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Metadon

28.08.2010 | Sekce: Harm Reduction

Vyšlo v Dekontaminaci - říjen 2000

 

Článek popisuje látku metadon, která se používá v substituční terapii závislosti na opioidech. Věnuje se historii této látky, účinkům a výhodám užívání metadonu oproti např. heroinu. Zmiňuje i kombinace metadonu s jinými návykovými látkami a jejich následky.

Metadon (Methadoni hydrochloridum) je syntetický opiát. Je to bílý krystalický prášek výrazně hořké chuti, dobře rozpustný ve vodě. Poprvé byl syntetizován v Německu v roce 1940. Po válce se zjistilo, že má analgetické (tlumivé) účinky podobně jako morfin a může v závislosti na dávce vyvolat euforii i útlum.

Jeho farmakologické vlastnosti byly později využívány při léčbě závislosti na opiátech, původně při zvládání abstinenčního syndromu a od druhé poloviny 60. let při tzv. udržovací léčbě.

Metadon je jako každý opiát návykový. Je přibližně dvakrát silnější než morfin a má dlouhodobý účinek. Dávka kolem 50 mg (tedy nižší dávka, než se podává při běžné substituci) může být pro člověka bez zvýšené tolerance k opiátům smrtelná. Výhodou metadonu je, že ho lze užívat perorálně, tedy pít. Roztok se pro potřeby substitučních programů sladí a často i barví. Pokud je metadon podán v adekvátní dávce, účinkuje 24 hodin i déle. Znamená to, že jediná dávka stačí na celý den, aniž by se u dlouhodobě závislých na heroinu objevily abstinenční příznaky. To je jeden z důvodů jeho využívání v substituční léčbě.

Tolerance na metadon se nezvyšuje, takže není třeba neustále zvyšovat dávky. Při udržovací léčbě musí být všechny dávky určeny individuálně z důvodu rozdílů v metabolismu, tělesné váze a udržování náležitých hladin metadonu v krvi během 24 hodin. Další výhodou metadonu je, že zmírňuje neustálou touhu neboli „bažení" po heroinu. Dále blokuje účinek krátce účinkujících opiátů (heroinu), tudíž užití běžné dávky heroinu nebo jiného opiátu nepřinese očekávaný efekt. To ale zvyšuje riziko předávkování - kdo si mermomocí na metadonu chce „užít" jiný opiát, musí přitvrdit v dávkování a to může být naposled. Současné užívání metadonu a ostatních opiátů je tedy nejen nežádoucí z hlediska cílů substituční léčby, ale také nebezpečné. Kombinování drog a zejména konzumace metadonu v kombinaci s některou z tvrdých drog, obvykle heroinem a kokainem, je údajně hlavním důvodem, proč v loňském roce zemřelo v Německu na následky užívání drog nejvíce osob od roku 1992. Velmi nebezpečná je také kombinace metadonu s alkoholem, protože tyto látky navzájem posilují svůj tlumivý efekt, což může skončit i smrtí, aniž byla užita smrtelná dávka jednoho z nich. Při užívání metadonu se tedy vyplatí dodržovat základní pravidla substitučních programů.

 

Daniel Tlamka

 

Metadon Metadon 24,00 kB

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