Drug addiction is a very real and a tremendously difficult public health problem to deal with across the world. Those who are addicted to opioids (such as heroin, oxycodone, morphine, etc.) often feel helpless to get themselves out of the situation. Trying to break free of the downward spiral is often the toughest decision of their lives as the withdrawal symptoms from stopping opioids are notoriously difficult to deal with, but a drug named Methadone can prove particularly useful. But what is Methadone and how can it help?
Methadone is also an opioid, but it decreases cravings and reduces withdrawal symptoms in people who have made the decision to stop taking opioids. Short story is that is helps take the edge off the withdrawal stage so that the addict can get through to the other side, and stay clean. In addition to this, Methadone is also used as a pain killer in some countries due to its pain killing effects similar to Morphine.
Statistics on Opioid Addiction
To put it in perspective, according to the European Monitoring Centre for Drugs and Drug Addiction:
- approximately 1.4 million people in Europe are considered to be addicted to opioids (like heroin, morphine, oxycodone, etc.)
- upto 20,000 people are thought to die from an opioid overdose (as well as related diseases & issues) each year
As you can see, preventing and treating drug addiction is an unfortunate yet a crucially necessary undertaking, as it can destroy lives, far beyond those of the actual drug users.
Most people don’t think of it in this way, but not only are the drug addicts themselves affected, but their family members and friends feel the helplessness and grief when the addicted individual is in the grip of the addiction.
Not only are drug users at an increased risk of health complications (due to overdose and related conditions such as hepatitis & HIV through sharing used needles), but they are also vulnerable to being afflicted with infectious diseases due to engaging in risky behaviour to get their ‘fix’, as well as death.
In addition to this, in an effort to ensure they can maintain their habit, drug users are more likely to resort to violence, prostitution and other forms of criminal behaviour.
Trying to leave that life behind, and make a change for the better can be, and is often, the most arduous & gruelling decision a drug abuser will make. Methadone is currently licensed to help reduce the withdrawal symptoms, thus making getting ‘sober’ significantly more achievable.
What Is Methadone Used For?
Methadone is prescribed as part of a detoxification regimen to aid drug abusers in getting off opiates, heroin in particular. This does not necessarily mean all those on Methadone were previously addicted to heroin. Many patients on Methadone treatment programs are on it after getting addicted to prescribed painkillers such as Oxycodone and Morphine.
Doctors may prescribe these opiates to help patients deal with severe, and often chronic, pain (such as cancer or back pain for example), and people on them long term can get easily addicted, often without realising that it is happening.
Although treating drug dependence is often a controversial topic, helping prevent drug addiction by properly educating patients taking opiate pain killers and providing better community structures to deal with early signs of drug dependency can notably play a role in preventing this widespread problem.
For those who become addicted and actively seek to improve their situation and turn their lives around, Methadone can be prescribed by Doctors and dispensed by certified pharmacies within the community. Often a referral by the community drug team is made, but in some cases, the physician may handle the prescribing off their own initiative.
In a community setting, Methadone is taken orally. Patients are either given the medication to take under the supervision of a Pharmacist (i.e. within the store), or they may be given the Methadone to take home.
It is sometimes common to see Methadone users to associate with other addicts, live with other drug users, or be easily influenced by street users, which increases the risk that they may not take their Methadone dose for a number of reasons.
They may be burgled, or forced to share their Methadone therapy, be at risk of overdose, or even try to sell the Methadone in the streets in which case the community drug liaison team may advise the Doctor that the patient should be on supervised Methadone therapy.
As acquiring the heroin can be dangerous in itself and the purity of the drug is never corroborated, and then the method of usage of it can prove to be harmful too, providing Methadone serves another important purpose – it allows users to get off the illegal opiate safely whilst preventing them from being ostracised members of the society.
Is Methadone an Opiate?
As a Pharmacist dealing with not only Methadone patients themselves, but also with concerned family members seeking more information, a common question I get asked is: ‘Is Methadone an Opiate?’. Many doubt the effectiveness of the therapy once they are informed that Methadone is in fact an opiate.
