Information on Methadone, its Detox and Rehabilitation

Methadone is a powerful drug that is commonly used to treat opioid dependence. Unfortunately, it can lead to dependency, so it is not uncommon to seek methadone rehab. Coming off methadone is a long process and requires medical oversite, so a medical detox is recommended. Drug Rehab Services has a list of detox for methadone, but always call a center to ensure they can deliver a methadone detox.

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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.

TIPS: If you feel you're going to use

  • Call your sponsor or a friend who doesn’t use it and understands your situation.
  • Extrovert your attention. Walking and spending time outside can be very therapeutic. 
  • Find a hobby or activity to take your mind off of using. (i.e., art, music, cooking, gardening)
  • Find a purpose in your life and pursue it. (i.e., school, career, volunteering)
  • Recognize the people in your environment who affect you emotionally. They could be one of the reasons for your emotional problems.
  • Make sure to eat healthy foods. A deficiency in vitamins and minerals can create a drop in mental and physical energy.

TIPS: If you want to help someone

  • Don’t enable the addict. This includes not giving him any money, not paying their rent, etc.
  • Encourage the person to seek help. This can be done by finding a treatment or a form of support.
  • Be aware of signs of overdose. If you see one of your friends blacking out, or showing other severe side effects, get help immediately.
  • Support the person while they look for rehab since the process can be overwhelming.
  • Don’t wait for rock bottom; it may be too late.

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 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, 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 similarly 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 severe withdrawal symptoms. Another advantage is that a high quantity of the drug will not increase its effects after a certain point, decreasing the risks of overdose. A medical professional should discuss the difference between the two drugs and which would be best during detoxification.

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 due to the observed side effects, the substance’s production remained very low throughout World War II and 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 “methadone.” Eli Lilly introduced methadone in the U.S. under the {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 as other opioids and cocaine. This means that the substance is accepted for medical use in the United States but has a high potential for abuse and that its misuse can lead to severe physical or psychological dependence.

Effects of Methadone

Many adverse reactions are 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.

  • Anxiety
  • Appetite changes
  • Chest pain
  • Rapid heartbeat
  • Confusion
  • Constipation
  • Delusions
  • Depression
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Excessive sweating
  • Fainting
  • Flushing
  • Gastrointestinal distress
  • Hallucinations
  • Headache
  • Hives
  • Impaired concentration
  • Insomnia
  • Irregular heartbeat
  • Itchy skin
  • Lightheadedness
  • Low blood pressure
  • Mood changes
  • Nausea
  • Overdose
  • Paranoia
  • Restlessness
  • Seizures
  • Sexual impotence
  • Sexual problems
  • Shortness of breath
  • Sleep changes
  • Slow breathing
  • Stomach pain
  • Suicidal thoughts
  • Swollen lips, tongue, throat, or face
  • Tiredness
  • Tremors
  • Trouble breathing 
  • Trouble swallowing
  • Unusual menstrual periods
  • Urinary retention
  • Vision problems
  • Vomiting
  • 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.

Methadone 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 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
  • Coma
  • Confusion
  • Constipation
  • Constricted pupils
  • Disorientation
  • Dizziness
  • Drowsiness
  • Fatigue
  • Low blood pressure
  • Muscle twitches
  • Nausea
  • No breathing
  • Slow, labored, or shallow breathing
  • Slowed heartbeat
  • Spasms of the stomach or intestines
  • Vomiting
  • Weak pulse
  • Weakness

If a methadone overdose happens, is first 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 treating opioid addiction (such as heroin), it can often be perceived as a prescription drug with a 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, primarily 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 allow it to continue. One way to differentiate between helping and enabling is that you want to support the person but not support the habit. You can take some steps 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 clarify that you know 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 you want to help them get treatment. Beforehand, be mentally prepared for the reaction you might get. Some people can get very defensive and lash out when confronted with their behavior and actions. 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 to let 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, an intervention can be performed if a person is resistant to getting help. This can be done with a trained professional interventionist with 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 challenging to stop independently. The main reason is that withdrawal can be pretty 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
  • Anxiety
  • Chills
  • Constipation
  • Cramps
  • Depression
  • Diarrhea
  • Dilated pupils
  • Drug cravings
  • Increased breathing rate
  • Increased heart rate
  • Fatigue
  • Headache
  • Hot flashes
  • Increased blood pressure
  • Insomnia
  • Irritability
  • Joint pain
  • Loss of appetite
  • Muscle aches and pains
  • Muscle cramps
  • Nausea
  • Restlessness
  • Runny nose
  • Sweating
  • Teary eyes
  • Trouble sleeping
  • Vomiting

Stopping methadone cold turkey when these severe symptoms 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 from 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 severe 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 person’s needs 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. Although depending on the person’s challenges (unemployment, legal troubles, lack of education), some rehabilitation facilities will offer specialized services such as vocational, legal, and education services.

Another facet of rehabilitation is family services. Families often go through hardship because of one’s addiction. Some rehabilitation treatments will also offer counseling for families 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.

4,418

methadone poisoning deaths in 2011 in the United States

201

teens and young adults aged 15 to 24 died from a methadone overdose in 2015

735

young adults aged 25 to 34 died from a methadone overdose in 2015

Definitions of standard terms related to methadone

Term Definition
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 binds to opioid receptors in the brain and causes the same action as the opioids that normally bind to those receptors.

Contributors to this Article

Marcel Gemme has been helping people struggling with addiction for over 19 years. He first started as an intake counselor for a drug rehabilitation center in 2000. During his 5 years as an intake counselor, he helped many addicts get the treatment they needed. He also dealt with the families and friends of those people; he saw first-hand how much strain addiction puts on a family and how it can tear relationships apart. With drug and alcohol problems constantly on the rise in the United States and Canada, he decided to use the Internet as a way to educate and help many more people in both those countries. This was 15 years ago. Since then, Marcel has built two of the largest websites in the U.S. and Canada which reach and help millions of people each year. He is an author and a leader in the field of drug and alcohol addiction. His main focus is threefold: education, prevention and rehabilitation. To this day, he still strives to be at the forefront of technology in order to help more and more people. He is a Licensed Drug and Alcohol Treatment Specialist graduate with Honours of Stratford Career Institute. Marcel has also received a certificate from Harvard for completing a course entitled The Opioid Crisis in America and a certificate from The University of Adelaide for completing a course entitled AddictionX: Managing Addiction: A Framework for Succesful Treatment.

Michael Leach

Medical Reviewer

Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.

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