Methadone Addiction and Abuse

Methadone is a synthetic opioid used for the treatment of moderate to extreme pain management. It has also been widely used to treat opiate addictions such as heroin dependency. Methadone is federally designated as a Schedule II drug, indicating that it has a legitimate legal usage while also having a high potential for causing addictions.

Methadone was initially created as a replacement for highly addictive morphine during the mid-1900s. Although it was primarily used as a medication for pain management, during the 60s and early 70s, methadone was recognized for its potential for narcotic addiction treatment. Following this recognition, the federal government in 2001 strengthened laws for the effective, regulated dispensing of methadone, enabling methadone to be recognized as a gold standard in Medication-Assisted Treatment (MAT) programs.

Since methadone itself is an opioid, there are clinical and ethical concerns revolving the use of this drug to combat other opioid addictions. Although methadone does not produce the same euphoric effects as other opioids, it does, however, possess a high potential for developing an addiction among those with a history of opioid dependency.

Methadone maintenance programs have widely been recognized as one of the most popular and efficient approaches for treating heroin addiction since the late 1970s. Thousands of individuals recovering from opioid addictions are treated with methadone every year. Methadone is an opioid medication designed to help alleviate withdrawal symptoms of other opioids. It is, however, not a treatment for addiction itself.

Methadone is a central nervous system depressant that functions by exclusively connecting to the mu opiate receptor in the brain. As a result, methadone effectively blocks pain receptors as well as the euphoric effects created by other opiates. Although methadone does not produce a high, it does, however, produce a sedative effect that can be addictive.

The effects of methadone are generally felt within 30 minutes after its consumption and last for 8 – 12 hours. Methadone is a long-acting medication that typically stays in the users’ system anywhere between 2 – 13 days even after its effects wear off. Due to its long-acting nature, methadone can increase the risk of overdose if not used under the strict guidelines and supervision of a doctor’s prescription.

The illegal consumption of methadone without a prescription or beyond the prescribed dosage is considered abuse. The misuse of this drug can lead to serious mental defects and physical dependence.

Prolonged abuse of methadone can lead to the development of tolerance, dependence, and addiction among patients. During this period, patients will require higher doses to achieve desired effects as well as require the drug to function on a day to day basis.

Although widely accepted and used as a treatment to counteract opioid withdrawal, it does possess a high potential for addiction among patients with opioid dependency.  Methadone addiction is a controversial topic among medical professionals as they view methadone as a critical aid to help heroin addicts recover. However, as with any opiate, addiction is a typical side effect of methadone. Resulting in exposing patients from one addiction to another.

The warning sign of addiction may become apparent when someone’s behavior changes significantly, particularly during the early stages of methadone abuse.

Some of the typical signs of methadone addiction are:

Although methadone does not contain the same euphoric highs as heroin or morphine, it does contain sedative properties that can be addictive and euphoric. Although these euphoric sedative effects are constrained, they can be dangerous in certain situations. As a result, the National Highway Traffic Safety Administration (NHTSA) has determined that methadone users are not fit to drive due to adverse side effects of said drug.

Some of the potential side effects of methadone are:

• Dizziness
• Fatigue
• Difficult, labored breathing
• Trouble sleeping
• Blurred vision
• Confusion
• Muscle pain and cramps
• Nausea or vomiting
• Pain
• Sedation
• Euphoria
• Decreased reaction time
• Decreased attention span
• Drowsiness
• Droopy eyelids
• Dry mouth
• Muscle weakness
• Decreased body temperature
• Decreased blood pressure
• Little to no reaction to light

As methadone is a powerful opioid that generally remains in your system for a very long period, it does dramatically increase one’s chances of an overdose.

Some of the symptoms of a methadone overdose are:

• Constricted pupils
• Nail and fingertip discoloration
• Dizziness
• Hypertension
• Loss of consciousness
• Nausea and vomiting
• Respiratory depression in potentially fatal cases

As methadone itself is a central nervous system depressant, combining this drug with other depressants such as alcohol and benzodiazepines can lead to severe complications. Considering that most methadone addicts are also alcoholics has led to unfortunate and fatal situations among users as both substances integrate to induce extremely low blood pressure and respiratory depression. Combining methadone along with any other drug, such as herbal remedies (especially St. John’s Wort), can also be dangerous.

