Most opioids are derived from the opium poppy and include heroin, morphine, codeine and hydrocodone. Methadone is a synthetic opioid that is structurally dissimilar to naturally derived products, even though it acts at the same sites in the body. It is the similarity in effect that makes Methadone useful as a treatment for heroin addiction.
The main differences between Methadone and other opioids is that it has a slower onset and lasts longer in the body. This is partly due to the form it is taken – orally, as a syrup instead of by injection – but also a characteristic of the drug itself. Without the ‘rush’ of heroin and without as severe a withdrawal phase, some addicts find that methadone treatment is a middle ground between abusing heroin and complete abstinence. Addicts are more likely to stick with a gradual reduction in methadone dosage than they are with heroin or other opiates.
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Besides its use as a tool to kick opioids altogether, methadone can be prescribed as a daily maintenance drug. A steady, low cost supply of methadone can stabilize heroin addicts and allow them to gain back parts of their lives that have been damaged by their addiction. So although abstinence may be the ultimate goal, methadone as a daily, long-term treatment is also beneficial.
Methadone facts
- Brand Names: Dolophine®, Methadose®, Amidone®
- DEA Drug Classification (U.S.) – Schedule II – special license to dispense, risk for dependence to develop is high.
- Side Effects: Dizziness, drowsiness, lowered respiration rate, constipation, lethargy, elevated mood – these are dose dependent.
- Pharmaceutical Classification: Synthetic Opioid, Analgesic
Benefits of Methadone
Methadone is not a safe drug. Its benefits are only relative to the great harm that addiction to illegal narcotics causes. Reduction in harm is a key philosophy in addiction treatment – the idea that maintaining an addiction to a safer type of drug is less harmful than denying addicts any alternative. Heroin in particular is dangerous, not only because of an unregulated supply (with questionable purity) but also because addicts typically have poor administration technique. This leads to secondary issues such as contagious infections and damage to the circulatory system. The public good is served by reducing healthcare costs when addicts can be switched from heroin to methadone.
Problems with methadone
Although it is less addictive than heroin or morphine, methadone is still highly addictive. It doesn’t produce the quality ‘high’ that other narcotics do, but it has to be tightly regulated so it doesn’t become a problem with naïve users. Methadone can serve as a ‘gateway’ drug for the narcotic class. It is also dangerous in combination with many other drugs that act on the central nervous system, especially alcohol or barbiturates.
Diversion has been a concern of the DEA and the use of methadone requires constant monitoring, both of patients and medical staff who might succumb to over-prescribing or fraud. In fact, there have been cases of physicians who dispensed methadone without due care – in effect, running ‘pill mills’ for cash.
Many addicts do not like methadone and will return to heroin when they are able to procure a new supply. Methadone may be a way to extend an addiction rather than forcing an addict to undergo withdrawal. This is why dispensing of methadone to narcotic dependent patients has to occur along with an approved treatment program. Typically, patients will be tested to make sure they aren’t using heroin ‘on the side’.
The side effects of methadone are problematic. Patients may be refused employment because a job requires mental alertness or the operation of heavy machinery. There are also the social consequences of methadone use – while heroin use may be concealed, if an insurance company is paying for methadone treatment, it is quite likely an employer or others will find out.
Conclusions
When administered properly and taken responsibly, methadone has proven to be both safe and effective for millions of patients. Problems usually occur at the beginning of treatment, when a patient’s opioid tolerance is overestimated, or because the patient is using other drugs in addition to Methadone, such as alcohol or alprazolam (Xanax), both of which can be fatal when combined with methadone. As with all medications, methadone should only be used in accord with a licensed physician or certified health professional.
photo by Rodrigo Valladares
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