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Methadone, also known by the brand name Dolophine, is a synthetic opioid drug that is often used for withdrawal management from opioids, oftentimes meaning heroin.
Opiate or opioid drugs are derivatives of the poppy plant, and they are commonly used in the management of chronic pain. Methadone can also be used as a pain reliever like other opioid drugs.
When an individual uses methadone, the drug blocks the effects of any other opioid drugs, and this results in the potential to use methadone as a withdrawal management medication for individuals with opioid use disorders. It has a longer half-life than drugs like heroin and is less potent; therefore, it remains in the system longer and does not produce the powerful effects that other opioids produce.
According to a number of sources, such as the book Mechanisms and Treatment: Opioid Dependence, methadone has found its place as a replacement opioid medication for individuals with severe heroin addiction and other opioid use disorders. Much of the empirical research using objective physiological measures to determine treatment compliance, such as urine analysis or hair analysis, have indicated that methadone is generally successful in preventing relapse during the withdrawal period from powerful opioid drugs like heroin. However, the same research has not consistently demonstrated that these individuals decrease their involvement in criminal activities, such as theft and assault, while using methadone to prevent withdrawal from opioids. For this and other reasons, as will be discussed in this article, the use of the methadone has resulted in mixed reactions from treatment providers and government officials.
Treatment with methadone is often used for individuals who have unsuccessfully tried to stop using heroin or other opiate drugs multiple times. The general approach to methadone is to use it as a replacement medication and to engage in a tapering strategy by slowly decreasing the amount of methadone the individual receives over time, so the person can adjust and be weaned off the medication without feeling any withdrawal effects.
Methadone is a long-acting drug, and it is typically only given once a day. Individuals using methadone will not experience severe withdrawal symptoms from other opioids, such as heroin or morphine; should not experience cravings for these drugs; and will not need multiple daily doses. Once the drug tapering process results in an individual receiving a specified minimum level of methadone, it should be discontinued altogether. Then, the individual should be able to function without needing any opioid drugs or feeling significant cravings.
Unfortunately, methadone is often used for individuals who have experienced multiple relapses, significant legal entanglements, and significant personal and financial issues. In many cases, methadone treatment programs have failed to integrate sufficient aftercare programs and behavioral treatments to address many of the psychological issues associated with opioid use disorders. As a result, a number of individuals are perpetually administered methadone without the tapering strategy, essentially just in place of them just taking some other opiate drug like heroin. The hope is that methadone maintenance schedules of this nature will result in a number of positive changes in these individuals; however, these hopes have not been fully realized. An interesting commentary on methadone treatment can be found in the book Methadone: The Bad Boy of Drug Treatment.
Some of the hopes and some of the realities of long-term methadone maintenance include:
Despite the drug’s hopeful potential in reducing opiate use disorders, methadone can be abused. There are a number of different signs that someone is abusing methadone.
A number of factors can affect the withdrawal process from any drug, including the length of time the individual use the drug, the amount the individual used typically, how they took the drug (taking methadone orally typically results in less severe and shorter withdrawal syndromes than injecting it), whether or not the abused methadone with other drugs, and individual differences in metabolism and emotional makeup.
A general timeline for withdrawal from methadone follows:
Individuals who are placed on a withdrawal management strategy and involved in a tapering program under the supervision of an addiction medicine physician will go through a much longer time period of tapering that may last for several months; however, they will not experience nearly as severe withdrawal symptoms and in many cases may not experience significant withdrawal symptoms at all. Because the tapering process requires professional guidance and supervision, it should only be administered by trained addiction medicine physicians or addiction psychiatrists. Individuals should not attempt to use a tapering strategy without engaging in medical supervision.