Methadone for Cancer Pain

Dr. Weeks’ Comment: Would you throw a lead lifejacket to a drowning man?

I hope not.

Would you recommend an immunosuppressive pain medication to a person dying of the immune disorder commonly referred to as “cancer”?  

I hope not. 

However, doing just that is  the standard of care?  

Here is the bizarre fact:     Opiates, which suppress immune function in humans,  are the primary pain medication used for cancer pain and while helping pain, this medication weaken the life support system called your immune system.  Palliative care (“comfort care”) is one thing, but if you want to live and have notgiven up, ask your oncologist to give you a different medication for your pain such as, perhaps, methadone which acts like opiates except for 3 things: 1) methadone doesn’t lessen the immune function; 2) methadone is not damaging to the liver;  3) methadone has been shown to  “significantly inhibit the in vitro and in vivo growth of human lung cancer cells”.   Curious?  Search the internet for  “methadone” and “opiate” and “immune function”.

#1

Twelve Reasons for Considering Buprenorphine as a Frontline Analgesic in the Management of Pain.

Davis MP.    J Support Oncol. 2012 Jul 16. [Epub ahead of print]

Buprenorphine is an opioid that has a complex and unique pharmacology which provides some advantages over other potent mu agonists. We review 12 reasons for considering buprenorphine as a frontline analgesic for moderate to severe pain:     (1) Buprenorphine is effective in cancer pain;     (2) buprenorphine is effective in treating neuropathic pain; (3) buprenorphine treats a broader array of pain phenotypes than do certain potent mu agonists, is associated with less analgesic tolerance, and can be combined with other mu agonists;    (4) buprenorphine produces less constipation than do certain other potent mu agonists, and does not adversely affect the sphincter of Oddi;     (5) buprenorphine has a ceiling effect on respiratory depression but not analgesia;     (6) buprenorphine causes less cognitive impairment than do certain other opioids;      (7) buprenorphine is not immunosuppressive like morphine and fentanyl;     (8) buprenorphine does not adversely affect the hypothalamic-pituitary-adrenal axis or cause hypogonadism;     (9) buprenorphine does not significantly prolong the QTc interval, and is associated with less sudden death than is methadone;      (10) buprenorphine is a safe and effective analgesic for the elderly;       (11) buprenorphine is one of the safest opioids to use in patients in renal failure and those on dialysis; and       (12)withdrawal symptoms are milder and drug dependence is less with buprenorphine. In light of evidence for efficacy, safety, versatility, and cost, buprenorphine should be considered as a first-line analgesic.

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#2

Methadone HIV Infection and Immune Function  by Herman Joseph

 

….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….

 

Source  http://www.methadone.org/namadocuments/es04hiv_immune_function.html

 

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#3

The effects of methadone on immune function among injecting drug users: a review

COLIN McLACHLAN1, NICK CROFTS2,*, ALEX WODAK3, SUZANNE CROWE4

Abstract

Methadone maintenance therapy is advocated as a major preventive strategy for the spread of the human immunodeficiency virus (HIV) and other blood-borne infectious agents among injecting drug users (IDUs) because of its effects in decreasing the frequency of injecting and presumably sharing of equipment. As an opioid agonist, methadone may share the direct and indirect immunoregulatory effects of other opioids, and thus affect susceptibility to, and the natural history of, HIV infection. Available evidence pertaining to methadone and immune function is reviewed. The long-term immunosuppression observed in heroin injectors on present (incomplete) evidence appears to be caused by factors associated with a drug-using lifestyle rather than by a direct action of heroin. Although data are conflicting, it is most likely that methadone does not significantly impair immune function and is safe for HIV-infected IDUs, possibly even allowing some improvement of immune function to occur. The increasing reliance placed on methadone maintenance to control the epidemic of HIV infection in IDUs requires that remaining uncertainties regarding methadone and immune function are clarified urgently.

Source:  http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1993.tb00809.x/abstract

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#4

Methadone is Safe for Liver

Since the start of using methadone to treat patients with addiction, suspicion has circulated that the methadone-maintenance treatment would cause damage to various internal organs, including the liver. However, the commonly used daily oral doses of methadone for the purpose of preventing withdrawal symptoms are safe. Methadone has been shown to be nontoxic to the liver, according to a study led by D.M. Novick, published in “Alcoholism: Clinical and Experimental Research.” Reported side effects include sweating, constipation, sexual dysfunction and sleep irregularities. These side effects are mild and transient, often disappearing without medical

SOURCE  http://www.livestrong.com/article/274591-effects-of-methadone-on-the-liver/#ixzz25Lytovqy

http://www.livestrong.com/article/274591-effects-of-methadone-on-the-liver/

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 #5

Nonconventional opioid binding sites mediate growth inhibitory effects of methadone on human lung cancer cells

Author: R Maneckjee and J D Minna  National Cancer Institute-Navy Medical Oncology Branch, National Cancer Institute, Bethesda, MD 20889.

 

Abstract

Methadone was found to significantly inhibit the in vitro and in vivo growth of human lung cancer cells. The in vitro growth inhibition (occurring at 1-100 nM methadone) was associated with changes in cell morphology and viability detectable within 1 hr and was irreversible after a 24-hr exposure to the drug. These effects of methadone could be reversed in the first 6 hr by naltrexone, actinomycin D, and cycloheximide, suggesting involvement of opioid-like receptors and the requirement for de novo mRNA and protein synthesis. The inhibitory effects of methadone on the growth of lung cancer cells also could be achieved by the less addictive (+) isomer of methadone. Characterization of the methadone binding to lung cancer cell membranes revealed high-affinity (nM), saturable binding sites for (+/-)-[3H]methadone, which cross-reacted with ligands for kappa, phencyclidine, sigma, but not mu, and delta opioid receptors, and the binding characteristics appeared to be different from methadone sites present in rat brain. Methadone decreases cAMP levels in lung cancer cells, but the receptors are not coupled to a pertussis toxin-sensitive guanine nucleotide-binding regulatory protein. We conclude that the lung cancer growth inhibitory effects of methadone are significant, occur at low concentrations, and are mediated by a nonconventional type of opioid binding site distinct from methadone receptors found in the brain.

 

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Dr. Weeks’ Comment: Would you throw a lead lifejacket to a drowning man? I hope not. Would you recommend an immunosuppressive pain medication to a person dying of the immune disorder commonly referred to as “cancer”?   I hope not.  However, doing just that is  the standard of care?   Here is the bizarre fact:  …
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