Pros and Cons of Methadone

Beginning in the 1970s, methadone has been used to assist in opiate addiction treatment.
 
In 2009, more than 100,000 individuals who had struggled with heroin addiction were regularly taking methadone as an opiate replacement medication, according to Harvard Medical School’s Harvard Health Publications Methadone treatment is also known as a substitution therapy, or a treatment that enables the individual who struggles with opiate addiction to effectively manage cravings and withdrawal symptoms with another opiate. It is viewed as a safe treatment for opiate addiction when used under medical supervision and in conjunction with therapy. Methadone is known as a full opiate agonist, which keeps individuals from getting high on other opiates, such as heroin or prescription painkillers, according to the UCLA Dual Diagnosis Program.

Goal of Methadone Use in Drug Addiction Treatment 

methadone doseUltimately, the goal for the person who chooses methadone maintenance is to return to a more normal life. Once they begin taking methadone under medical supervision, they may be able to benefit from substance abuse treatment, vocational counseling and educational assistance. As they begin feeling more healthy, they may self-refer to social service agencies so they can get back on their feet.

According to Harvard Medical School, approximately 25 percent of persons admitted to a methadone maintenance program will, over time, become abstinent from methadone if they choose to have themselves weaned. Another 25 percent will continue using methadone while the remainder will stop using methadone and resume its use when they enter another substance abuse treatment program.

How Methadone Works

When people become addicted to heroin, they crave the drug so strongly that, even when they know what consequences they face as a result of their heroin use, they are unable to stay away from the drug. This makes relapse to heroin use incredibly likely after detox. Often, those struggling with heroin addiction experience multiple episodes of relapse on their road to recovery.

In some instances, methadone can help these people to avoid relapse. Since methadone works as a long-acting opioid, it fills the same opioid receptors in the brain that heroin and prescription painkillers do. As a result, when people are taking methadone as part of an addiction recovery program, they won’t experience cravings for heroin or the intense withdrawal symptoms associated with heroin withdrawal. This can allow those in treatment to fully focus on therapy, establishing a strong basis for recovery, without continually battling cravings and urges to relapse.

As a long-acting opioid, methadone stays in the body for up to 56 hours. This means it works well as a maintenance medication since frequent dosing throughout the day isn’t necessary.

Since those using methadone in recovery don’t have to grapple with continual heroin cravings or experience the severity of intense withdrawal symptoms, they often experience greater success in treatment. Benefits of methadone therapy include:

  • Reduction in infectious disease due to stopping opiate abuse, particularly injection drug abuse
  • Reduction in criminal activity due to stopping illicit drug use
  • Overall improvement in quality of life
  • Better chance at long-term recovery success
  • Improved social functioning
  • Better participation in addiction treatment since withdrawal symptoms aren’t a distraction

Oftentimes, methadone maintenance therapy can make stability possible in early recovery. People can give their full attention to therapy, allowing them to address the root issues that led to opiate use. They can find a job, and begin to find more balance in life. It also allows individuals to resume parenting their children in a stable home environment. In addition, if people are facing legal consequences related to addiction issues, they may receive a reduced sentence they are able to show a judge proof of participation in a methadone maintenance program.

According to the University of New Mexico Hospital, people who begin taking methadone are often able to reduce their use of alcohol and other drugs. Once people begin taking methadone, they will have to take it on a long-term basis. If their life circumstances change, requiring that they stop using methadone, they will have to be safely weaned from the drug, which must take place under medical supervision.

While some states require that individuals visit a methadone clinic daily to get dosages, some states allow take-home dosages. Individuals who are approved for take-home treatment receive a small supply of the medication. The program they are admitted to requires them to account for every dosage, keep the medication in a locked container, and comply with random audits to ensure compliance with their treatment program, according to the University of Missouri.

While other medication-assisted treatments are available for those addicted to opiates, such as buprenorphine, methadone is often viewed as the most effective option for those who are severely addicted to opiates. According to Harvard Medical School, approximately 25 percent of people admitted to a methadone maintenance program will become abstinent from methadone , over time. Another 25 percent will continue using methadone as a replacement medication, while the remainder will likely go on and off methadone as they leave and re-enter substance abuse treatment programs.

Those who choose methadone replacement therapy may experience some mild side effects, such as stomach ache, constipation, or sweating. Serious side effects of methadone include:

  • Slowed breathing
  • Sexual dysfunction
  • Nausea
  • Vomiting
  • Restlessness
  • Itchy skin

If you experience any of these short-term side effects, talk to the prescribing doctor immediately. Dosages may need to be adjusted, or another medication may be more appropriate for your situation.

Long-term side effects of methadone use may include lung and respiratory problems, according to the Center for Substance Abuse Research (CESAR) at the University of Maryland.

The biggest risk of methadone use in addiction treatment involves abusing the medication. As an opiate, methadone can itself be addictive. Some critics view replacement medications as merely substituting one addiction for another, and in some instances, methadone can be diverted and abused. In addition to the physical dependence on methadone that is present with use, individuals may also develop a psychological dependence on the drug. If methadone is abused, various ill effects may occur, including:

  • Sexual disinterest/dysfunction
  • Respiratory issues
  • Insomnia
  • Swelling of limbs, feet and hands
  • Nausea and constipation
  • Difficulty urinating
  • Lowered blood pressure
  • Loss of appetite
  • Vomiting
  • Irregular heartbeat
  • Depression

In addition, if a person on methadone treatment combines use of methadone with other substances, such as alcohol or other drugs, serious reactions can occur. Combining methadone with alcohol or another depressant or sedative can result in depressed breathing, unconsciousness, coma, and even death.

According to Science Daily, long-term use of methadone can potentially lead to changes in the brain. Methadone begins affecting nerve cells in the brain, resulting in changes in learning, cognitive function, and memory. In the study, researchers studied the effects of methadone on the brains of rats that were given methadone daily for three weeks. The three-week course of methadone led to a “significant” – 70 percent – reduction of a signal molecule that supports memory and learning in the brain’s frontal lobe and hippocampus. Further research is needed to determine if such an effect occurs in humans.

What Kind of Treatment Is Appropriate?

The choice whether or not to use methadone – or another opioid replacement medication – is a personal one that should be made between the individual and the supervising doctor. In addiction treatment, an individual undergoes an initial assessment. During this assessment, the person will be examined and interviewed, and the treatment team will then devise the optimal treatment plan for that individual.


Methadone treatment may be right for some individuals, and that determination must be made on a case-by-case basis.


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