What Is Methadone?
Methadone is an analgesic medicine or painkiller. This opioid was created by Germany in World War II and is now used to treat pain or narcotic addiction. It works by changing how the brain and nervous system react to pain so that the body feels relief.
To treat drug addiction, methadone works more slowly than other opioids like morphine and blocks the euphoric feeling from drugs like codeine and oxycodone while providing its own euphoric feelings to decrease the symptoms of withdrawal. (1)
Methadone replaces the drugs already in the system with a weaker effect to prevent withdrawal symptoms and wean the user off of the painkillers they may already be using. This effect is called replacement therapy. This is, however, not a cure for addiction; It is only a temporary treatment due to the risks of addiction associated with methadone as well. (1)
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Available Forms of Methadone
Medically, methadone can be administered as a liquid, tablet or powder. None of these forms should exceed 80 milligrams to 100 milligrams daily. A single dose can last between 24 and 36 hours, lowering the frequency the drug is administered and decreasing the chances of addiction. (2)
The liquid form is most often used in treatment clinics as it can be measured exactly to how much is needed for the client, whether it be for pain or to diminish the effect of withdrawal symptoms. This gives the physician much more control of the drug and lowers the risk of abuse and addiction. The tablet form is typically a 40-milligram dosage and is dissolved in water and ingested. The powder form is also dissolved in water and drunk by the client. (2)
When used illegally, methadone is frequently injected directly into the bloodstream. This increases the risks of the user being exposed to multiple blood-borne diseases, such as HIV or AIDS. (2)
Medical Uses of Methadone
Methadone is medicinally used for two primary purposes: alleviation of pain and withdrawal relief.
Methadone is an opioid medication that directly affects the way the brain and nervous system feel pain by tricking them into feeling something more pleasant. This works much more slowly than other narcotics such as Percocet. (3)
To treat drug withdrawal symptoms, methadone blocks the euphoric feeling from the source of the addiction while still treating the pain. It is an effective way to wean a client off their other painkillers because it achieves the same goal but in a lesser fashion. Once the client is in a stable position, they are able to go through a rehabilitation program or therapy with a psychiatrist.
The replacement therapy also allows the client’s condition to be carefully monitored by a physician who gives them carefully controlled doses of the methadone. The carefully controlled doses free the client from the physical dependence on the drug and help them to stop doing everything within their ability to acquire more of the drug. (3)
Uses of methadone to fight heroin addiction
At first, heroin causes feelings of pleasure and joy in the user. This effect diminishes the more it is used, leading the user to take higher and higher doses to achieve the same effect until they develop a substance dependence. When an addicted person tries to stop using heroin, they will face withdrawal symptoms. These symptoms can include cravings for heroin, sweating, nausea, pain or even death if other medical issues coexist. (4)
Methadone is used to fight these symptoms by giving the addict a feeling similar to that of heroin but to a lesser extent. This gives the addict a chance to stop using heroin without feeling the intense cravings to acquire and use more.
Once the addict is in a stable condition, they can go through therapy and rehabilitation. Since the methadone helped to eliminate the dependence on heroin and the cravings for more, there is a much smaller risk of the former addict relapsing after becoming sober. (4)
Legal Status (UK)
Per the Misuse of Drugs Act of 1971, methadone is considered a Class A drug in the United Kingdom. By law, these are considered the most dangerous drugs.
Punishable offences with these drugs under this act include possession, possession with intent to sell, production, supplying or offering to supply another person with the drug, import or export or allowing premises under one’s control to be used for the sale or consumption of these drugs. (5)
Those found in possession of a Class A drug can be fined and sentenced to up to seven years in jail, while those found in possession with intent to sell the drug can be fined and sentenced to life in jail. There are exceptions to the Misuse of Drugs Act for certain drugs that are used medicinally, including methadone.
