Methadone is a synthetic, or man-made, pharmaceutical drug derived from the poppy plant. It is prescribed mainly as a replacement drug during treatment for addiction to strong opioid drugs like heroin, and sometimes used as a painkiller medication. It is in the same class as opium, morphine and heroin, and has the potential to be just as addictive.
Methadone is an important medication in the treatment of physical detoxification for opioid addiction, and in this capacity the treatment is known as methadone maintenance treatment, or MMT. It is used as both a tapering drug or as a maintenance drug. Statistics show that treatment for addiction recovery without methadone maintenance has an average 5-10% success rate, but with methadone maintenance boasts a whopping 60-90% success rate.
Due to its low cost and high success rate, methadone is one of the favored medical replacement medications used for drug addiction treatment. It works on the same opioid receptors in the brain as other drugs in its class including the infamous OxyContin. Because of this, strict regulation and oversight are required, and it should only be administered from a facility that is certified as an Opioid Treatment Program, or OTP.
How Does Methadone Work?
Methadone binds opioid receptors in the brain to block pain, much like other drugs of its class. Unlike many other drugs, however, it has no “ceiling effect,” meaning there is no dose limit where it loses its effectiveness; a characteristic that makes it an effective maintenance treatment for heroin and other severe addictions.
Methadone is also a long-lasting drug. This allows the user to feel the effects of it for anywhere from 24 to 36 hours after the dose is taken. But this also means that it stays in the system longer, so even if just a little over the prescribed amount is taken, the potential for overdose is greatly increased. Careful oversight of taking this drug is crucial for safe treatment, and illicit use of the drug should be stopped as soon as possible.
Unfortunately, in our propensity to use medications more than any other treatment for pain, America has an opioid problem, and sadly methadone has become part of the epidemic. In fact, in 2009, one in three deaths by painkillers involved methadone.
Tragically in the same year, over 4 million prescriptions were written for methadone as a painkiller even as the FDA put a black box warning on the drug and advised against using it as a pain medication.
Armed with what we know about methadone and the capacity for its abuse, we might be able to avert methadone abuse. While it may be helpful in addiction treatment, widespread use means there is more of the drug in circulation to be diverted and sold illegally on the street. Methadone treatment that is not properly controlled can easily get out of hand and turn into addiction. Through methadone abuse awareness, both situations can be prevented to avoid the trap of addiction.
Signs of Methadone Use
While methadone is commonly sold as a liquid dose, a tablet or a wafer, some addicts crush methadone pills and snort the powder to achieve a quicker and more intense high. Some users with a more acute addiction may inject it. Signs of abuse may include finding evidence that one is snorting their prescription pills or finding used needles or syringes for no other known medical reason.
If a person has a prescription and is abusing it, you might notice they have an increased tolerance for the drug. This may lead them to attempt to fill the prescription sooner, try to persuade their doctor to increase their dosage or go “doctor shopping” to find one who will write another prescription.
As addiction sets in, physical signs may become more prominent. These may include constant drowsiness or fatigue, irritated skin or rash, constipation and unexplained, unpredictable mood swings. If they are intolerant to the drug, or a new user, they may experience nausea or vomiting, headache, or weakness.
Long term use or abuse of methadone can induce more severe signs such as disorientation, low blood pressure, weak pulse, and respiratory failure. Methadone overdose may occur with extended abuse and symptoms can happen quickly. Signs to watch for are; shallow, labored breathing, bluish skin, weak pulse, uncontrollable muscle twitching, sharp drop in blood pressure, clammy skin, coma and death.
Overdose may onset quickly in a person who has used it for a longer period of time. The high tolerance causes them to seek more of the drug while the long-lasting effect means more of the drug stays in the body longer. This creates a higher risk for accidental methadone overdose. It is imperative to call 911 or your local poison control center if you suspect this has occurred.
Street Names for Methadone
Because methadone is in wide use, the chance is great that one can purchase it on the black market or illegally on the streets. To hide the fact that one is dealing in this drug, street names are often used to ensure secrecy. Knowing some of the street names can help you identify if someone is using. Here is a list of common nicknames, or street names to watch for:
- Jungle Juice
- Chocolate Chip Cookies (when combined with MDMA or Ecstasy)
The most popular brand names for methadone also may be used and include; Methadose, Dolophine and Diskets.
Methadone Withdrawal Symptoms
Methadone withdrawal symptoms may begin about 30 hours after the last dose. The long-lasting effect means the drug lingers in the body longer, which delays the onset of withdrawal. This effect also causes the time frame for withdrawal to last longer.
Early withdrawal symptoms may include sleepiness, restlessness, excessive yawning and anxiety for some. Other physical symptoms may mimic a flu or cold with runny nose, watery eyes and sweating.
Acute symptoms may occur when longer term use of methadone is a factor. These are more prominent when the drug has been abused. These are the same as above with more intensity but may include other acute withdrawal symptoms such as; agitation, irritability, body aches, chills and goosebumps, stomach cramps, diarrhea and depression.
