People typically argue on the subject of medication-assisted treatment for patients with substance use disorders. Some believe that MAT cannot substitute other forms of treatment such as 12-step programs and cognitive behavioral therapy. Others believe that MAT is the only effective form of treatment available. Those who tend to see both sides of an argument suggest that MAT works, but only in conjunction with other treatment methods. But one particular drug used in MAT gets a worse rap than any of them. This drug, of course, is methadone.
Doctors use methadone for a variety of purposes. Recently, they began using it as a pain medication. They do not always use it on its own, but sometimes rotate it with other opioids. This allows for fewer side effects while also keeping the patient from gaining enough tolerance to hurt the efficacy of the drug. More commonly, however, people associate methadone with clinics meant to treat opioid dependency. This allows patients to recover from addiction to drugs such as heroin without the same severity of withdrawal symptoms. Methadone treatment may follow a few different forms, which we intend to cover in greater detail below.
Note that we are neither condoning nor condemning the use of methadone in addiction treatment. That said, we do intend to cover its addictive qualities, and the side effects experienced by those who become addicted. We will also cover methods of treating patients with substance use disorders who elect methadone as their drug of choice. First, however, we will discuss the history of methadone use, as well as the purpose of its creation. Because while it may surprise some to hear, its intended purpose varies greatly from the manner in which we use it today.
History of Methadone Use
Some may know that heroin was originally created as a non-addictive alternative to morphine. Obviously, that did not quite work out. In the case of methadone, it seems that history has an unfortunate way of repeating itself. When Germany found itself facing an opium shortage in the late 1930s, scientists created a synthetic opioid with only slight structural similarities to morphine. After Germany lost World War II, the Allies requisitioned all existing German patents, including those pertaining to the synthetic opioid in question (then named Hoechst 10820). When the US Department of Commerce Intelligence investigated the drug, they discovered its addictive potential.
While the US knew that Hoechst 10820 might prove addictive, they still believed it a commercially viable drug. Two years after the war, the American Medical Association gave it a generic name—methadone—and allowed pharmaceutical companies to buy commercial production rights for just a single dollar. While its widespread use as a painkiller might be a recent phenomenon, methadone’s first commercial purpose in the 1940s actually was as an analgesic. Nonetheless, it wasn’t long before hospitals discovered its potential in the treatment of heroin withdrawal. Before long, the public associated methadone almost exclusively with this purpose.
Methadone treatment takes a few different forms. The first, methadone maintenance therapy, can sometimes last for the patient’s entire lifetime. Usually, this form of treatment appeals to people who cannot seem to abstain from opioid abuse on their own. Methadone replaces their previous drug of choice, thereby reducing their respiratory depression due to methadone’s slightly milder symptoms. This also reduces their chances of contracting diseases through the use of shared needles. Maintenance treatment suppresses the patient’s cravings, and generally fails to sedate patients when administered properly. In fact, some believe that this treatment can even prove effective for opioid addicts during pregnancy.
The other form of treatment is methadone reduction. Unlike maintenance treatment, reduction treatment does not maintain the same dosage throughout the length of treatment. This means that the length of treatment depends on numerous factors. These include the starting dosage (which further depends on the patient’s physical attributes and drug history) and the rate at which dosage is reduced. Various clinics may perform reduction treatment in differing ways, with different speeds of reduction. Detox clinics also use a method similar to maintenance or reduction treatment, but this does not differ between clinics due to federal regulations on the treatment of opioid addiction. Outpatient programs are regulated in an especially strict manner.
Dangers of Getting Hooked
Each form of methadone treatment mentioned above should not harm patients when performed properly. Unfortunately, not all methadone users receive their dosage at a clinic. Patients undergoing pain management therapy may take methadone at home. Generic methadone tablets do not cost much, allowing users to acquire a fair amount at one time. Those who use more than prescribed will generally develop a tolerance before potentially becoming dependent. Since tolerance to euphoria does not take long to begin, addicts will often raise their doses quite soon after beginning to abuse their dosage.
This becomes problematic for the user in question. While tolerance to euphoria does not take long to build, tolerance to physical side effects may never develop. Milder side effects include fatigue, weight gain, loss of appetite, stomach pain, and difficulty urinating. Users may also experience sweating, vomiting, headache, dry mouth, insomnia, decreased libido and menstrual irregularities. Vision problems, sore tongue, and mood changes are also on the list. On the more serious side, users may experience difficulty breathing, hoarseness, itchiness, rash, swelling, extreme drowsiness, audiovisual hallucinations and seizures. While respiratory depression is less severe when taking methadone than it is when taking heroin, it can still be life-threatening at higher doses. Overdose may lead to excessive vomiting, unconsciousness, coma and hypoventilation. Much like heroin and other opioids, this can be treated with the administration of Narcan.
Withdrawal symptoms don’t match those of other opioids in terms of severity, but they do last longer. Such symptoms may include chills, tremors, cramps, muscle aches, runny nose, watery eyes, diarrhea and increased sensitivity to pain. Insomnia, loss of appetite, irritability and anxiety may also occur. Restlessness, dysphoria (general unease or dissatisfaction), sweating and dilation of the pupils are also symptoms that may accompany withdrawal. Other withdrawal symptoms may include piloerection (better known as goosebumps) and tachycardia (better known as rapid heart rate). Cognitive symptoms may also include delirium, suicidal ideation, panic, paranoia, depression, apathy and spontaneous orgasm.
Naturally, methadone clinics put regulations in place to prevent patients from overdosing. They also enact restrictions against taking methadone when under the influence of alcohol or other drugs. Unfortunately, these things still occur. Furthermore, while the size of methadone’s black market pales in comparison to that of heroin, it still very much exists. And while some sources treat this as news, studies show the market’s existence extending at least as far back as 1972. This allows methadone addiction to continue unabated, no matter how well the clinics follow protocol.
Treating Methadone Addiction
The first step to treating methadone addiction is detoxification. For long-term users, quitting cold turkey might not be recommended. When engaging in abrupt cessation, one must do so in the care of a licensed detox facility or treatment center. This allows the patient to better overcome any potential medical complications during the process of detox and withdrawal. Short-acting benzos or antidepressants may be administered during this process. Again, one should consult the care of medical professionals when undergoing such treatment. Licensed professionals can monitor dosage to ensure that patients do not simply replace their methadone dependence with benzo addiction.
After detoxification, patients with substance abuse disorders should prepare for long-term addiction treatment. While outpatient treatment allows patients to continue their daily lives, inpatient treatment generally proves most effective. Not only does inpatient treatment allow the patient to receive immediate medical care when necessary, but constant supervision means constant support. Patients do not have to go through their treatment alone, and they can experience a sober routine while developing bonds with their fellow patients. Inpatient treatment also provides increased access to counselors, with whom patients can engage in cognitive behavioral therapy to better understand their disease.
Treatment will do a lot to help ease one’s substance use disorder, but then it becomes time to form an aftercare plan. At this stage, the patient learns a few necessary relapse prevention skills to keep them off of methadone in the future. They learn about their triggers and how to avoid them. If their aftercare plan involves 12-step meetings, they must find meetings in their area and plan their meeting schedule. Many patients elect to extend their care at a sober living facility. This helps them to begin coping with the real world without sacrificing some of the resources they had in treatment. No matter what the details, the important part is that they stick with the plan. Otherwise, they risk winding up right back where they started.
Methadone addiction is tricky, but it is much like every other addiction in at least one very important way—it can be overcome. With time and discipline, methadone addicts will learn to adjust to life without their drug of choice. It will prove more difficult for some than others, but the effort will yield the reward of a long, happy, and drug-free life.