The laws still apply; however, methadone can be obtained legitimately through a prescription. In this case only, a person can be in possession of and use methadone. (5)
The government can allow individuals or companies to be in possession of some of these drugs in the interest of medical or scientific advancement. Class A drugs can only be possessed for research or other specific purposes by people licensed by the Home Office.(5)
Routes of Administration
Typically, methadone is administered in a liquid, tablet or powder form. When used illegally, it is commonly injected directly into the bloodstream. The liquid form is most common in treatment centres because it can be measured precisely to the milligram, allowing the physician to diminish an addict’s withdrawal symptoms while lowering the risk of substance abuse. The tablets come in 40-milligram dosages and are typically dissolved in water and ingested. The powder works very similarly to the tablets and is taken in water as well. (2)
As a prescription-only medication, methadone can only be administered by the one holding the prescription, unless the person is a physician or acting on the orders of a physician. Methadone is not included in the list of medications that are exempt from this specification to save a life in an emergency. (6)
Pharmacological Actions of Methadone
Methadone is an opioid medication that binds to opioid receptors in the brain and works to change how the brain and nervous system process and feel pain. It tells the brain to feel relief instead of pain.
It also blocks the euphoric feeling associated with other painkillers like Percocet and morphine while giving its own lesser euphoric feeling to curb the symptoms of withdrawal, making the drug helpful in assisting addicts get past their narcotic addictions.
Methadone has an active time of about 24 to 36 hours, which is longer than most other opioids. This allows the clients prescribed methadone to take less frequent doses, lowering the risk of abuse and addiction.
Chemical formula – C21H27NO
Composed of carbon, hydrogen, nitrogen and oxygen, the chemical formula of methadone is C21H27NO. It is a synthetic opioid medication with analgesic functions and performs similarly to endogenous peptides at CNS opioid receptors, mainly the mu-receptor. It has effects akin to that of morphine and other painkillers. Methadone, however, is different from morphine with regard to withdrawal symptoms; methadone’s symptoms are slower and less pronounced than those of morphine. Derived from heptan-3-one, methadone is a xenobiotic, meaning it is foreign to the body. The drug is soluble in water and ethanol and has a melting point of 235 degrees Celsius. (7)
Methadone Brand and Street Names
The major brand names for methadone are Dolophine and Methadose. Commonly used street names include amidone, dollies, dolls, fizzies, mud, red rock and tootsie roll. (8)
Methadone Addiction and How it Develops
Even though methadone is primarily prescribed by doctors as a way to help clients overcome addiction to other opioids, it is still addictive itself. When a client starts taking methadone, it will give them a small euphoric feeling and help to take away pain. (9)
As with all opioids, people begin to develop a tolerance for the drug, meaning they have to take more and more to achieve the same result they got before. This causes a dependence for the drug, and if they try to stop taking it, they will suffer from withdrawal symptoms and have an almost irresistible urge to find and take more methadone. (9)
Those with the addiction will resort to almost anything to get more, including stealing money from family and friends. Even those who manage to resist the urge to take more methadone may suffer from very serious withdrawal symptoms. (9)
Why is methadone addictive?
Methadone gives the user a slight feeling of euphoria and helps to diminish any pain they may be experiencing. The longer it is taken, the more the effect lessens. As the drug becomes less effective, people will take more than recommended for it to work as well as it did in the beginning. As they begin to take more, they develop a tolerance for methadone. Tolerance is the capacity of the body to become less responsive to a drug.
With the tolerance, they also become dependent on the drug. If they stop taking it, they will go through a drug withdrawal, which has an array of symptoms that may drive the recovering addict back to taking methadone. (9)
How addictive is methadone?
Methadone has a lower risk factor of addiction due to how it works and the typical reasoning behind prescription. While it is a very addictive drug physically, addiction can be avoided with proper supervision.
With an effect that lasts between 24 and 36 hours, methadone is taken much less frequently than other drugs, which lowers the risks. Withdrawal symptoms with methadone are also less common than with other opioids, which makes it easier for those with a dependence to stop taking the drug. Since methadone is often prescribed to help addicts stop taking other opioids, the use of methadone is almost always closely monitored by a doctor or the employees of a rehabilitation centre, which lowers the risk of people abusing methadone, and consequently becoming addicted to it. (2)
Common Drug Combinations
Methadone can be combined with a variety of other drugs; however, the risks associated with the combination often outweigh the benefits. Mixing methadone with other painkillers like morphine, Percocet or oxycodone is extremely high risk and should be avoided. Another extreme risk combination is methadone and buprenorphine, which is another drug often used to treat opioid addiction.
