Methadone is most commonly used to treat withdrawal from heroin and other opioids.
Methadone
Many people associate drug methadone with heroin abuse treatment. However, because it is both inexpensive and effective, methadone is one of the more commonly prescribed drugs for individuals suffering from chronic pain.
Methadone is a synthetic opioid drug that is man-made and has been used in the treatment of opioid abuse for many decades. It became popular in the 1960s to address the heroin epidemic of the time but was later abused on a large scale. As a result of the Narcotic Treatment Act of 1974, prescriptions are still restricted to specific pharmacies and doctors.
According to the latest data presented by the Substance Abuse and Mental Health Services Administration (SAMHSA):
- An estimated 1.4 million individuals admitted to some lifetime use of methadone in 2016. In 2017, this figure was 1.3 million individuals.
- An estimated 346,000 individuals admitted to misusing methadone at least once in 2015. On the next survey, 261,000 individuals admitted to misusing the drug in 2016.
Methadone and the Treatment of Opioid Use Disorders
The criteria used to determine the treatment plan for someone with a substance use disorder are standardized by the American Society of Addiction Medicine (ASAM) and other organizations. For each person in need of treatment, medical professionals consider:
- The potential for the drug to produce withdrawal and intoxication in the person
- All medical complications and conditions of the person
- Cognitive, emotional, and behavioral issues
- The readiness of the person to change their behavior
- The potential for relapse and other issues in recovery
- The person’s living environment and how that could either foster or inhibit recovery
Individuals with substance use disorders who are evaluated according to the above criteria are typically placed on some type of medication-assisted treatment (MAT) to address the withdrawal syndrome they will experience in the initial phases of treatment. In some cases, MAT might extend past the withdrawal period.
Methadone as MAT
The opioid epidemic has drawn significant attention to the misuse of prescription opioids in the United States.
Though data collected by organizations like SAMHSA indicates that there is a decreasing trend in the use of prescription opioids, there is also an increase in the number of overdose deaths associated with the drugs. Due to the increase in overdose deaths, it is generally considered that MAT is underutilized.
The development of physical dependence, such as high tolerance and withdrawal, significantly complicates the development of an addiction. The intense withdrawal symptoms associated with opioid abuse are why individuals might relapse in the early stages of recovery and feel reluctant to seek treatment for their substance use disorder.
MAT that includes methadone has been developed to address the taxing withdrawal syndrome associated with recovery from opioid abuse.
An Opioid Replacement Medication
MAT is the use of medication in combination with other interventions, such as therapy, to address specific aspects of a substance abuse problem.
The American Psychiatric Association (APA) outlines the best strategies for managing the physical dependence that occurs with opioid abuse. These strategies involve:
- Abruptly discontinuing abuse of the opioid and using medications to block the withdrawal symptoms that will inevitably occur.
- Using opioid replacement therapy with a gradual taper. These are medications designed to replace the effects of opioids and block withdrawal. They are administered in a way that reduces the dosage over time.
- Using different combinations of drugs to address specific symptoms that occur during recovery.
Treatment for opioid use disorder can involve just one strategy or any combination of them.
The use of a tapering strategy, for example, is designed to help the person get through the withdrawal process while entirely weaning them off opioids. Using a replacement medication to avoid withdrawal symptoms can be either a short-term strategy or long-term strategy.
While methadone is most often used in the treatment of heroin abuse, it can conceivably be used for any opioid use disorder. It can also be used according to any of the strategies outlined above.
Effectiveness
There are several advantages to using methadone in the treatment of opioid use disorders, such as:
- Comfort. People taking methadone will not experience cravings for heroin and other drugs. They will not undergo withdrawal and may stop using their opioid of choice.
- Affordability. Methadone is relatively inexpensive compared to other opioid replacements.
- Safety. Methadone treatment has been deemed safer than other forms of opioids for women who are pregnant. However, there is some controversy surrounding the use of methadone by pregnant women.
