Methadone is a synthetic opioid painkiller used primarily in the treatment of opiate addiction, especially heroin addiction. However, in the past two decades, methadone has increasingly been prescribed to treat chronic pain that has not responded well to other medications. People with methadone prescriptions can ingest this medication in pill, liquid, or powder form. Sometimes, methadone is injected.
Intended Use and Addiction Potential
When used as prescribed, methadone is used as a maintenance therapy to help people who struggle with opiate addiction by easing withdrawal symptoms. The drug binds to the same receptors as opioid drugs like heroin or oxycodone, so it can create some of the same relaxed, drowsy side effects. For people who have struggled with heroin or opioid painkiller addiction, methadone should not produce the same euphoric effects due to its slow onset; however, for people who take methadone as a prescription painkiller and who have not built up a tolerance to this drug, methadone can induce a “high.”
Methadone is used primarily in the United States. The general recommended length of methadone maintenance treatment is at least 12 consecutive months, although some patients have been on methadone maintenance therapy for decades.
Because methadone works essentially the same way that opioid drugs do, it can become addictive. Due largely to changes in prescribing practices and the use of methadone as a painkiller, more people are beginning to overdose on methadone. The Drug Enforcement Administration lists methadone as a Schedule II drug, meaning that the medication has a medical use but also a high potential for abuse.
Symptoms and Side Effects of Methadone Addiction
- Poor coordination
- Euphoria or a “high”
- Drowsiness or inability to stay awake
- Taking more than prescribed
- Inability to stop taking the drug
- Cravings for the drug, and concern or anxiety about when the next dose will come
- Stealing, forging, or illegally purchasing prescriptions
- Hostility when asked about the drug
- Doctor-shopping to get more of the drug
- Poor decision-making
Side effects of long-term methadone use, or methadone abuse, include:
- Upset stomach
- Nausea or vomiting
- Shallow, slow, or depressed breathing
- Chest pain
- Dizziness or fainting
- Drowsiness or fatigue
- Rapid or irregular heartbeat
- Flushing cheeks
- Anxiety or depression
How Addiction Develops
Although methadone is sometimes a recommended therapy to help people overcome heroin addiction, this medication itself can become addictive. People who struggle with addiction have a disease characterized by the inability to control compulsive behaviors, including consumption of drugs or engaging in harmful or dangerous activities. The mechanisms of addiction are just beginning to be understood, but people who are addicted to one drug are at a higher risk of struggling with addiction to other drugs later. For people who receive methadone prescriptions to treat heroin or opioid painkiller addiction, their chances of becoming addicted to methadone and abusing this drug are high. People who receive methadone prescriptions as maintenance therapy are also likely to develop a tolerance to the medication, so they may begin craving more of the drug in order to receive the same effects. Addiction and tolerance are not the same condition, however.
When a person has used other prescription painkillers for chronic pain, and these no longer work, doctors are increasingly turning to methadone as a painkiller. Because it is a generic drug, it is often inexpensive for the patient. Typically, doctors treating patients with chronic non-cancer pain are less concerned about addiction to painkillers due to their patients’ needs. This group is, unfortunately, more likely to accidentally overdose on methadone. According to the Centers for Disease Control, methadone contributed to one in three prescription painkiller deaths in 2009, and about 5,000 people die every year from overdoses involving methadone. Only 2 percent of painkiller prescriptions are for methadone, yet it accounts for about one-third of overdose deaths.
Methadone Addiction Statistics
The DEA notes several research surveys focused on the increase in methadone abuse in the United States. The National Survey on Drug Use and Health reported an increase between 2011 and 2012 in nonmedical use of methadone: In 2011, 2.10 million people ages 12 and up used methadone for nonmedical purposes, and this went up to 2.46 million people in 2012. The Drug Abuse Warning Network’s report estimated that, in 2011, there were 66,870 emergency room visits involving nonmedical use of methadone.
Risks of Abusing Methadone
The greatest risk of methadone addiction or abuse is overdose. The Food and Drug Administration reports that the painkilling and euphoric effects associated with methadone last between 4 and 8 hours; however, doses of methadone are typically prescribed to be taken every 12 hours. This means the patient taking methadone, either for maintenance or as a painkiller, is likely to begin craving the drug before it is safe to take their next dose. Potentially harmful respiratory depression from a dose of methadone can remain in effect for 59 hours, meaning that an extra dose can easily lead to depressed or stopped breathing, overdose symptoms, and even death.
People who receive a prescription for methadone may also not feel any of the effects of the medication for 3-5 days at regular doses, which can be very frustrating. This can lead to taking too much of the medication to feel its effects, and this can cause an overdose.
According to a report from the American Society of Addiction Medicine (ASAM), there are three patterns leading to methadone overdose. These are:
- Single overdose: Overdose can occur on the initial dose, especially in a person who has no built-up tolerance for opioid medications or in people who have lost their tolerance over time.
- Accumulated toxicity: Because methadone remains in the body for a long time, toxicity can build up even if the individual does not feel the effects of the medication. Doses can accumulate over several days and lead to respiratory depression.
- Combining methadone with other drugs: Other central nervous system (CNS) depressants, alcohol, sedatives, and stimulants should all be avoided while taking methadone.
Mixing methadone with other prescription or illicit drugs dramatically increases the risk of overdose death as well. At least half of reported opioid-related deaths in 2012 involved other drugs: Heroin or cocaine were involved in opioid overdoses 15 percent of the time, while Xanax or Valium (both benzodiazepine medications used to treat anxiety, insomnia, or panic disorders) were involved 17 percent of the time.
There are other long-term effects of methadone use or abuse, including breathing problems, changes in the menstrual cycle, hormone disruption in both men and women, and dangerous interactions with other drugs and alcohol.
Overdose and Withdrawal Symptoms
- Slow or shallow breathing
- Bluish tint to fingernails or lips
- Clammy skin
- Stomach cramping
- Weak pulse
When a person stops taking methadone or lowers their dose after physical dependence has taken hold, withdrawal symptoms will take place. These symptoms are not life-threatening but they can be very uncomfortable. Methadone withdrawal symptoms include:
- Excessive sweating
- Nausea or vomiting
- Intestinal issues
- Appetite fluctuations
- Anxiety or depression
- Petulance and mood swings
- Trouble sleeping
Because methadone releases slowly into the body, it can take days before withdrawal symptoms begin. On average, most people begin to feel methadone withdrawal symptoms 30 hours after the last dose. The most intense symptoms occur in the first week of withdrawal, but symptoms can continue for weeks after the last dose.
Although tolerance to methadone declines quickly during the detox process, cravings for the drug do not, which can be dangerous for people attempting to detox cold turkey. It is very important for people who want to overcome their addiction to methadone to undergo medical detox to ensure success and safety throughout the withdrawal process.
Comprehensive Addiction Treatment
While detox is a critical part of the recovery process, it does not make up addiction treatment on its own. It must be followed with comprehensive therapy to address the underlying reasons that led to methadone abuse in the first place.
Therapy comes in a variety of forms, and the specific therapies used will vary from person to person. It is critical that treatment is tailored to the needs of each individual client in rehab to ensure that all personal issues are addressed effectively and in a manner that best ensures long-term success.