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Methadone Alternatives, Side Effects, Withdrawal and FAQs

Methadone is a long-acting synthetic opioid used in opioid replacement therapy. Prescribed as a legal substitute for persons addicted to heroin or other opiates, it helps as part of a harm reduction program. Methadone is also prescribed for pain relief, and has slower effects than other opiates.
Methadone hydrochloride has been in use for pain relief since the late 1940s and a significant body of information about the drug has accrued over the decades.

Originally, the drug was marketed as an all-purpose pain reliever. In 1971, the focus on methadone changed with greater use of the drug focused on harm reduction and detox programs. There are benefits and risks with methadone, as with all drugs.

Methadone is sometimes prescribed as a pain killer, for instance, after surgery. It is also used in harm reduction programs to help persons transition from other opiates, such as heroin, to legal drugs as a form of replacement therapy. It is one of a number of opiate agonists that have been used in opiate addiction treatment programs.

From the years 1999 to 2009, it is estimated that 5,000 people died in the US as a result of methadone use, a six fold increase over that time period.¹ However, since 2009, deaths from methadone have declined in states that did not use methadone as a preferred drug for Medicaid patients, but death rates have continued to soar in states where methadone is a preferred drug for Medicaid patients, according to CDC 2014 statistics.

“Drug overdose deaths involving methadone peaked in 2006 and 2007, then declined 39% by 2014. Despite this decline, however, methadone continues to account for nearly one in four prescription opioid-related deaths.” ²

Below are a number of topics concerning methadone side effects, withdrawal symptoms and other frequently asked questions.

Whether you are considering starting or stopping a drug, it can be helpful to learn as much as possible about it in order to make an informed decision about your health and safety. The information below may be of assistance in doing such research.

What Is Methadone Used for?

Pain Relief:

Methadone was first introduced to the US as a medication for the relief of extreme pain. It is still used for this purpose, although today a doctor would likely prescribe adjunct medications along with methadone in the event that faster relief was necessary, as methadone has a slower onset than other painkillers such as morphine.

Opiate Replacement Therapy:

If a person is in treatment for addiction to other opioids, such as heroin or Oxycodone etc., a physician who is licensed to do so may prescribe methadone to prevent withdrawals, including cravings that otherwise may lead to relapse. When used for this purpose, it might be referred to as opiate replacement therapy, or methadone maintenance therapy, and is taken daily for the duration of the program, or until the decision is made to gradually taper off the drug.

Methadone Alternative Names and Slang

Methadone has acquired quite a number of slang names, and has developed a significant street presence. One reason for its prevalence is that it is addictive, though with less intense effects as heroin or others. Another reason points to the possibility that as a drug used in many community programs, and in some areas is provided free of charge in harm reduction programs, there is just a lot of the drug in circulation. Providing low cost or free methadone is an attempt to reduce crimes related to procuring drugs. However, sometimes the drug will be sold on the street as a means to get money to buy preferred (more potent) drugs.

Street or slang names include; juice, water, chocolate chip cookies, junk, dolls, done, dollies, Maria, jungle juice, “meth”, phy, fizzies, pastora, metho, and many others.

Methadone hydrochloride is also sold under brand names, such as: Diskets Dispersible, Metadol, Dolophine, Methadose and Methadone HCI Intensol. In countries outside the US, brand names include: Polamido, Adolan, Heptanon, Depredol, Mephenon, Heptadon, Ketalgin and Physeptone.

Methadone comes in dissolvable tablets, tablets, and liquid forms.

Methadone Side Effects

Side effects of methadone are similar to other opiates, but euphoric effects are reported as less intense. Some of these undesirable side effects can include:

  • Drowsiness
  • Lightheaded feeling or dizziness
  • Itchy skin, rashes, hives
  • Slowed breathing rate
  • Restless feelings
  • Dry mouth
  • Nausea
  • Vomiting
  • Profuse sweating
  • Loss of libido, sexual disinterest
  • Difficult urination
  • Constipation
  • Slowed or shallow breathing, cannot take deep breaths
  • Swelling in the lips, tongue, throat, face
  • Pain in chest accompanied by rapid heartbeat
  • Hallucinations
  • Mental confusion
  • Lung problems associated with long-term use
  • Change in female menstrual cycle
  • Pregnant women should talk with their prescribing physician before starting or stopping methadone. Aside from drug side effects, heavy withdrawal effects during pregnancy may be harmful to the baby and the mother.

