Treatment of Opiate Addiction: Methadone

These three blogs will touch on drug treatments for opiate addiction and a warning about an increasingly popular prescription drug used for recreational and addiction purposes. It is beyond the scope of this blog to comment on all aspects of addiction, opiate addiction alone, or even all treatments of addiction.

Consider methadone first. Methadone is a long-acting synthetic opiate which has legitimate uses for treatment of chronic pain and to help opiate addicts stop using heroin and other strong narcotics. It is important to bear in mind that methadone is addicting, powerfully so, but is a lesser of evils compared to the plethora of evils associated with the more harmful opiates. Methadone is a central nervous system depressant and is not a cure for opiate addiction. Rather, it is a substitute drug that can be a tool to suppress withdrawal symptoms when quitting opiates and lessens the cravings for the powerful addicting and destructive drugs. Methadone is an effective and generally safe drug and has a long duration of action, extremely powerful effects, and very low cost. The drawback (or perhaps an indirect benefit) is that it is only prescribed for once a day use; and for a lengthy period of time, the addict must receive the drug during a daily visit to a certificated medical provider.

There is no single dose that fits all individuals or addicts. It is unsafe for experimentation by casual users. Doses must be individually determined by well-trained medical personnel, and it must be remembered that methadone maintenance is a long-term supervised treatment for opiate addictions of all types. Since it is addicting itself, many people cannot get off the drug. However, faithful patients may be able to resume normal life free of injections with filthy needles, risks of overdoses, infections, and fake or even dangerous substitutes.

Is methadone safe? Generally speaking, yes. However, like all drugs, it has risks and adverse effects attached. In the United States, deaths linked to methadone increased four-fold between 1999 and 2004. According to the U.S. National Center for Health Statistics, medical examiners listed methadone as contributing to 3,849 deaths in 2004, up from 790 in 1999. Approximately 82 percent of those deaths were listed as “accidental”, and most deaths involved combinations of methadone with other drugs. Methadone treatment may impair driving ability and lead to accidents, even fatal ones. A new Substance Abuse Treatment Advisory from the Substance Abuse and Mental Health Services Administration (SAMHSA), “Emerging Issues in the Use of Methadone,” presents information on the increase in deaths related to methadone, particularly in combination with other drugs or substances.

Serious side-effects include: signs and symptoms of an allergic reaction including hives, difficulty breathing, shallow breathing, facial swelling of the face, lips, tongue, or throat; confusion, hallucinations, dizziness, feeling faint; chest pain, fast or pounding heartbeat. All of those are cause for seeking prompt medical attention.

Less serious but still miserable problems stemming from methadone use are: feeling anxiety, nervousness, restless, insomnia; weakness, drowsiness, dry mouth, nausea, vomiting, diarrhea, constipation, loss of appetite, decreased sex drive, impotence, or difficulty having an orgasm.

Withdrawal from the drug should only be done under careful medical supervision. Abrupt withdrawal can be done, but causes intolerable symptoms and should only be done under general anesthetic. Because methadone has such a long half-life, withdrawal should usually be carried out over many weeks, and even up to a year, and always under medical provider control. Withdrawal symptoms include both physical and cognitive discomfort and malfunction.

The physical symptoms include: lightheadedness, tearing, runny nose, yawning, sneezing, nausea, vomiting, diarrhea, severe Itching, fever, sweating, chilling, tremors, akathisia, tachycardia, aches and pains—most often in the joints and/or legs, elevated pain sensitivity, elevated blood pressure—which can cause stroke–and even sudden death.

Cognitive symptomsinclude: suicidal ideation, susceptibility to cravings, depression, reduced breathing—which may be fatal in 2–4 hours–spontaneous orgasm, prolonged insomnia, delirium, auditory  and/or visual hallucinations, increased perception of odors–real or imagined–marked decrease or increase in sex drive, agitation, anxiety, panic disorder, paranoia, and delusion.

 In brief, then, methadone is a moderately safe and effective way of dealing with opiate addiction; but it is not worry free. Embarking on a regimen of methadone to supplant the worse addicting narcotics is often worth the possible problems, but that choice should be made with a doctor who specializes in addiction management. It is intended for long-term treatment, and withdrawal should be the outcome of a serious amount of discussion between patient and doctor, and should always be managed by the doctor.