Due to the fact that Methadone is a longer acting opioid, it delays (and lessens the severity of) the ‘low’ the user may feel a short while after taking heroin.
To get a little more technical, Methadone is a synthetic mu-opioid receptor agonist, and copies the action of endogenous opioids and endorphins, resulting in a plethora of actions:
- analgesic (pain killing)
- respiratory depression
- prevents coughs
- decreases bowel movements
- increases prolactin and growth hormone release
- constriction of the pupils
- low blood pressure
As the receptors are stimulated, just like they would be in response to other opiates binding to them, this limits the cravings and prevents the patient from going into withdrawal.
Many people find the physical withdrawal symptoms much more difficult to handle than the psychological withdrawal, and this is another reason why Methadone is a good option and tends to work for those who really do wish to get clean.
Does Methadone Block Opiates?
Is Methadone an opiate blocker? This is another commonly asked question, but one that has no straightforward answer. In short, yes it does block opiates…to some extent, depending on the Methadone dose & how long ago it was taken.
To explain further- once Methadone binds to the mu-opioid receptors in the brain, it occupies the receptors that other opiates such as Fentanyl, Morphine, Oxycodone or even heroin would bind to, so in this way you can say that it acts as a ‘blocker’ as it prevents them from binding to the same sites on the receptors. It is not however an opioid receptor blocker (or antagonist).
This means that once other opiates get into the system (and this is sometimes the case with users, as they may take their daily dose of Methadone and then take a heroin hit later in the day), they may still have a minimal effect because depending on the dose of Methadone and how long ago it was taken, all the mu-opioid receptors in the brain might not be saturated.
Methadone Half Life
This is where it gets a little more complicated. Another reason why Methadone acts as a blocker to other opiates is because of the amount of time it stays bound to the opioid receptors.
Methadone has a relatively long half life, which means that it takes much longer for the concentration of Methadone to drop to half the administered dose than other opiates. It takes anywhere between 8-40 hours for Methadone concentration to drop to half its therapeutic dose, keeping the patient stable, and preventing them from craving or going into withdrawal.
In other words, the brain has a steady concentration of Methadone to occupy its opioid receptor sites for hours (often until the next dose, the next day). The good thing about this is that the patient is less likely to engage in risky behaviour trying to procure illegal narcotics as the Methadone is effectively keeping the cravings at bay.
An important point to note is that the pain killing effect of Methadone lasts for a much shorter period of time (around 4-8 hours) which means that they may need to top up their Methadone dosage after that time.
Dosing regimens for Methadone for pain relief needs to be carefully monitored due to its long duration of action. Taking multiple doses of Methadone on the premise that the analgesic effect has worn off does not account for the fact that the drug itself is still present in system, so taking more and more doses in an attempt to achieve pain relief can result in a massive build up of Methadone in the body. This of course can lead to Methadone toxicity, which is why it is essential to keep a tight eye on dosing regimens for Methadone.
Side Effects of Methadone
It is important to understand and recognise the adverse effects of Methadone, and know when to seek medical help if necessary. To summarise, Methadone side effects are similar to the effects associated with other opiates.
Nausea and vomiting can occur in 20% of patients, making it the most likely side effect. The most serious side effect however is respiratory depression, which means ventilation is inadequate to allow gas exchange (oxygen to be taken into the body, and carbon dioxide to be released from the body) causing a build up of carbon dioxide. If left untreated this can rapidly progress to respiratory arrest (breathing stops) which can easily be fatal.
Some may experience breathing problems during sleep, shock or even cardiac arrest. Euphoria, hallucinations, drowsiness, dry eyes, blurred vision, constricted pupils, dizziness, lack of balance, constipation, weight increase, sweating, and fatigue are all relatively common side effects of taking Methadone.
Over time the adverse effects of Methadone can become more manageable, but it is essential to be aware of alarming side effects so that if you start experiencing them, you can seek medical attention immediately.
Symptoms of Methadone Overdose
It is absolutely essential that people on Methadone are aware of the dangers of not only mixing opiates together, but also taking higher than prescribed dosages of Methadone. Both of these scenarios can easily result in an overdose which can rapidly lead to death if not treated in time.