Drugs like Neurontin and Cymbalta are a moderate risk when combined with methadone and should only be prescribed in very rare cases. When they are prescribed, the client should be monitored very closely for negative reactions. There are very few drugs that present a low risk when combined with methadone, so all combinations should be thoroughly researched before prescribing. (10)
Certain antibiotics like clarithromycin and antidepressants such as fluoxetine increase the effects of methadone, while drugs like naltrexone and rifampin lower its effects. (11)
Causes and Risk Factors of Methadone Addiction
Methadone addiction is caused by the tolerance and subsequent dependence created by the abuse of methadone. Risk factors of addiction to methadone can include a number of consequences, including damage done to one’s health and personal life.
The addiction to the drug may cause the person to seek out more methods of acquiring methadone, which can include stealing money or other drugs from family and friends. This may lead to the loss of friends and family or even imprisonment for the addict.
Methadone addiction has many physical risks as well, from short-term risks like nausea to long-term risks like respiratory problems.
Methadone addiction and other substance abuse disorders make the victim more vulnerable to a number of other diseases. Most of these are mental disorders, such as depressive, anxiety and bipolar disorders. Others may include schizophrenia, post-traumatic stress disorder or eating disorders. In an attempt to self-medicate or to achieve the same euphoric effect from before their methadone tolerance became too high, an addict may begin to drink or take other opioids. This may lead to other substance abuse disorders or alcoholism. (12)
Signs, Symptoms and Dangers of Methadone Addiction
Methadone addiction comes with a range of signs, symptoms and dangers.
These signs may be physical, mental, cognitive or behavioural. Physical symptoms are changes in the addicted person’s bodily health, such as vomiting, nausea or respiratory failure. Mental symptoms affect the mental health of the user, such as coexisting mental disorders like depression or anxiety or mental issues like hallucinations.
Cognitive symptoms affect the user’s ability to move and the body’s performance, such as stumbling or sexual problems. Behavioural symptoms affect how the person behaves around those near them, such as family and friends. The user may attempt to steal from them to acquire more methadone, or they may be unpleasant to those close to them. (13)
- Difficult, laboured breathing
- Troubled sleeping
- Blurred vision
- Muscle pain and cramps
- Nausea or vomiting
- Sexual problems
- Slow, shallow breathing, known as respiratory depression
- Clammy or bluish skin
- Blue-tinted lips and fingertips
- Extreme fatigue to the point of fainting
Signs and Symptoms of Methadone Dependence
Visual signs of dependence on methadone are sweating, constricted pupils, slowed breathing, confusion and drowsiness. Other less obvious symptoms include nausea, vomiting and constipation. Someone with a dependence on methadone will feel a nearly irresistible urge to find and take more methadone if they haven’t taken any in some time. This may cause them to do anything they can to acquire the drug, whether it be stealing money from family and friends or selling their belongings for money to purchase more methadone. (9)
When someone is taking small doses of methadone, they may be able to function normally. If they are taking more than the recommended amount, however, they may seem slow and unable to do things they were able to do before, like drive a vehicle or operate machinery. (9)
Impact of Long-Term Methadone Abuse on the Brain
Long-term opioid abuse can affect the brain by diminishing the effect that opioid receptors in the brain have. This means that after the use of methadone, someone may be much more receptive to pain than they were before. It also means that any painkillers will have less of an effect than they would have had before the abuse. It can also cause changes in areas of the brain associated with learning and memory. Specifically, it can affect the ability to learn through positive conditioning and pleasure. (14)
Other effects that methadone addiction may have on the brain include mental disorders that may coexist or have been caused by the addiction, such as other substance abuse disorders, alcoholism, depression, anxiety or bipolar disorders.
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Methadone Overdose Explained
Methadone overdose can be caused by a number of things, such as taking it concurrently with other painkillers, taking too much to try to achieve a euphoric feeling or taking too much because the user has developed a high tolerance for the effects of the drug. The official amount of methadone required to overdose with an intolerant adult is 25 milligrams; however, an adult who has developed a high tolerance may take as much as 200 milligrams before overdosing.
