What is Methadone?
Methadone is a long-acting synthetic opioid painkiller that is often used to treat individuals who suffer from addiction to opioid drugs, such as heroin or prescription painkillers.
When taken as prescribed, methadone can be very useful in treating opiate addiction, but it too can be addictive, as it is still an opiate.
When used as a treatment to wean individuals off other drugs of addiction, methadone prescriptions and use are closely supervised by medical professionals. However, due to the cost of many prescription painkillers and the relatively low cost of methadone, doctors have been prescribing methadone as a long-acting painkiller for chronic pain for years. This has allowed more people exposure to methadone than before, including numerous individuals who have not been exposed to opioid medications in the past. This exposure has caused a rise in addictions to methadone, as well as easier access to methadone as a recreationally abused substance.
How Does Methadone Work?
Methadone works on the brain by binding to the same receptors as other opioid drugs like heroin or OxyContin. Since methadone remains in the body for a long period of time – typically 1-3 days – it helps to block euphoric effects of other opiate drug abuse and lessen painful symptoms of withdrawal from these drugs.
Because methadone is such a long-acting drug, designed to ease symptoms in people addicted to heroin for 1-2 days, it can build up quickly in the body and remain in the bloodstream for a long time. It is important for individuals with methadone prescriptions to use this medication exactly as prescribed, and to not adjust their own dose without a doctor’s advice and oversight. It is easy to overdose on methadone due to the strength of one dose.
What Is Methadone Used For?
Since the 1970s in the US, methadone clinics and methadone maintenance have been promoted as ways for people who struggle with heroin addiction to avoid the worst withdrawal symptoms while preventing relapse. Today, methadone is still used under close medical supervision to help people suffering from opioid addiction to ease through the withdrawal process.
However, according to the Centers for Disease Control and Prevention, in 2009, methadone contributed to one in three prescription painkiller deaths. As stated above, doctors sometimes prescribe this long-acting drug to treat chronic pain from multiple sclerosis, cancer, or injuries. Legitimate use via a prescription can turn into abuse as tolerance develops. Once abuse starts, addiction can quickly take hold.
Methadone Side Effects
Methadone’s side effects are similar to those associated with other opioid drugs. These include:
- Lightheadedness or dizziness
- Sleepiness or drowsiness
- Nausea or vomiting
- Impaired cognition or confusion
- Impaired balance or coordination
It is much easier to overdose on methadone than other opioid drugs. Symptoms of overdose include:
- Slow, shallow breathing, known as respiratory depression
- Clammy or bluish skin
- Blue-tinted lips and fingertips
- Extreme fatigue to the point of being unable to stay awake
Mixing methadone with other drugs, whether prescription or illegal drugs, can lead to serious heart problems as well. These heart problems range from arrhythmia to heart attack.
Use to Abuse and Addiction
Because many individuals receive prescriptions for strong painkillers every year, more and more people find themselves suffering from addiction to prescription pain medications. These are often an oxycodone- or hydrocodone-based medication, such as Vicodin, Percocet, or OxyContin. Lawmakers and regulators now say that prescription pain medications are over-prescribed for problems that may not be fixed by this medication, such as chronic back pain, or they are prescribed in large quantities for post-surgery pain treatment. Although the Food and Drug Administration does not recommend methadone as a prescription painkiller for these types of pain, over 4 million prescriptions were written for methadone in 2009. The rise in methadone prescriptions, specifically for use as a painkiller, is due to the fact that methadone is cheap, especially compared to hydrocodone and oxycodone. Insurance companies are sometimes more willing to cover the cost of methadone instead of brand name opioid painkillers, and that has driven many people to switch their prescriptions to methadone.
Because methadone is designed to be a long-acting drug, it can build up very quickly in the body, and that can mean that taking even one more dose than prescribed can lead to an overdose. Unless carefully monitored by a medical professional, methadone use is dangerous, and abuse or addiction can lead to very serious consequences.