Methadone withdrawal symptoms may last two weeks and up to 21 days if the symptoms are acute. But like any opioid, a severe addiction may result in a syndrome known as PAWS or Post-Acute Withdrawal Syndrome.
PAWS is considered separate from the common withdrawal period and can last for months. While the later phase of methadone withdrawal may last up to 21 days, these symptoms begin around that time. Symptoms and their severity changes and may intensify and diminish in cycles. Some PAWS symptoms are; tremors, sweating, nausea, tachycardia (or rapid heart rate), intense drug cravings and even seizures.
Some psychological symptoms of PAWS may be noticed as the brain chemistry is healing and attempting to balance. As this is occurring, severe or ongoing depression may set in, or anxiety may occur as stress levels increase. This is because for as long as the drug was taken, the “feel good” substances like dopamine and the pathways they use were being artificially stimulated by methadone. Once methadone is stopped, it takes time for the brain to heal and adjust.
Because methadone is an opioid that causes extreme relaxation, stopping it may result in increased anxiety. If alcohol or other drugs were a factor in addiction, this feeling may be intensified. Cognitive impairment may also occur, impairing memory and concentration. The symptoms of PAWS due to methadone addiction or abuse are often temporary and last in correlation with length and intensity of drug use.
Treatment for Methadone Addiction
Suddenly stopping methadone is dangerous and not recommended by addiction professionals. And treatment for methadone addiction it tricky because methadone is the main drug used as a taper down, or replacement drug during medical detoxification. For this reason, a treating physician may use methadone, itself, as the taper down drug.
Taper down is a way of reducing the amount of a drug used each day, which in turn lessens the severity of withdrawal symptoms. The also reduces the craving for the drug until the patient no longer requires it.
Some facilities may use clonidine as a replacement drug, which is a medication normally prescribed for blood pressure. It has been found to be a good replacement, and can ease sweating, anxiety and restlessness. It also may help reduce the amount of time it takes for physical detoxification.
Other medications may be used in addition to clonidine to ease nausea, control pain and help with sleep issues. Finally, naltrexone may be used. This is known as an “opioid antagonizer,” effectively blocking the euphoric effects of an opioid and help minimize cravings that may linger.
Once initial physical detoxification is complete and symptoms are somewhat eased, treatment for methadone addiction will move to the next phase. Mental and psychological therapies for substance abuse issues are necessary to help with ongoing recovery. These may include individual and group counseling, family counseling or more proactive approaches such as Cognitive Behavioral Therapy (CBT), Contingency Management (CM) or Motivational Interviewing.
Individual, group and family counseling are important methods to help the patient work through personal, psychological or environmental factors that may have led to addictive behaviors. Most are available through insurance. Because they may require complete abstinence of any drugs, some programs, such as 12-Step, are avoided as recovering addicts may be using methadone maintenance treatment (MMT) or using a taper down replacement medication. But other options may be more successful.
Cognitive Behavioral Therapy for methadone addiction treatment may include individual and group therapy sessions with a certified CBT counselor. Often used alongside MMT, the patient learns the benefits of treatment, the effects of addiction on all aspects of their lives and then learn more positive behaviors to replace harmful habits or behaviors. It has shown a higher rate of recovery success for patients who use it with and without MMT.
Contingency Management (CM), is the most widely used method in addiction treatment, because of its high success rate. It utilizes positive reinforcements to reward healthy and positive behaviors that helps many people stay on a path of sobriety.
Motivational Interviewing (MI) in a counseling method with a goal of motivating the patient to make healthier and more positive choices instead of self-destructive behavior. Often reserved for those unwilling or unmotivated for change, it has proven successful for those who began with a lack of desire to leave their addiction behind.
Both inpatient and outpatient treatment facilities are options for recovery. Inpatient may be best for someone with an acute addiction profile with co-addictions or long-term addictions. Residing at the facility allows medical oversight to ensure safe administration of taper down or replacement medications is utilized correctly. Various methods of therapy and counselors are often available on site to help with substance abuse and addiction disorders.
Outpatient treatment is also a valid recovery option. In this case a patient checks into a hospital or clinic for daily or regular administration of replacement or recovery drugs. A patient not using transition drugs can be checked regularly and given medications to aid in withdrawal symptoms such as restlessness or nausea. These facilities offer therapies, counselors and programs for mental and psychological health. Some places may offer life skills or job training classes.
Methadone addiction and abuse are dangerous. Its use in addition treatment often gives people a false sense of security that the drug is safer than other drugs. If you or a loved one is addicted, get help right away. It’s never too late and recovery is possible for everyone.
- Methadone Addiction: Signs, Withdrawal & Treatment. (n.d.)
- Get Smart About Drugs. (n.d.)
- Pan, S., Jiang, H., Du, J., Chen, H., Li, Z., Ling, W., & Zhao, M. (2015). Efficacy of Cognitive Behavioral Therapy on Opiate Use and Retention in Methadone Maintenance Treatment in China: A Randomised Trial. PloS one, 10(6), e0127598. doi:10.1371/journal.pone.0127598