- Accessibility. Methadone use is legal if the person has a prescription for it, whereas heroin use is illegal.
Although methadone can be administered on a tapering schedule, it is often used as a replacement drug for chronic heroin abusers. Therefore, it may be administered on a long-term or indefinite basis.
Methadone Maintenance Programs
Methadone maintenance programs, or methadone maintenance treatment (MMT), describes a common practice used for individuals who have abused heroin for some time.
Individuals in MMT programs do not participate in the tapering phase of the program because they are not expected to wean themselves off the drug entirely.
Instead, these individuals maintain use of methadone indefinitely in place of use of heroin. This practice continues because it is considered:
- Cost-effective for people who have significant histories of relapse, recovery, and then relapse.
- Useful in reducing crime associated with those who have chronic heroin abuse issues.
- 10 times less expensive than the cost of incarceration for people with chronic heroin abuse issues.
- Useful in reducing the spread of disease associated with needle-sharing practices among chronic heroin users.
The Downside of Long-Term MMT
Older research studies looking at individuals placed on methadone for three months or less indicate that these individuals do not often progress in their programs, especially if they are long-term heroin abusers.
There are several downsides to the use of long-term MMT, such as:
- The development of physical dependence on methadone. Critics of the process suggest that society is just replacing one addiction with another and not “treating” anyone in these programs.
- The ineffectiveness of MMT programs for individuals who are polysubstance abusers. This represents a significant portion of the population experiencing chronic heroin abuse issues, such as individuals who abuse both cocaine and heroin.
- The failure of MMT programs to address other psychological disturbances that are common in individuals who have opioid use disorders.
- The failure of these programs to fully address issues associated with criminal activities, particularly in individuals who illegally sell their methadone to others or have issues with polysubstance abuse.
Can Someone Use Methadone Maintenance Without Medical Supervision?
Methadone is a very potent synthetic opioid. It is listed as a controlled substance and placed in the Schedule II classification.
Although drugs in this classification are considered to have useful medical applications, they are considered to be dangerous drugs of abuse that can lead to serious physical dependence in a very short time. They also can result in potentially fatal overdoses.
It is illegal for anyone to possess or use these drugs unless they have a prescription for them. Therefore, no one should attempt to obtain methadone without a prescription from a physician.
A person cannot legally or safely use methadone if they are not under the treatment of a physician.
Methadone Overdose Issues
According to the U.S. Centers for Disease Control and Prevention (CDC), the prescription rate for methadone increased until 2009, when it then tapered off and began to decline.
Methadone overdose deaths followed a similar pattern, accounting for nearly one in three deaths associated with prescription painkillers in 2009. Currently, methadone accounts for about one in four overdose deaths associated with prescription painkillers.
According to the World Health Organization (WHO), individuals who are at an increased risk for an overdose on opioid drugs include:
- Those who have previous opioid dependence, particularly individuals who have reduced tolerance following medical detox or some other period where they have not been exposed to the drug of abuse.
- Those who inject opioids.
- Those abusing prescription opioids.
- Those who use opioids and have other medical conditions or psychiatric conditions, including depression or HIV.
- Those who abuse opioids in combination with other substances that produce sedation, such as alcohol and benzodiazepines.
- Those who live in the household of someone who has a prescription for an opioid.
Many people who are on MMT, or who are following a tapering strategy that uses methadone as an opioid replacement medication, are at an increased risk for overdose. They should only be using the drug under the supervision of a physician and as part of their overall treatment recovery program.
How to Get Involved in Methadone Treatment
The safest and most productive way to get involved in a methadone treatment program for opioid abuse is to discuss your situation with an addiction medicine physician or psychiatrist who specializes in the treatment of addictive behaviors.
The professional will perform a full assessment and place you in a substance use disorder treatment program or MMT. If appropriate, you can benefit from the use of methadone as an opioid replacement medication in a safe and productive manner.
