Methadone is a fully synthetic prescription opioid. It is a slow-acting drug that is currently used as a painkiller and in the treatment of addiction to opioids (such as heroin). It can be taken orally (tablet) or injected intravenously, depending on the situation. Methadone is available through prescription only.
Although people often prescribe it to combat opioid addiction, it has a high potential for abuse. The 2018 National Survey on Drug Use and Health found that almost a quarter (23.5%) of all the people who used methadone in the last year misused it at least once during that period; this represented around 256,000 Americans.
Methadone Used in Detox vs. Methadone maintenance
Methadone can be used to help someone detox from drugs such as heroin. Heroin is a short-acting opioid; therefore, the withdrawal symptoms appear quickly and can be quite severe. Using methadone can help delay those symptoms and make them less painful because of its long duration of action. When used to get someone through the detoxification process, doses are usually lowered throughout with the ultimate purpose of being completely drug-free. There are some risks of tolerance and dependence developing during this process, which is why methadone should be used for the shortest duration possible.
Methadone maintenance is the long-term administration of methadone to someone who is addicted to opioids. There are some debates about whether or not methadone maintenance is actually a real solution or just replacing one form of addiction with another. Because of the devastation caused by heroin abuse and addiction (high overdose rates, the spread of HIV because of intravenous abuse, etc.), methadone is the lesser of two evils as it aids curb many of the problems associated with opioid abuse. However, some will argue that the person is not drug-free. Given the evidence of physical tolerance and dependence that methadone brings about, people can make a case that this doesn't solve the addiction problem in the person, it just masks it.
Methadone vs. Buprenorphine
Buprenorphine (brand name Suboxone) is another drug used to treat opioid addiction. There are some key differences between the two. Buprenorphine acts in the same way by binding itself to opioid receptors in the brain but will have lesser effects since it is a partial opiate agonist (methadone is a full agonist). This means that it will cause less analgesia and euphoria than methadone will. This lowers the abuse potential and means that it might not be as effective if someone has very severe withdrawal symptoms. Another advantage is that after a certain point, a high quantity of the drug will not increase its effects, therefore decreasing the risks of overdose. The difference between the two drugs and which would be best during detoxification should be discussed with a medical professional.
History of methadone
Methadone was first developed in the 30s in Germany by a pharmaceutical conglomerate Interessengemeinschaft Farbenindustrie AG, commonly referred to as IG Farben. The need to create a synthetic opioid happened because of an opium shortage (the substance used to produce morphine). Clinical trials began that same year, but to the side effects observed, the substance's production remained very low throughout World War II, and it was not approved for commercial use. At the end of the war, the Allies took possession of all German patents and research records. The research done at IG Farben was reviewed by a U.S. Department of State committee. They were more optimistic about methadone and found that although there was a potential for addiction, the side effects (such as sedation and respiratory depression) were less severe than those produced by morphine.
Methadone was further studied in the United States and was approved by the Food and Drug Administration in 1947 for use as an analgesic and antitussive drug. The Council on Pharmacy and Chemistry of the American Medical Association gave the substance the generic name of "methadone." Eli Lilly introduced methadone in the U.S. under the trade name Dolophine that same year. It wasn't until 1972 that the FDA approved methadone to treat opioid addiction (including heroin).
When the Comprehensive Drug Abuse Prevention and Control Act of 1970 was enacted, it classified methadone as a Schedule II substance, the same classification as other opioids and cocaine. This means that the substance is accepted for medical use in the United States, but that it has a high potential for abuse and that its misuse can lead to severe physical or psychological dependence.
Effects of Methadone
There are many adverse reactions linked to methadone use, even if used as prescribed. Some are mild, and others are more severe. Effects will vary from person to person, but the higher the dose, the more likely there will be adverse effects.
- Appetite changes
- Chest pain
- Rapid heartbeat
- Dry mouth
- Excessive sweating
- Gastrointestinal distress
- Impaired concentration
- Irregular heartbeat
- Itchy skin
- Low blood pressure
- Mood changes
- Sexual impotence
- Sexual problems
- Shortness of breath
- Sleep changes
- Slow breathing
- Stomach pain
- Suicidal thoughts
- Swollen lips, tongue, throat, or face
- Trouble breathing
- Trouble swallowing
- Unusual menstrual periods
- Urinary retention
- Vision problems
- Weight gain
Although prescription methadone appropriately used will not have euphoric effects, taking large amounts can give the person a high. Some people will also snort it or inject it to feel the euphoria. This can rapidly lead to addiction and increases the risks of overdose.
Different scenarios can lead to a methadone overdose.
- The most obvious one is misusing or abusing the drug. A methadone prescription should be followed precisely. An overdose can happen when someone takes too much methadone, whether on purpose or accidentally.
- A person could also be intolerant to methadone initially and could overdose even with a regular prescription.
- A person can also overdose because of the buildup of methadone in one's body. The long half-life of methadone compared to other opioids like morphine means that it stays much longer in the body. Therefore there can be a buildup of methadone after a few doses, leading to an overdose.
Here are some signs and symptoms of a methadone overdose.
- Blue fingernails and lips
- Cold, clammy skin
- Constricted pupils
- Low blood pressure
- Muscle twitches
- No breathing
- Slow, labored, or shallow breathing
- Slowed heartbeat
- Spasms of the stomach or intestines
- Weak pulse
The first thing to do if a methadone overdose happens is to call for help. You can call the Poison Control Center or 9-1-1. Try to get specific information regarding the incident (how long ago the methadone was taken, how much was taken, the dose's strength, etc.). It can help the professional tell you precisely what to do to assist the person. A methadone overdose can be fatal; therefore, seeking professional help is strongly advised.
