Methadone was first introduced in the mid-1940s in the United States, and is known by the trade name Dolophine. It was initially used to treat pain. It can be used I.V. or orally, although the overwhelming majority of prescriptions are for oral use. In fact, use by the I.V. route is very limited and occurs only in the hospital setting. Methadone is an opioid, and is fully synthetic. In later times, it began being used as a replacement therapy for heroin addiction, and as a detox medication for opiate withdrawal.
Methadone has a few properties that are unique to it. One is that it binds to opioid receptors more tightly than most other opiates. Therefore, if taken by one who is also taking another opiate, it tends to displace the second opiate, as it binds to the receptor.
The other peculiarity of methadone is that it sometimes must build up in the body over a period of a few days to have its maximum pain-relieving effects. Even though the effects of methadone are experienced relatively rapidly, it also has a relatively long half-life. The long half-life of methadone helps with stabilizing pain control and makes it a suitable drug for opiate detox and maintenance. In fact, most opioid maintenance programs give methadone only once per day. A second dose may be given in drug detox, if the patient did not get adequate relief with the first dose.
In 2009, Mattick, et. al, reported that those on methadone maintenance therapy was effective in preventing heroin use, but did not change the incidence of criminality or the risk of death. Methadone has been sold on the streets since its introduction. Though it seems to not to create as intense of a “high” as some other opiates, it is still sought after as an illegal drug. Sometimes it is purchased illegally simply to prevent the buyer from experiencing opiate withdrawal symptoms. Others are simply addicted to and prefer methadone. Patients at methadone clinics, whether they receive the medication on site, or have a take-home prescription, have been known to divert the drug and illegally supply it to street addicts.
For those women who are addicted to opiates, methadone has been used for maintenance until delivery, at which point both the mother and child undergo drug detox. It is recommended that opiate-addicted pregnant women not undergo detox, but be maintained on another opioid like methadone or buprenorphine (Subutex) because of the risk of miscarriage. Methadone is also a very effective prescription pain killer. It also seems to be more effective than other opiates for pain caused by a neurologic problem. Although tolerance to sedation and euphoria occur, the tolerance to pain relief seems to develop more slowly than other opioids.
An overdose on methadone can occur rapidly and go unnoticed, as the slowed respirations and heart rate may not be recognized by the user. Although the user may be experiencing an opiate overdose, he/she may remain awake and not recognize the symptoms of an impending overdose until full collapse. Because of this, methadone carries with it very specific dosing and monitoring guidelines. Methadone should always be titrated up in dosage, starting with a low dose and gradually increasing it. This allows the prescriber to closely monitor the patient for effectiveness as well as any signs of overdose.
Side Effects Of Methadone
The side-effects of methadone are similar to that of other opioids and include nausea, vomiting, constipation, sedation, and respiratory and cardiac suppression. One important note is that anyone beginning on methadone therapy will likely have an EKG pre- and post-treatment. This is because methadone has the side-effect of changing the hearts electrical impulses, which can change the cardiac rhythm and lead to a full arrest.
Methadone Addiction Treatment
For those who are addicted to methadone, it is critical that they be tapered down to a low level, such as less than 60 mg per day of methadone before entering an inpatient or residential drug detox. The same applies to those who are on methadone maintenance and wish to be completely detoxified. This is because the maximum dose that can be given, by law, in a drug treatment center is 30 mg in a single dose and an additional 10 mg on a given day, when required. That being said, some addicts and methadone maintenance patients are on upwards of 240 mg per day. The dosage span between 40 mg and 240 mg, for example, is too great and the symptoms will be intolerable and potentially lead to medical complications.
After detox is complete, it is recommended that a methadone addict or former methadone maintenance patient seek treatment in a drug rehab. This can be done at the inpatient, residential, or outpatient levels. In a residential drug rehab, the patient will be monitored 24 hours a day, 7 days a week and receive intensive therapy and life skills training. Removing the addict from his/her environment is oftentimes key to establishing long-term recovery.
If you or a loved one are receiving methadone maintenance therapy or are addicted to methadone, the staff at the National Addiction Institute is here to help you locate the resources you need for your recovery journey.