Methadone is a semi-synthetic opioid drug that has a long half-life of 30 hours or more on average. This means the drug can remain active in the bloodstream for up to a full day or longer, making it an ideal candidate for long-term opioid dependence treatment.
Methadone is meant to be taken by mouth once per day for the management of withdrawal symptoms and cravings in people struggling with opioid addiction. The Drug Enforcement Administration (DEA) publishes that nearly 2.5 million people in the United States reported misusing methadone at some point in their lifetimes as of a 2012 national survey.
Methadone is a full opioid agonist, and as such, it still has a high potential for diversion and abuse. It may be abused by crushing the tablets and then smoking or snorting the resulting powder. Abusing methadone in this way can be highly dangerous. It greatly increases the risk of physical dependence and compounding addiction, and it also raises the odds for a potentially life-threatening overdose.
More than 2 million Americans battle addiction involving an opioid drug, reports the 2016 National Survey on Drug Use and Health (NSDUH). Opioid addiction involves changes in brain chemistry that are created by chronic exposure to drugs that interact with the chemical balance in the brain.
Neurotransmitters are the brain’s chemical messengers that send signals around the body telling a person how to think, feel, and act. Normal levels of these neurotransmitters are affected by the activity of opioid drugs. Over time, the regular presence of mind-altering drugs can influence the brain’s chemical stability and even make some changes to its wiring, thus altering moods, thinking and memory processes, sleep functions, and movement abilities.
Opioid dependence is often treated with a combination of medical and therapeutic techniques. Because of the changes in brain chemistry caused by opioid dependence and addiction, it is not a good idea to stop taking an opioid suddenly since doing so can lead to intense drug cravings and difficult withdrawal symptoms. Methadone is an opioid medication that is commonly used in the treatment and management of opioid withdrawal and dependence. It can be used during detox to wean a person off shorter-acting opioids such as heroin or oxycodone (OxyContin), or it can be used as a maintenance medication to control cravings and minimize relapse in recovery.
Methadone is dispensed through federally regulated opioid treatment programs (OTPs), typically in a sublingual wafer or pill form that is to be swallowed once a day. The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that nearly a quarter of all people in a substance abuse treatment program (between 2003 and 2015) received methadone treatment. When used as part of a larger program, it can be a useful tool to keep drug cravings and withdrawal symptoms to a manageable level.
Methadone still works in the brain and on the central nervous system in the same way other opioids do. However, it can still cause a high when used in larger quantities or in ways that are inconsistent with its design. The medication is most often meant to be swallowed orally or taken sublingually. In this manner, methadone is metabolized through the gastrointestinal system.
If the drug is altered and then smoked or snorted, it goes straight to the bloodstream and bypasses the intended route of metabolism. Snorting and smoking methadone can more quickly lead to a fatal overdose. According to the U.S. Department of Health and Human Services (HHS), an estimated 116 people die from an overdose involving an opioid drug every day in the United States.
Methadone has a long mechanism of action in the body, which means it can keep working even after the main effects of the drug seem to have worn off. The analgesic, or painkilling, actions of methadone typically wear off in about four hours to eight hours while the drug stays active in the body for much longer, up to few days even, the journal Pharmacy and Therapeutics explains. While a methadone high may end more quickly, the drug will still be working in the background. This can make it easy to overdose on it as a person may think the drug has worn off and then takes more.
Snorting methadone is a quick route of administration of the drug, sending it straight across the blood-brain barrier for a near-instantaneous high. The risk for overdose when taking methadone in this manner is much higher than it is when taking it orally. Less of the drug is needed for fatal results as well.
A methadone overdose can be life-threatening. It can lead to coma or brain damage. Swift administration of the opioid antagonist naloxone can help to reverse a methadone overdose.
An additional side effect of snorting methadone is long-term damage to the nasal and sinus cavities, which can cause a person to suffer from chronic nosebleeds and a runny nose as well as possible permanent damage to the sense of smell. Respiratory issues, such as lung infections and illnesses, can also result from snorting methadone. Since the drug is more powerful when snorted, abusing it in this manner can more quickly lead to drug dependence and addiction.
When methadone is smoked, it may often be combined with other drugs like heroin, cocaine, or marijuana. Mixing methadone with other drugs can lead to dangerous and unintended complications, not the least of which is overdose.
As a central nervous system depressant, if methadone is combined with other opioids, benzodiazepines, sedatives, or alcohol, these substances can interact with each other to exacerbate the effects of the sedative. Respiratory depression and cardiovascular collapse can be a disastrous result.
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Smoking methadone with stimulant drugs like cocaine, methamphetamine, or prescription stimulants can also be hazardous, as these substances work opposite ways. This means the stimulant drug can mute the sedative effects of methadone. A person may then take more and more of each without recognizing that the drugs are actually building up in the bloodstream. As a result, they can reach toxic levels quickly.
Smoking methadone may induce a mellowing, euphoric, and relaxing high, but long-term use can create a tolerance to the drug, and more of it will be needed to keep feeling the desired effects. Increasing the amount taken each time builds drug dependence, and then when methadone wears off, withdrawal symptoms comparable to the flu can make it hard to stop taking the drug. Also, emotionally difficult symptoms, like depression, anxiety, and insomnia, can take hold. Addiction and compulsive drug use can be side effects of smoking methadone. Smoking drugs can lead to an increased risk for lung infections and respiratory illnesses like pneumonia or bronchitis. Chronic cough can be a risk factor for smoking methadone. Smoking a drug introduces irritants into the respiratory tract that can damage this system, and when repeated over time, it can lower the body’s ability to properly heal these affected tissues. In the short-term, smoking methadone can lead to burns on the face, lips, or hands.
Both smoking or snorting methadone heightens the potential risk factors associated with the drug. Both forms of abuse can be incredibly dangerous and result in overdose.
(March 2014). Methadone. Drug Enforcement Administration. Retrieved September 2018 from https://www.deadiversion.usdoj.gov/drug_chem_info/methadone/methadone.pdf
(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm
(August 2017). Trends in the Use of Methadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003-2015 (Update). Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from https://www.samhsa.gov/data/sites/default/files/report_3192/ShortReport-3192.html
(March 2018). What is the U.S. Opioid Epidemic? U.S. Department of Human Health and Services. Retrieved September 2018 from https://www.hhs.gov/opioids/about-the-epidemic/index.html
(August 2011). Keeping Patients Safe From Methadone Overdoses. Pharmacy and Therapeutics. Retrieved September 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171821/