If indicated, naloxone can be administered to counter the effects of the methadone overdose. Because it is a long-acting opioid, people are often kept under supervision for at least 24 hours, to make sure the symptoms don't come back.
Methadone Abuse and Addiction
Because methadone is used in the treatment of opioid addiction (such as heroin), it can often be perceived as a prescription drug with low potential for abuse and addiction. But methadone is a Schedule II drug, which means that the drug is known to have a high potential for abuse and that this abuse can lead to severe psychological and/or physical dependence. A person put on methadone as a replacement for a drug like heroin is especially at risk since they already have a history of opioid abuse and addiction.
Even a person taking methadone as a painkiller is at risk of abusing or developing a dependence on the drug, especially when used over a long time as physical tolerance can develop, leading to abuse. Some of the signs that you may have a methadone abuse or addiction problem are:
- Continuing to take the drug even when you don't need it
- Dropping your responsibilities
- Having withdrawal symptoms when the drug is stopped, which lead to continued use
- Lying about or hiding your use of methadone (or how much you are taking)
- Taking more methadone than prescribed (in terms of quantity or frequency)
Methadone is also a drug that is abused recreationally. It is the drug of choice for some people and can be an incredibly challenging drug to quit.
How to help a loved one addicted to methadone
Once you have realized that someone you love is addicted to methadone, whether because of abuse or methadone maintenance, something needs to be done. The first part is educating yourself on methadone addiction to understand what is happening with the person. The issue needs to be addressed, and it can be treated. It is a thin line between helping a methadone addict and enabling them. Enabling refers to actions that help the addiction go unaddressed and allows it to continue. One way to differentiate between helping and enabling is that you want to support the person but not support the habit. There are some steps you can take to get them the help they need.
Once you are educated on the subject and understand it, you can look at treatment options. The treatment plan should be adapted specifically to methadone addiction and meet the needs of your loved one. It can be a good idea to decide on treatment plans and facilities before confronting your loved one because if the conversation goes well and they agree to get help, they should go to the facility as soon as possible. We have referral specialists available 24/7 who can help narrow down the best treatment options in your area.
When having the conversation, you need to make it clear that you are aware that they have a problem and want to help them, but that the behaviors associated with their addiction are not okay. It's important to let them know that you want to help them get treatment. Beforehand, be mentally prepared for the reaction you might get. When confronted with their behavior and actions, some people can get very defensive and lash out. Others might be in complete denial. It is crucial not to get swayed by those reactions. It can be counter-intuitive to set boundaries and establish consequences if the person continues this behavior, but the alternative is letting the person keep abusing methadone.
If the addict agrees to get treatment, do not waste a second. Get them into treatment as soon as possible. However, if a person is very resistant to getting help, an intervention can be performed. This can be done with a professional interventionist trained and has experience performing interventions. There are specific steps to be followed to be successful.
Methadone Addiction Treatment
If a person becomes addicted to methadone, it can be difficult for them to stop on their own. The main reason is that withdrawal can be quite uncomfortable. Symptoms can vary depending on the person, the length of use, and the amount used daily. Here are some of the symptoms associated with methadone withdrawal:
- Abdominal pain
- Dilated pupils
- Drug cravings
- Increased breathing rate
- Increased heart rate
- Hot flashes
- Increased blood pressure
- Joint pain
- Loss of appetite
- Muscle aches and pains
- Muscle cramps
- Runny nose
- Teary eyes
- Trouble sleeping
Stopping methadone cold turkey when these symptoms are severe can be very hard on the individual psychologically and physically. This can cause a person to relapse. It is advised to seek professional withdrawal management help to safely and fully withdraw off methadone. They will be able to monitor vitals and ensure that the symptoms are adequately managed. Things like staying hydrated when experiencing diarrhea and vomiting during withdrawal can sometimes be overlooked when detoxing at home. During a medically supervised detox, the healthcare specialists will often wean the person down gradually to offset the withdrawal symptoms. It should be noted that detox is only the first step to recovery. There are often serious underlying issues related to addiction that one should address in a rehabilitation program.
The purpose of rehabilitation is to help the person stop using the drug and stay drug-free while also giving him the skills necessary to be a productive member of society (work, family, community, etc.). A rehabilitation program should typically be constructed so that all the needs of the person are being met and that the purpose of rehabilitation is achieved. Different rehab programs will use various techniques to achieve that, but counseling and therapy are the basic ones. Although depending on the person's challenges (unemployment, legal troubles, lack of education), some rehabilitation facilities will off specialized services such as vocational services, legal services, and education services.
Another facet of rehabilitation is family services. Families often go through hardship because of one's addiction. Some rehabilitation treatments will offer counseling for families as well to help them heal. It can also give them tools to help their family member stay drug-free after completing the program. Once a person completes their rehabilitation, their family might be better equipped to support and help them get their life back together.
Definitions of common terms related to methadone
|Opioid||a class of drugs derived from opium (poppy plant), it also includes drugs that produce similar physiological effects than opium (such as pain relief).|
|Opioid receptors||a set of receptors in the brain that control pain signaling. When an opioid such as methadone is taken, the drug binds to these receptors, telling them to slow down or stop the pain signals. They are also responsible for addictive behavior, so methadone and other opioids have a high potential for abuse.|
|Schedule II drug||a drug classification that means that, even though it is accepted for medical use in the U.S., the drug has a high potential for abuse and can lead to severe psychological or physical dependence. Methadone is a Schedule II drug.|
|Methadone overdose||when a person takes too much methadone or when methadone is mixed with other substances and can lead to coma and death in severe cases.|
|Methadone maintenance treatment (MMT)||a long-term prescription of methadone to combat another opioid addiction.|
|Opioid agonist||a drug or substance that binds to opioid receptors in the brain and causes the same action as the opioids that normally bind to those receptors.|