A large risk with overdosing on methadone is its long half-life. A user may think it is out of their system and take more, but the previous dose is still in them, causing an overdose. It could take up to 10 hours before the symptoms of a methadone overdose begin. (9) Signs may include a weak pulse, cold skin, blue lips or fingernails, body spasms or absence of breathing or consciousness. In extreme cases, especially when taken in combination with other drugs, methadone overdoses can cause death. (15)
Methadone Addiction Medications
Drugs that can help clients overcome methadone addiction include buprenorphine and L-alpha-acetylmethadol, or LAAM. Buprenorphine shares a similar purpose to methadone by helping addicts to survive withdrawal symptoms by lessening them and the urge to take more of the drug. It is much more accessible than methadone because it can be prescribed and dispensed at physicians’ offices. It can also be dispensed for treatment in opioid treatment programs. This drug is typically prescribed as part of addiction treatment plans that include therapy and social programs. (16)
LAAM is another drug that works very similarly to methadone. It is another opioid designed to assist clients with their pain while diminishing the effects of withdrawal symptoms. LAAM lasts longer than methadone and can be taken on alternating days, while methadone must be taken daily. The downside to LAAM, however, is that it cannot be prescribed to be taken at home and must be administered by a physician. (17) Both of these treatments come with their own risks and can be abused, leading to another substance abuse disorder.
Psychiatric drugs can be used during methadone addiction to treat some of the symptoms and coexisting disorders associated with the addiction.
They can be used to alleviate symptoms of depression, anxiety or bipolar disorders, schizophrenia or post-traumatic stress disorders. When using any other medications alongside methadone, there are risks involved, and no drugs should be combined without knowledge of the effects.
Buprenorphine is a drug prescribed to alleviate withdrawal symptoms associated with someone trying to overcome a substance abuse disorder. It is typically given to clients as a part of a treatment plan involving medication, therapy and eventually social programs.
Buprenorphine is much more accessible than LAAM or methadone because it can be easily prescribed and dispensed at physicians’ offices. A benefit to buprenorphine is that is gives the user the euphoric feeling they are attempting to achieve but in a lesser form. There is also a point at which the drug will no longer affect the user, further reducing the risk of addiction and abuse of buprenorphine. (16)
L-alpha-acetylmethadol, also called levomethadyl acetate or LAAM, is another synthetic opioid very similar to methadone. It binds to the brain’s opioid receptors, changing the way they feel and respond to pain. Then, it helps to diminish the symptoms of withdrawal that the addict is feeling from no longer taking methadone.
One of the benefits to LAAM is that it has an even higher active time than methadone and can be taken every other day, as opposed to methadone’s daily doses. This lowers the risk of abuse and addiction because clients take much less of it than other drugs. A negative factor of LAAM is that it can’t be prescribed to be taken at home. LAAM can only be administered by a physician in a medical setting. (17)
Psychiatric medications can be prescribed by a doctor to help the client with some of the symptoms of addiction and withdrawal, as well as symptoms of coexisting disorders that may have been caused by the addiction. These medications can help with depression, anxiety, bipolar and eating disorders, schizophrenia or post-traumatic stress disorder. They should be taken with care due to risks with combining other drugs with methadone.
Therapy for Methadone Addictions
The purpose of therapy for substance abuse disorders is to help the recovering addict prevent relapsing.
Therapy can help them rebuild their lives and relationships, giving them motivation to stay sober. There are many different approaches when it comes to therapy, and what works for one person may not work for others
The most common therapy for substance abuse disorders is behavioural therapy. The purpose is to help clients understand the causes behind high-risk behaviour and take steps to avoid or cope with stressful, high-risk situations.
One method of this is cognitive behavioural therapy, which helps clients to anticipate stressful situations and use self-control to prevent relapses. The clients learn the underlying causes and triggers of behaviours that cause relapse to develop strategies for handling these situations.
Dialectical behaviour therapy emphasizes acceptance of self-destructive thoughts of self-harm and suicide in order to overcome them. This is most effective when the addiction coexists with mood and personality disorders.
Motivational therapies are used in combination with behavioural therapies and are the second most commonly used. The goal is to help clients find motivation within themselves to begin and continue therapy. This provides reasons for a recovering addict to remain sober.
An example of this is motivational enhancement therapy, which prioritizes encouragement of change. The therapist works with the client to overcome their doubts and enter rehabilitation.
Family counselling and therapies focus on rebuilding the client’s relationships with their family. In turn, their family becomes a source of motivation for the client to stay away from the drugs. Family therapy sessions typically involve the client and multiple members of their family to improve communication and set goals for the family to achieve.