Working in the pharmacy, I have had patients openly tell me that they were forced to be on Methadone, and were still going to take a ‘hit’ later that day. This is worrying for two main reasons.
Firstly, what is Methadone for? One of its most vital uses is to specifically aid drug users in getting off heroin, hence preventing them from overdosing, engaging in risky behaviour, getting infectious diseases and also to enable them to be functional, productive members of the society again. Taking Methadone and then taking a heroin hit invalidates all that.
Secondly, taking heroin (or any other opiate) alongside Methadone is an incredibly dangerous practice as it can lead to fatal cases of overdose. As explained earlier, Methadone takes up the receptor sites where other opiates such as heroin or oxycontin would usually bind. This means that despite taking Methadone (which does not provide a ‘high’ like heroin) and heroin together, the user may still not feel high, leading to them increasing the doses of one or even both of the opiates.
This can obviously lead to massive build up of opiates in the body, which coupled with the fact that Methadone has a very long half life, can result in toxicity and accidental overdose, and eventually, death.
Symptoms of a Methadone overdose may not be immediately apparent, especially if mixing opiates together, which makes it all the more important that users are well informed of the signs to watch out for.
Withdrawal from Methadone
Once a patient is initiated on Methadone, the way the regimen is organised is to gradually wean them off the Methadone without risking them returning to prescription opiates or even heroin.
Generally, the daily dosage of Methadone is reduced by a one or two millilitres every few months, rarely any sooner. This ensures that the individual patients opiate dependency is accounted for, and the dosage regimen is tailored to their needs without risking a relapse.
If the Methadone is abruptly reduced or stopped, it can result in withdrawal from Methadone which can result in muscle aches, chills and sweating, fever, anxiety and depression, nausea or vomiting, rapid heart beat, diarrhoea, physical cravings, sleeplessness and hallucinations, and even paranoia.
Although the symptoms of Methadone withdrawal are less intense than with heroin or other opiates, depending on the daily dose of Methadone that person was taking, the withdrawal can be very gruelling.
This is why if you want to get off Methadone, it is best to work out a withdrawal plan with your drug counselor to ensure that you do it in a safe and successful manner without suffering from intense withdrawal from Methadone.
Benefits of Methadone for Opiate Dependent Patients
For patients who are addicted to opiate pain killers such as Fentanyl, Oxycodone, or Morphine, and wish to get clean, Methadone is an ideal choice. It provides pain relief, and users can be weaned off the Methadone under a treatment program without having severe cravings or withdrawal symptoms.
Additionally, Methadone proves to be particularly useful in the treatment of heroin addiction. It serves multiple important functions. Firstly, it helps prevent cravings and delays the onset (and severity) of withdrawal symptoms. This improves the outcome for the patient as it makes it more likely they will succeed in getting clean.
Secondly, as the patient is getting a daily dose of Methadone, this reduces the chances of the user taking to the streets to buy heroin. It also cuts the risk of engaging in antisocial or illegal behaviour in order to get it.
Lastly, a successful Methadone treatment regimen boosts the patients chances of reintegrating into society even whilst they are on it.
In summary, when people ask ‘what is Methadone?’, yes, it IS an opiate. Yes, it DOES have side effects (similar to those of other opiates). And yes, there is a possibility users can overdose on it (especially if they mix other opiates with it). All these points do not invalidate the plethora of benefits Methadone has when it is used in the correct way as part of an agreed treatment plan.
If you have any other questions about this medication, or would like to discuss addiction with a health professional, please do not hesitate to contact your doctor, or community drug team. You can also use our contact form to reach a qualified Pharmacist who can give you professional medical advice.
If you feel this article could provide some clarity to someone suffering from opiate dependency or addiction, or could give a loved one more information about Methadone as a treatment option, then please share this post. If you have had experience with Methadone or opiate addiction, either personally or as a supporter whilst a loved one goes through it, then we would love to hear success stories, please comment and share your story below!
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