Methadone is an effective pain-killer, but it is most commonly used in methadone maintenance treatment. This is a form of opioid replacement/substitution therapy that helps people overcome an addiction to other opioids or opiates. Despite these benefits, methadone itself can also be highly addictive, with the tragically ironic result of individuals becoming addicted to the very drug that was supposed to help them. When this happens, comprehensive treatment, advice and ongoing support are needed to help them achieve long-term recovery.
What is methadone?
Medically, methadone is administered as a liquid, tablet or powder with a single dose lasting between 24 and 36 hours. The liquid form is most often used in treatment clinics as it enables the physician to measure the exact amount the individual needs, reducing the chances of abuse or addiction.
The Misuse of Drugs Act of 1971 classifies methadone as a Class A drug. This means it is considered to be among the most dangerous drugs, so there are severe legal penalties for illegal possession and supply.
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.
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Methadone maintenance treatment
When an individual has been using opioids or opiates in large doses for an extended period of time, their body gets used to the presence of high levels of the drug and becomes physically dependent on it. If the person then stops taking the drug, they can experience unpleasant and potentially life-threatening withdrawal symptoms as their body reacts in shock to the sudden absence of methadone.
Methadone maintenance treatment (MMT) is designed to manage this situation. Methadone has the same mechanism of action as opioids but is less potent and longer-acting. This means it can be used to replace the stronger opioid the individual is dependent on. Here is how MMT works:
Stabilisation
Methadone is administered in a controlled medical setting to stabilise the individual. The presence of methadone satisfies the body’s physical dependence on opioids without producing the same intense high, thereby reducing cravings and methadone withdrawal symptoms.
Dosage adjustment
The dosage of methadone is carefully adjusted and monitored by healthcare professionals to ensure it is a large enough dose to be effective but not large enough to present a risk of a new addiction developing.
Long-lasting withdrawal prevention
Methadone’s long-acting nature means it can be taken just once a day to keep withdrawal symptoms at bay. This helps individuals avoid the repeated cycle of drug abuse that comes with short-acting opioids and opiates.
Tapering off
Eventually, the goal for many individuals is to gradually reduce their methadone dosage under medical supervision, eventually weaning off opioids entirely. However, some individuals may continue methadone treatment for an extended period, depending on their unique circumstances and needs.
Methadone for pain relief
Methadone can also be used for pain relief, especially in cases of complex pain and when other opioids have proven ineffective. Its pain-relieving function works by binding to mu-opioid receptors in the spinal cord and brain, which are crucial parts of the body’s natural pain management system. By binding to these receptors, methadone effectively reduces the sensation of pain by altering the pain signal sent to the brain. One of the distinctive features of methadone is its long half-life, allowing it to provide sustained pain relief over a longer period compared to other opioids.
Methadone also acts on NMDA receptors, which are involved in pain signalling and opioid tolerance. This action can help in managing certain types of pain that are less responsive to traditional opioids and may slow the development of opioid tolerance.
Finally, methadone has mild effects on the reuptake of neurotransmitters like serotonin and norepinephrine. This can contribute to its analgesic properties, especially in the context of neuropathic pain such as fibromyalgia or diabetic neuropathy. These conditions often involve nerve damage or dysfunction, where traditional opioids may not be as effective as methadone.
Methadone addiction and how it develops
Even though methadone is primarily prescribed to help individuals overcome addiction to other opioids, it still carries an addiction risk itself. This is particularly true when not used as directed, either in dosing or duration. The development of methadone addiction typically follows a path similar to other opioid addictions:
- Flu-like symptoms
- Methadone cravings
- Muscle aches and pains
- Sweating
- Runny nose and teary eyes
- Shivering or goosebumps
- Nausea and vomiting
- Diarrhoea
- Fever or hot flashes
- Anxiety
- Mood swings
- Insomnia and disturbed sleep
- Depression
- Neglecting responsibilities: Ignoring or failing to fulfil work, school or family obligations due to methadone use.
- Isolation from social activities: Withdrawing from social interactions, hobbies or interests that were once important, often to spend more time using methadone.
- Financial problems: Experiencing financial difficulties due to spending significant amounts of money on acquiring methadone.
- Health deterioration: Declining physical and mental health as a result of continued methadone use.
- Risky behaviours: Engaging in dangerous or illegal activities to obtain methadone or while taking it, such as stealing or driving under the influence.
- Impaired relationships: Strained or broken relationships with family and friends due to the prioritisation of methadone use and drug-fuelled behaviour.
- Denial of addiction: Refusing to acknowledge the severity of the methadone addiction and its impacts on various aspects of life.