• Between 1999 and 2006, the number of fatal poisoning involving methadone increased dramatically from 790 to 5,420 (This increase was assumed to be related to the increasing use of methadone as pain medication).
• In 2008, 750,000 prescriptions for methadone were written to relieve pain.
• The number of people getting treated for opioid abuse, including methadone, rose from 28,235 to 36,265 (2000 – 2001).
• Although the  Food and Drug Administration does not strongly suggest methadone as a pain killer for chronic back pains and post-surgery pains, more than 4 million prescriptions for methadone were written in 2009. This is believed to have occurred mainly due to the affordability of methadone in comparison to hydrocodone and oxycodone.
• Methadone is linked to one-third of opiate pain reliever-related fatal overdose.

Prolonged use of methadone can cause an individual to develop a dependence upon the drug. This is caused by the body’s reliance on methadone to function on a day to day basis. During this stage, abrupt cessation of methadone consumption can lead to uncomfortable withdrawal symptoms. Due to the adverse withdrawal symptoms of methadone, users are highly advised to seek medical and professional help during detox.

The withdrawal symptoms and duration can vary depending on the severity and duration of the addiction, body chemistry, and drug tolerance of the individual. The withdrawal symptoms of methadone are very similar to that of heroin and morphine.

Many patients struggle with methadone withdrawal because the medication stays in the body longer. Methadone withdrawal symptoms are usually moderate and flu-like.

Some of the common and severe symptoms of methadone withdrawal include:

• Chills
• Fever
• Nausea or vomiting
• Sweating
• Rapid heartbeat
• Stomach cramps
• Irritability
• Paranoia
• Diarrhea
• Cravings
• Insomnia
• Hallucinations
• Depression
• Anxiety
• Muscle aches and pains

Individuals with severe methadone addictions and polydrug abuse are likely to experience prolonged and adverse symptoms of withdrawal.

Methadone detoxification can be just as complicated as heroin detoxification since both opiates affect the body in the same way during withdrawal. Therefore medically-supervised detox may be the ideal option for methadone detoxification. During this process, patients may be prescribed buprenorphine to help ease withdrawal symptoms and to cut down the time it takes to detox. Medical professionals may also combine the tapering down method along with medications to help alleviate the severity of withdrawal. The tapering down method involves the gradual decrease in methadone dosage within a certain period. The weaning or tapering down process should only be performed under a physician’s guidance since they can monitor the dosage and ensure medication compliance.

Individuals who have been prescribed methadone for MAT are usually tapered down to less than 40 mg per day. They are gradually tapered off the drug until they hit 10-20 mg over a few days before the dosage decreases drastically to 2 mg per day. This tapering down phase effectively helps reduce the severity of symptoms, including drug cravings, nausea, vomiting, muscle aches, physical pain, anxiety, profuse sweating, and restlessness. Doctors may also administer naltrexone, in combination with methadone, to further ease the patient’s cravings once a 2 mg dosage is achieved.

Certain drugs, also termed as comfort medicines, may also be prescribed by doctors to help relieve additional withdrawal symptoms. Anti-anxiety medications such as Buspar, clonidine, and ibuprofen are just a few examples of comfort medicines.

In 2011, the National Survey on Drug Use and Health (NSDUH)  reported that nearly 25 million Americans over 12 years of age, approximately 10% of the population, had used illegal drugs in the month prior to the survey, classifying them as active drug users. Addictive substances change the way the brain manages emotions and controls mood. Thus, it is crucial to seek help and treatment for all forms of addiction, legal or illegal.

Drug treatment facilities use the knowledge of doctors and counselors to create individualized treatment plans for patients. In almost all instances, inpatient treatment programs give moderate to serious methadone abusers the greatest chance of successful rehabilitation.

Inpatient facilities also referred to as residential treatment centers, provide patients with round-the-clock medical treatment, a range of therapy programs, and valuable life skills training courses. Treatment plans may differ from one patient to another as each program is designed to fit the individual needs of the patient.

Outpatient treatment is also an alternative for individuals who have been diagnosed with minor methadone addiction by a drug abuse specialist. Outpatient care is also highly recommended for patients who have completed an inpatient treatment as they require additional support and therapy to gradually integrate into the world outside.

There are various stages of outpatient care, including Partial Hospitalization Programs (PHPs), Intensive Outpatient Programs (IOPs), and Standard Outpatient Programs (OPs). Thus, it is imperative for patients to seek professional assistance when determining the right course of outpatient treatment for them.

Upon being discharged from treatment, treatment centers generally recommend aftercare programs to further facilitate the transition from treatment to routine life. Aftercare programs help patients build a healthy schedule, life skills, and relapse prevention techniques, alongside therapeutic support throughout the process. At the end of aftercare programs, patients are encouraged to engage in alumni programs to receive continued support and guidance.