Methadone was originally developed in the 1930s as an opioid analgesic, intended to be less addictive than heroin or morphine. While the medication was introduced to the US as a prescription painkiller in the 1940s, it became a popular maintenance therapy in the 1960s as heroin addiction began to spread across the country again. Methadone clinics began as an important part of treating heroin addiction throughout the 1970s; however, the drug acquired a negative stigma as a substance of abuse, replacing heroin addiction with a longer-lasting, equally addictive drug.
In the United States today, methadone has fallen out of favor as medication-assisted therapy (MAT) for opioid addiction, but it is often prescribed for people with serious, chronic pain conditions who need full-day pain relief because it is a long-acting opioid agonist. In some instances, methadone is still used to help people struggling with heroin addiction. However, methadone itself has become a substance of abuse, causing numerous overdoses and deaths.
How Does Methadone Addiction Begin?
When methadone is applied as a maintenance therapy, the drug is given only to people who have struggled with high-dose narcotics addiction that has lasted a long time. Methadone’s potency helps reduce or prevent withdrawal symptoms; however, the person must have a high tolerance to opioids, otherwise they will experience an intense and potentially addictive euphoria. A survey published by the California Society of Addiction Medicine (CSAM) reported that methadone helps 60-90 percent of people struggling with opioid addiction overcome this condition.
As a prescription painkiller, methadone has become popular because it can reduce pain for a full day or sometimes up to 36 hours. For people with chronic pain, the duration of methadone’s effects is a huge benefit; they take less of the potent narcotic, they worry less about taking their medication on time, and they get relief that lasts long enough for them to live a normal daily life. Medicaid patients are the primary recipients of this drug since it is inexpensive. In 33 states in the US, methadone is listed as a preferred medication for Medicaid patients.
Since methadone has re-emerged as a prescription painkiller, it is more available in people’s homes, which means it can be abused for nonmedical reasons. Additionally, for people who do not have a high tolerance to narcotics, the high from methadone can be intense and addictive. While methadone may be an effective treatment when use is closely monitored and the drug is taken as prescribed, it is responsible for one in three overdose deaths in the US, according to the Centers for Disease Control and Prevention (CDC). Between 1999 and 2006, deaths involving methadone increased sevenfold. Over 5,000 people die every year from methadone-related overdoses.
Methadone prescriptions have increased in the past several years, but they still account for only 2 percent of the painkiller prescriptions available; however, methadone is involved in 30 percent of overdose deaths. This suggests that many people are acquiring methadone through illicit sources and taking larger doses than intended. Methadone is also likely being combined with other prescription narcotics in a deadly cocktail that leads to overdose.
Some people may overdose because methadone stays in the body for longer than its analgesic effects last; adding more narcotics on top of a narcotic already in the body can cause an overdose. People may accidentally mix their medication with other drugs, especially benzodiazepines and alcohol. Warnings on methadone prescriptions tell those who have these medications that they should not consume other intoxicating substances with methadone, but people who struggle with opioid addiction, dependence, and tolerance are less likely to follow those instructions. People who abuse methadone for nonmedical reasons are more likely to suffer dangerous side effects.
Signs of Methadone Intoxication and Overdose
If a person is abusing methadone recreationally, they may display symptoms like people who struggle with heroin, OxyContin, or other opiates. However, the symptoms may last for longer, as methadone stays in the body for several hours. Symptoms include:
- Nausea and vomiting
- Other stomach aches and pains
- Loss of physical coordination
- Severe sweating
- Slow or irregular breathing
- Fatigue, sleepiness, or falling unconscious
Signs that a person is overdosing include:
- Small, pinpoint pupils that do not react to light
- Slow, shallow, irregular, or stopped breathing
- Bluish tint to the skin
- Cold and clammy skin
- Stupor (awake but unresponsive)
- Limp muscles
If a person overdoses on methadone, call 911 immediately. To survive, they need emergency medical treatment. Like other opioid drugs, methadone overdoses stop the person’s breathing, so they suffer oxygen deprivation and may die without treatment. Respiratory depression from a methadone overdose can last up to 59 hours, so people who experience this problem need hospitalization and careful medical monitoring.
Methadone Withdrawal: Symptoms and Risks
Since methadone remains active in the body for up to 36 hours, withdrawal symptoms may not begin for one or two days after the last dose is taken. Additionally, because methadone has such a long half-life, withdrawal symptoms may last for a week or two longer than other, shorter-acting opioid drugs.
Symptoms of methadone withdrawal during the first 30 hours include:
- Watery eyes
- Runny nose
- Excessive yawning
- Difficulty sleeping
Once methadone withdrawal peaks, typically after three days, symptoms will feel a lot like the flu but may include psychological symptoms and cravings. These symptoms include:
- Muscle aches and pains
- Severe nausea
- Stomach cramps
After the peak of withdrawal, some of these symptoms may linger, but they will gradually go away. However, many people who attempt to stop taking opioids like methadone without help are likely to relapse, which puts them at risk for overdose. It is very important to get help from medical professionals and a comprehensive rehabilitation program to safely and successfully detox from a potent narcotic like methadone.
How Is Methadone Addiction Treated?
Detoxing from methadone will likely involve a taper. Since methadone is still used as a maintenance therapy for other opioid detox processes, a physician may work with their patient to taper how much methadone they take rather than trying to replace the drug. However, a physician may also prescribe buprenorphine to taper their patient’s methadone dependence. The doctor will use the Clinical Opioid Withdrawal Scale (COWS) to determine how severe their patient’s withdrawal symptoms are, which helps them determine how to adjust the length of time they will slowly taper their patient off methadone.
Where to Find Help Overcoming Methadone Addiction
Because the opioid epidemic is sweeping the nation, many organizations are offering evidence-based treatment options to help people overcome this severe addiction. However, many people who struggle with addiction to methadone or other opioids may not know where to start to get help.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a treatment finder, which identifies a variety of mental and behavioral health options across the country.
- Men and women who have served in the Armed Forces can receive treatment for any substance abuse, including methadone addiction, through the Office of Veterans Affairs (VA).
- Qualifying individuals can receive opioid treatment by signing up with Medicaid or Medicare. Since many of those struggling with opioid and prescription drug addiction are low income or older adults, these programs are working hard to expand access to this form of treatment. Those who do not qualify for Medicaid coverage may still have access to income-based help through the Office of Disease Prevention and Health Promotion (ODPHP).
- The American Society of Addiction Medicine (ASAM) maintains a list of treatment resources, as does the National Association for Addiction Professionals (NAADAC). The Police Assisted Addiction and Recovery Initiative (PAARIUSA) helps train police officers and sheriffs’ departments to assist people struggling with addiction rather than criminalizing them. The National Coalition Against Prescription Drug Abuse (NCAPDA) offers resources to help people get started on the path to recovery.
- For those who need ongoing support, Narcotics Anonymous (NA) meetings provide free social support based on the 12-Steps model. For those seeking a 12-Step alternative, SMART Recovery offers nationwide meetings.