- Changes in appearance: Noticeable changes in physical appearance, including weight loss or gain and neglect of personal hygiene.
These methadone addiction symptoms and signs paint a picture of how the drug can completely take over an individual’s life and the widespread damage that needs addressing during methadone recovery.
These methadone addiction symptoms and signs paint a picture of how the drug can completely take over an individual’s life and the widespread damage that needs addressing during methadone recovery.
Risk factors for methadone addiction
The risk factors for developing an addiction to methadone are multifaceted and can vary from person to person. However, some common factors increase the likelihood of developing an addiction:
- History of substance abuse: Individuals with a past or current history of substance abuse, especially opioids, are at a higher risk of developing methadone addiction. Given the reason that methadone is usually prescribed, most people who are addicted to methadone were previously addicted to another opioid.
- Genetic factors: Genetics play a role in all types of addiction, so individuals who come from families with a substance abuse history are at higher risk.
- Mental health disorders: People with mental health issues such as depression, anxiety, or PTSD are at increased risk, as they may use methadone without supervision for self-medication.
- Environmental influences: Peer pressure, stressful life events and being exposed to drug use as a child or adolescent can all contribute to the development of addiction, including to methadone.
The dangers of methadone addiction
Methadone addiction creates a complex web of challenges that affect nearly every aspect of an individual’s life. These include:
Health harms
- Physical health issues: Long-term methadone use can lead to liver and kidney damage, gastrointestinal problems, respiratory complications and increased risk of methadone overdose.
- Mental health deterioration: Methadone addiction can exacerbate existing mental health issues like depression and anxiety or lead to new psychological disorders.
- Increased risk of infectious diseases: If methadone is injected (especially with shared needles), there is an increased risk of contracting diseases like HIV and hepatitis.
Personal and social harms
- Relationship strains: Addiction to methadone often leads to strained or broken relationships with family and friends due to behavioural changes and neglect
- Workplace issues: Methadone addiction can lead to decreased productivity, absenteeism and potential job loss, impacting professional life and career.
- Financial problems: The cost of sustaining the addiction can lead to financial strain, debt and even legal problems related to the acquisition of methadone.
Methadone detox
The first stage of methadone addiction treatment is detox, where the drug is slowly removed from the body. This requires medical support and guidance to help the individual cope with methadone withdrawal and keep them safe. During methadone detox, drugs like buprenorphine and L-alpha-acetylmethadol (LAAM) play the tapering role that methadone itself plays in other types of opioid detox.
Methadone rehab therapy
During methadone addiction treatment, a range of therapies are used to help the individual identify and work through the underlying personal, emotional and psychological causes. These may include:
- Cognitive behavioural therapy (CBT): CBT helps individuals anticipate stressful situations and utilise self-control strategies to prevent relapses. This is achieved by learning to identify negative thoughts and feelings that drive addictive behaviour so that difficult situations can be effectively handled.
- Dialectical behaviour therapy (DBT): DBT emphasises the acceptance of negative thoughts through CBT methods and then uses mindfulness to prevent a harmful reaction to them. It can be a very effective form of treatment for a range of mental health and addiction disorders.
- Motivational interviewing (MI): The goal of MI is to help individuals find the motivation within themselves to begin and continue methadone rehab therapy. For example, they may want to repair damaged relationships, restore their physical or mental health or get their career or education back on track.
- Family therapy: Family counselling and therapies focus on repairing relationships with loved ones that have been damaged by methadone addiction. In turn, friends and family can become a vital source of motivation and support during and after rehab.
- Holistic therapies: Holistic therapies aim to treat the client’s well-being through methods such as yoga, meditation, art and music. These methods aim to help individuals express themselves, bring some peace into their lives and connect to themselves and others on a deeper level.
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Relapse prevention
The final stage of treatment is relapse prevention, which usually includes aftercare, ongoing therapy sessions and the implementation of strategies for long-term sobriety. These may include:
- Attending aftercare
- Building and being supported by a network of friends, family and peers
- Identifying the people, places and situations that could trigger relapse
- Using meditation and mindfulness techniques during difficult moments
- Stay physically and mentally healthy
- Taking up new hobbies to keep busy
- Getting enough sleep
- Joining a support group like NA (Narcotics Anonymous) in the local area
Get help for methadone addiction
Methadone addiction can be a serious condition with life-changing and potentially life-threatening consequences. Anyone who is suffering from methadone addiction should speak to their GP or contact a professional addiction treatment centre to begin recovery immediately. It may be a scary prospect, but it is the best way to avoid the often deadly results of methadone addiction.
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