Opioid addiction is incredibly difficult to overcome, and methadone is one of the most commonly-used treatments in the United States. However, methadone is not a cure for opioid addiction or a replacement for prescription opioid painkillers or heroin. Methadone is a maintenance drug that can help a person struggling with opioid addiction handle the associated withdrawal symptoms with less discomfort.
Methadone in Addiction Treatment and Medicine
Methadone is a synthetic opioid that acts as an agonist. An opioid agonist essentially blocks the opioid receptors in the brain without causing the typical euphoria and psychoactive effects as heroin or other opioids. It is a long-acting drug that functions as an opioid replacement.
When an individual with an opioid addiction stops taking doses of opioids, the withdrawal symptoms can be unbearable or even life-threatening. Methadone helps these individuals more easily manage their withdrawal symptoms and maintain sobriety more easily. It also functions as a treatment for some types of chronic pain but does not carry the same risk of addiction as other opioids.
Methadone first saw widespread use during World War II when morphine supplies ran low. Methadone offered similar effects at a much lower cost, and eventually the Food and Drug Administration (FDA) recognized its value as a treatment for opioid addiction. Methadone is also a common treatment measure for patients struggling with certain types of chronic pain or undergoing surgery.
The most common use of methadone is as an opioid replacement. An individual addicted to heroin or prescription opioid painkillers will experience a wide range of unpleasant and even dangerous side effects. Methadone offers an easier transition away from more harmful opioids; however, it does carry a risk of abuse and addiction.
Tapering With Methadone
When a doctor recognizes that a patient needs opioid replacement therapy, he or she may prescribe methadone as a form of maintenance therapy until the patient is ready for full detox. Methadone generally exists in liquid, pill, or dissolvable tablet forms. A patient follows a methadone prescription’s instructions in an effort to gradually wean off the drug. Many community assistance programs and substance abuse clinics offer methadone free of charge as a harm reduction measure. These programs also aim to reduce crime related to procuring drugs. Unfortunately, many people will simply take the free methadone and sell it on the street to procure their preferred drugs.
Opioid addiction escalates very rapidly because the drug causes a user to develop a tolerance in a short amount of time. After abusing opioids for a while, the user will eventually need larger and larger doses to achieve the desired effects. This inevitably increases the risk of an overdose, as an individual in need of a stronger dose of opioids may use more than usual, and there is no way to tell the strength of opioids purchased on the street or identify what other substances a dealer may have added to them. Once tolerance develops, the individual will feel withdrawal symptoms more acutely. Some of those symptoms include:
Intense cravings for more opioids
Irregular heart rate
Fever and sweating
Nausea and stomach cramps
Irritability, confusion, and unpredictable mood swings
Symptoms of depression and anxiety
Without immediate treatment, opioid withdrawal can very quickly turn fatal. Methadone functions as a maintenance treatment that prevents the onset of withdrawal symptoms without causing the euphoric effects that amplify addiction, but only when people suffering from addiction use it properly.
How Does Methadone Work?
Methadone effectively alters the way the brain responds to pain. It blocks opioid receptors in the brain, preventing the individual from feeling the euphoric effects of other opioids like heroin while offering relief from opioid withdrawal symptoms. It is important to note that methadone is not a self-contained opioid addiction treatment; it should be part of a comprehensive system of treatment that addresses an individual patient’s unique needs.
Since methadone carries potential for abuse, patients may only receive a prescription for methadone maintenance therapy from a prescribing doctor and generally receive their doses under supervision. Once a patient has proven consistently responsible use of the drug, the prescribing doctor may allow the patient to take the medication at home between office visits. The law requires any methadone prescription to come through an officially recognized opioid treatment program certified by the Substance Abuse and Mental Health Services Administration.
