive sweating and changes in libido. The symptoms usually disappear once the dosage is adjusted and stabilized or tolerance for the drug increases. Methadone does not impair cognitive functions and has no adverse effects on mental capability, intelligence or the ability to hold a job. It isn't sedating or intoxicating and doesn't interfere with the ability to drive a car or operate machinery.

Withdrawing from methadone, if desired, should be supervised by a physician who probably will reduce the dose gradually. Those who stop taking the drug suddenly may experience withdrawal symptoms as unpleasant as withdrawal from heroin. If your friend is doing well on methadone maintenance, he or she probably can safely continue on it. It would be great to get off opiates entirely, but if the potential result is going back to heroin, methadone maintenance is certainly better.

Q: How much choline do we need? I've read most people don't get enough.

A: Choline is a micronutrient needed for nerve signaling, cholesterol transport, energy metabolism and maintenance of cell membranes. In the body, most choline is contained in phosphatidylcholine, a constituent of lecithin, which occurs in some fatty foods like egg yolks, and is also produced by the liver if the diet provides adequate amounts of choline. As an important component of cell membranes, lecithin is needed by every cell of the body. Without lecithin, liver metabolism is deranged, leading to "fatty liver" and, eventually, chronic liver failure. Choline also is a precursor for acetylcholine, a neurotransmitter vital to nerve and muscle function.

There is no RDA for choline. Instead, an "adequate intake" of 550 milligrams per day for men and 425 for women was set in 1998. However, recent research suggests that some people need more. A small study published in the May 2007 issue of the American Journal of Clinical Nutrition found that men and postmenopausal women may develop fatty liver even with "adequate" choline intake. The study included 26 men, 16 premenopausal women and 15 postmenopausal women, all of them healthy. For 10 days, the participants followed a diet that gave them the adequate intake of 550 milligrams of choline. For the next 42 days, their choline intake was cut to less than 50 mg daily. Some participants were randomly assigned to take a daily supplement of 400 mcg of folic acid.

By the study's end, 77 percent of the men, 80 percent of the postmenopausal women and 44 percent of the premenopausal women had developed fatty liver or muscle dysfunction. Some needed as much as 825 mg of choline daily to prevent or reverse their liver problems. The folic acid didn't protect against the effects of choline deficiency as previous evidence had suggested. What's more, even at the outset, when the men were getting 550 mg of choline, 23 percent developed signs of liver trouble.

The investigators concluded that men and postmenopausal women need more choline than today's "adequate intake."

Food sources of choline include egg yolks, beef liver, wheat germ, beef, soy foods, brussels sprouts, cod, salmon, broccoli, peanut butter and milk chocolate. Some multivitamins also provide choline.