 

Methadone Withdrawal Symptoms

Methadone withdrawals can be difficult to endure, and have been described as similar to other opiates. Some of these symptoms can include:

  • Drug cravings
  • Chills
  • Aching muscles
  • Pains
  • Twitching muscles
  • Flu-like symptoms, i.e. runny nose, sweating, general malaise
  • Bone pain
  • Nausea
  • Vomiting
  • Tachycardia or racing heart rate
  • Fever
  • Diarrhea
  • Stomach cramps
  • Constipation
  • Irritability
  • Anxiety
  • Paranoia
  • Suicidal ideation
  • Loss of focus or to concentrate
  • Hallucinations
  • Insomnia
  • Restlessness
  • Delusions
  • Depression

The withdrawals from methadone, like those of heroin of other opiates, can be long-lasting and severe especially if done abruptly. Gradual cessation is recommended to lessen the severity of these symptoms.

Discontinuing/Quitting Methadone

Withdrawal symptoms appear because the body has to adjust after becoming dependent on the presence of the opiates in the system. It can take a substantial period of time to totally normalize.

It is advisable to undergo methadone cessation, if possible, in a medical or inpatient environment which can significantly help reduce the severity of discomfort when coming off medications such as methadone.

Methadone FAQs

Below you will find further information and some frequently asked questions about methadone and methadone withdrawal treatment. Please contact us for further information which we can freely provide on request.

Is Methadone an Opioid?

Yes. Methadone is a synthetic opioid, derived from opium poppies and produced in a lab.

Treatment for Methadone Abuse and Addiction

Methadone may have filled a useful role in the relief of chronic or moderate to severe pain, or as a way to transition from other forms of opiate addiction. Yet, there may still be a decision to come off the drug for various reasons. At the Alternative to Meds Center, we strive to analyze all available information for each client, including history and other factors and discuss all available options with the client before proceeding.

There are several techniques that have been commonly used, two of which are applicable to those who have a pain diagnosis, for managing the process of withdrawal from an opiate medication like methadone.

Short-acting Opiate Equivalency Method (concurrent pain diagnosis)

This method uses a straight forward approach where there has been a pain diagnosis, by transitioning quite seamlessly to a short-acting opioid prescribed at an equivalent potency. The person continues on this medication for three days, and then it is stopped. This is to enable a steep enough withdrawal to successfully induct Suboxone, which will quickly neutralize the withdrawals. After some days, the Suboxone can be gently and comfortably tapered to zero in approximately 2 weeks. The above method will be made most tolerable using the Alternative to Meds Center process of neurotransmitter replacement protocols concurrently.

Tapering Methadone Directly

A pain diagnosis is not necessary for this technique. Weekly reductions, for example 10mg per week, continue on until the medication is reduced to zero. The process has been described as difficult and possibly even agonizing. Adding a non-opioid medication may lessen the discomfort.

Vicodin/Suboxone Rapid Transition (concurrent pain diagnosis)

In this method, timing is critical for success. Methadone is restricted until withdrawal symptoms begin to appear. At that point, a nominal dose of Vicodin, just enough to avoid intense withdrawal, is given at 4-6 hour intervals, over the next 36 hours. This method prevents severe withdrawals. After the 36-hour window, the Vicodin is stopped. When withdrawals become highly pronounced, a 2mg dose of Suboxone is administered. Timing is important, as if the Suboxone has been given too early, the withdrawals will worsen; and, if so, waiting until the patient is further along into the withdrawal phase is prudent. Concurrently, the patient can be continued on a non-narcotic medication to provide comfort during the additional wait time.

After several hours have passed, the induction of Suboxone can be repeated, at 2mg, and if well-tolerated, adding 4mg in one hour. If the 4mg dose is well-tolerated, then the dose can be increased up to the desired level of Suboxone. After reaching stability on Suboxone after approximately 3 to 7 days, the Suboxone taper process can then begin, gently reducing the dose at appropriate intervals, until reduction to zero is attained.

However, other methods may be more pragmatic, and while the above strategies are still the ones most commonly used, they may not be right for everyone. Please contact us for further information or discussion on the best program and techniques available that would be most appropriate for you or a loved one wishing to withdraw from Methadone successfully.


This content has been reviewed, and approved by a licensed physician.

Dr. Michael Loes, M.D.

Dr. Michael Loes is board certified in Internal Medicine , Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally he is a well published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.

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