Withdrawal Symptoms and Side Effects
While methadone can be an effective initial treatment for opioid addiction, it does carry its own risk of addiction as it is also an opioid. Methadone generally does not cause the same level of euphoria as other opioids. But individuals who abuse methadone by snorting crushed pills or melting and injecting it directly, experience more intense effects. Methadone is a generally reliable form of opioid replacement therapy, but it demands responsible use.
It is not without side effects, either. In addition to a risk of addiction or replacing one addiction with another, those who take methadone also commonly report several side effects, including:
Respiratory issues, such as difficulty breathing
Trouble with swallowing
Rapid or irregular heartbeat
Confusion and irritability
Hives, rash, or swelling of the face, throat, tongue, and lips
Pregnant women who take methadone usually do not have to worry about it resulting in birth defects, but the baby may develop neonatal abstinence syndrome and require treatment at birth.
Methadone treatment may continue for several months or even several years depending on the patient’s condition. Some people suffering from chronic pain experience adequate relief from consistent methadone treatment. But there is a caveat here. They inevitably face a risk of developing a tolerance, experiencing diminished relief from their pain, and feeling tempted to take more than prescribed or use an unapproved delivery method for more potent results.
Methadone is a reliable treatment for chronic pain and opioid withdrawal, but it demands appropriate use. Any patient who starts to experience diminished efficacy or withdrawal symptoms between methadone doses must report these issues immediately to their prescribing physician. Patients who rely on methadone for pain relief generally do not experience addiction or withdrawal when they follow their prescription directions properly. However, their pain symptoms may worsen over time, reducing the efficacy of their methadone prescription and encouraging inappropriate use.
Doctors also prescribe a specific dosage amount per patient. One patient’s dose could be significantly higher than another patient’s dose, so sharing the drug is very dangerous. Patients should never take additional methadone after a dose wears off because the active ingredients remain in his or her system long after the initial effects subside. This can lead to an unintentional overdose or increase the risk of addiction.
A prescribing doctor must ensure no dangerous interactions with a patient’s existing prescriptions and advise whether there are any potentially dangerous interactions when taking over-the-counter medications. Methadone can also interfere with the ability to safely operate a vehicle or heavy machinery. Anyone taking methadone on a consistent basis should refrain from consuming alcohol, even in small amounts. The combination of opioids and alcohol can lead to respiratory depression, a fatal condition responsible for the majority of opioid overdoses.
Alternatives to Methadone Treatment
Although methadone can be a valuable addition to any opioid addiction treatment plan, it is not a long-term solution. Those that benefit from methadone generally report the best results when they use methadone to transition from opioids to sobriety through a drug rehab program. Many of the methadone clinics and community support centers offering low-cost or free methadone to people struggling with addiction enforce strict taper-down policies, requiring patients to receive increasingly smaller doses over time.
Unfortunately, tapering is not a requirement in many methadone clinics and community treatment centers. Some people essentially replace addiction to one opioid with addiction to methadone, requiring consistent doses to avoid the associated withdrawal symptoms.
Treatment beyond Methadone
One of the most difficult aspects of opioid addiction treatment is many patients’ fears of withdrawal; they have heard the stories or seen others go through opioid withdrawal and they want to avoid the experience at all costs. Methadone can potentially aid the detox process, but anyone who wants to recover from opioid addiction must acknowledge the addictive properties of methadone and avoid replacing one addiction with another.
People struggling with addiction who use methadone as a transitional treatment from other opioid addiction to detox generally report positive results. Methadone can be the catalyst that encourages an individual with an opioid addiction to take charge of his or her situation and seek professional help. As long as he or she uses methadone responsibly and enters a comprehensive treatment program, methadone can be a valuable element of the recovery experience.
Ultimately, methadone is an opioid and carries a significant risk of abuse and addiction, but when used correctly and responsibly it can offer relief from the serious withdrawal symptoms that accompany opioid addiction. Anyone considering methadone as a treatment for an ongoing opioid addiction must consider methadone a temporary treatment that paves the way to detox and rehab.