Other Kinds of Intervention
One of the more unorthodox methods of substance abuse intervention is holistic therapies. Holistic therapies aim to treat the client’s well-being through methods such as yoga and meditation. The goal of these methods is to use controlled breathing and the body to improve strength and concentration. Clients who perform yoga may find themselves with an improved, calm state of mind. This is an effective method for preventing and coping with stressful situations and triggers that may cause a relapse.
Animal therapy is another unorthodox method of improving the mental state of recovering addicts. One example of this is equine therapy, in which clients interact with horses. These horses respond to the client with nonverbal clues, which helps the client to understand their own feelings and overcome feelings of anger and fear. Other therapies involve having animals present during traditional therapy, which encourages the client to be more open during the sessions.
Art and music therapies help clients to express themselves and to understand the hidden meanings and feelings behind their art. This helps them to understand their own emotions and be able to better control them, lowering the risk of a stressful situation causing a relapse. These feelings can help to move discussions in group therapy and encourage the participants to change their behaviours. (18)
Acupuncture is a treatment that is sometimes offered for free at rehabilitation facilities. This is a process in which a therapist inserts fine needles into the body to stimulate the healing process. Some studies have shown that acupuncture increases the rate at which recovering addicts abstain from drugs and lowers the percentage of addicts who relapse. (18)
Horticultural therapy is therapy in which a client uses farming or gardening as a coping method. These processes improve critical thinking, increase attention span and help reduce stress in the client’s life. This helps them to deal with stressful situations and triggers without going through a relapse. (18)
Therapy for substance abuse disorders works to its highest potential if it targets all of the reasons behind the addiction. For this reason, many recovering addicts in the process of rehabilitation participate in multiple different types of therapy at the same time. (18)
Detoxification is the process of expunging all of a drug from the body after a client has suddenly stopped taking the drug. This can come with many physical and mental symptoms, including a nearly irresistible desire to take more of the drug. When someone is going through detoxification in a medical setting, they may be prescribed a medication to assist them, such as buprenorphine.
Symptoms of detoxification may include anxiety, fatigue, restlessness, irritability, sweating, insomnia and an urge for more of the drug. Buprenorphine can diminish some of these symptoms and give the client the euphoric feeling associated with their addiction to eliminate the desire for the drug. (19)
Methadone Addiction Statistics
Since 1998, fewer doctors in the UK have been prescribing methadone and instead prescribe buprenorphine. From 1998 to 2000, 83% of prescriptions for substance abuse disorders were methadone and 17% were buprenorphine. From 2010 to 2014, only 59% of prescriptions were methadone, while 41% were buprenorphine. The average duration of treatment with buprenorphine is also lower than that of methadone: 173 days and 363 days, respectively.
Methadone also has four times the number of drug-related poisoning deaths within the first four weeks of treatment compared to buprenorphine (0.3 deaths per hundred people per year, compared to 1.24 deaths per hundred people per year). (20)
Ready to Get Help for Your Addiction?
Starting on the road to recovery from substance abuse can be a daunting and terrifying task filled with obstacles.
Those suffering from addiction, or those with loved ones suffering, should make it a priority to find someone to guide them and help them through these difficult times. Advice from experts who have seen people go through this and come out of the other side a healthier, happier person is a valuable resource that should be taken advantage of. Anyone who decides to find help will be given as much support as they need to make it through.
Get help today
It is vital that anyone with a substance abuse disorder, or anyone with a loved one suffering, find help as soon as they can. Please call UKAT at 0800 511 8111 to find someone to help through this difficult time. Loved ones will be treated in a safe, nurturing environment, and an individual treatment plan will be set up for the needs of any who decide to seek help.
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- (11) https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Types-of-Medication/Methadone%C2%AE
- (12) https://americanaddictioncenters.org/methadone-addiction
- (13) https://www.therecoveryvillage.com/methadone-addiction/side-effects/
- (14) https://americanaddictioncenters.org/methadone-addiction/effects-on-the-brain-and-body
- (15) https://www.therecoveryvillage.com/methadone-addiction/methadone-overdose/#gref
- (16) https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine
- (17) https://www.crchealth.com/addiction/heroin-addiction-treatment/heroin-detox/laam/
- (18) https://www.drugrehab.com/treatment/types-of-therapy/
- (19) https://www.therecoveryvillage.com/methadone-addiction/withdrawal-detox/#gref
- (20) https://findings.org.uk/PHP/dl.php?f=Hickman_M_10.txt
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