Methadone’s half-life, depending on dose, ranges anywhere from 8 to 59 hours, while the analgesic, or painkilling, effects last up to 8 hours. The long half-life benefits those in recovery from heroin or prescription painkiller addiction, as it stays in the body to ease withdrawal symptoms and cravings. However, this means it is less effective for treating chronic pain conditions related to diseases, such as cancer, multiple sclerosis, or osteoarthritis, because the painkilling effects do not last as long as the drug remains in the body. As a result, individuals who take methadone as a painkiller can put themselves in danger of an overdose if their pain returns before they can safely take their next dose.
Recreational Methadone Abuse
As methadone has increasingly been used to treat pain, not just opioid addiction, more of this long-acting opiate has become available to people who abuse drugs. Much like the wide availability of hydrocodone or oxycodone, people who abuse opiate drugs can more easily find methadone by stealing it from friends or family, or by buying it illegally. Illegal selling of a prescription medication is called diversion, and it is the leading cause of the opioid drug abuse epidemic in the US.
When an individual abuses methadone for recreational purposes, the person is at a much higher risk of developing an addiction to this medication.
In addition, the person is at a very high risk of overdosing on the drug.
Since methadone was originally designed for use in treating heroin addiction, and it is used in treating all kinds of opioid addictions, its symptoms of withdrawal are less severe and do not set in as quickly as with other opiates. This is because methadone stays in the body in some form for 1-3 three days. Though less severe, withdrawal symptoms from methadone are similar to withdrawal symptoms from other opioid drugs. They include:
- Watery eyes
- Runny nose
- Fever or chills
- Tremors or shaking
- Muscle aches
- Nausea or vomiting
- Loss of appetite
- Anxiety or irritability
Treatment for Methadone Addiction
Whether the person started abusing methadone recreationally or began using the medication as part of an opioid addiction treatment regime, treatment for methadone addiction requires both medical detox and comprehensive therapy.
Since methadone is an opioid, medical detox is always required to withdraw from the drug. In some instances, individuals will be gradually tapered off methadone, whereas individuals may be switched to another medication, such as buprenorphine, in other instances. Medications that may be used during treatment include:
- Buprenorphine: A semisynthetic narcotic, buprenorphine was the first medication approved by the FDA to treat opioid addictions with more flexibility. Whereas methadone is highly regulated and patients must visit clinics for their daily doses, buprenorphine can be prescribed for take-home dosages. This prescription drug does have some similarities to methadone and other opioid drugs, meaning there is some potential for abuse or addiction, but it is viewed to have less abuse potential than methadone.
- L-alpha-acetylmethadol (LAAM): This medication is a Schedule II substance that is often used in opioid addiction treatment. Like buprenorphine, LAAM is an alternative to methadone therapy. It can therefore be helpful for individuals who are struggling with methadone addiction. There are a number of side effects associated with this medication, especially when used on a long-term basis, including rash, nausea, increased blood pressure, and abnormal liver function.
- Psychiatric medications: There are many psychological and emotional effects associated with withdrawal and recovery. Medications to treat depression or anxiety can be used with careful oversight to treat these effects. These are typically administered with a psychiatrist’s prescription in addition to individual and/or group therapy treatment.
Many individuals who struggle with methadone addiction have co-occurring disorders, like depression, post-traumatic stress disorder, schizophrenia, bipolar disorder, or another medical health condition. People who struggle with mental health issues may try to “self-medicate” their symptoms, often with drugs like alcohol, painkillers, marijuana, or cocaine. For these individuals, methadone addiction may stem from try to overcome other opioid addictions.
Psychiatrists and other medical professionals involved in the treatment of drug addiction work to identify underlying mental health disorders that might have led the individual to self-medicate addictive behaviors. Comprehensive care that addresses all co-occurring disorders is needed for the individual to achieve true recovery from methadone addiction.