A person who is questioning the duration of methadone’s activity in the body is likely to be currently taking this drug or planning on doing so.
For this reason, it is important to understand the basics of methadone. Known as a treatment protocol for recovery from opioid abuse, methadone is a long-acting synthetic opiate.
A single dose of methadone typically has effects for 24-36 hours. Within this time period, a person on methadone maintenance therapy must return to the dispensing clinic, doctor, or other facility in order to get the next dose. Methadone comes in three formats:
- Tablets: Also called diskettes, they are dissolved in water and then taken orally.
- Powder: This is also dissolved in water for oral consumption.
- Liquid: Methadone maintenance clinics most often, if not always, use the liquid format.
Injectable methadone is always illicit. There are no accredited medical facilities or doctors that provide injectable methadone to a recovering individual.
Methadone is considered a replacement therapy because it allows a person to stop taking a more harmful opioid, such as heroin, and replace it with a safer one (methadone). Some individuals may think that taking methadone is tantamount to substituting one addiction for another; however, the National Institute on Drug Abuse entirely disagrees. When used as part of an addiction recovery plan, methadone is an effective, research-based treatment that can help a person to maintain abstinence from illicit opioids.
It is helpful to know a little bit about the history of methadone to see this medication in the light of its therapeutic merits. In 1937, what we know as methadone was first synthesized in a pharmaceutical laboratory in Frankfurt, Germany; it was identified as VA 10820. In 1942, the American Medical Association officially gave VA 10820 the name we know it by today: methadone.
Methadone was not clinically tested until 1947. In this same year, the pharmaceutical company Eli-Lilly began manufacturing methadone under the trade name Dolophine, labeling it a pain reliever (In fact, in Latin, dolophine translates to pain end).
In the 1960s, the US was facing rising rates of heroin abuse. Researchers recognized that methadone, being a synthetic opiate, could safely help heroin users during the withdrawal process by reducing drug cravings. According to the Center for Substance Abuse Research at the University of Maryland, by 1964, the medical community widely accepted that methadone could be used an opioid replacement therapy. In 1971, the federal government helped to expand and regulate the use of methadone in the field of addiction treatment. In 2001, methadone regulations were modified to improve accessibility.
As the history of methadone reflects, over time, there has been ongoing medical approval of this drug and a widening of its availability.
If Methadone Is a Synthetic Opioid, How Is It Any Safer than Heroin?
As noted, methadone does not stimulate opioid receptors in the brain to the extreme that heroin and other opioids do. In addition, methadone side effects are associated with being more mild than heroin. These side effects include but are not limited to:
- Loss of appetite
- Weight gain
- Tongue soreness
- Stomach pain
- Vision problems
- Changes in mood
- Dry mouth
- Trouble urinating
- Trouble sleeping
- In females, skipping menstrual periods
- Diminished sexual desire or ability
Methadone Side Effects
In some instances, individuals may experience more severe side effects after methadone use, including but not limited to:
- Pounding heartbeat
- Trouble breathing
- Difficult swallowing
- Itching, rash, or hives
- Severe nervousness
- Severe restlessness
- Extreme drowsiness
- Swelling of the throat, mouth, tongue, eyes, or face
The appearance of side effects, as well as their severity grade, depends in part on physiological factors that are specific to the individual who is receiving methadone maintenance therapy. Since this is a medically managed treatment, if any moderate to severe symptoms emerge, a person should ask the attending methadone clinic or prescribing doctor for assistance. In a serious situation, however, it is necessary to seek emergency help. Methadone is typically a safe medication provided the patient is observing the guidelines for use.
How Does Methadone Replace Opioids?
Methadone in the brain behaves in a way similar to heroin and other opioids. Neurotransmitters serve as chemical messengers between nerves and cells in the brain. To set off a chain of communications across the brain and body, neurotransmitters dock in receptors. In the case of heroin, for example, the body metabolizes it into morphine, and it fits, like a key in a lock, into opioid receptors. Methadone fits into these same receptors, but it is longer acting than heroin and other opioids. It is also considered to be less dangerous.
Methadone is a full mu-opioid agonist. This means that methadone can stimulate the release of beta-endorphin and enkephalin, which in turn induces pain relief, profound relaxation, and euphoria. Since the opioid receptors are activated by the methadone, though to a lesser extent than morphine, the body does not go into severe withdrawal. Methadone’s activation of the receptors has the effect of stemming or eliminating cravings for opioids.
How Long Does Methadone Stay in the Body?
According to Mental Health Daily, several factors are involved in the amount of time methadone remains in the body. These factors include but are not limited to the patient’s metabolic rate, level of liver functioning, weight, height, and food intake over the relevant time period.
According to reports, the half-life of methadone varies greatly, as follows: 24-36 hours, 13-47 hours, 15-40 hours, and 8-59 hours. Since the widest window is 8-59 hours and encompasses all other possibilities, it is safely considered to be the most accurate (though wide) window. In terms of days, an 8-59 hour half-life translates to 1.83-13.52 days. In other words, a person may retain methadone in the body for anywhere from 1.83-13.52 days. (Note: This day count is based on half-life math, which is not explained in detail here.)
Methadone , since it is a synthetic opiate, carries the risk of addiction if abused. As the National Institute on Drug Abuse explains, regular use of an addiction-forming drug leads to physical dependence, a natural process of adaptation to the ongoing presence of the drug. Physical dependence is not the same as addiction. While it is true that physical dependence is a component of addiction, the reverse proposition is not correct.
Individuals who take methadone as part of a structured drug abuse recovery plan will likely, over time, become physically dependent on this medication but will not typically manifest a psychological addiction to it. Psychological addiction involves displaying behaviors, such as stockpiling the drug of abuse, which protect and support the addiction. Whether a person is physically dependent alone or has become addicted to methadone, if use is discontinued or the familiar dose is dramatically reduced, withdrawal symptoms may emerge. Withdrawal is a main hallmark of physical dependence and, by extension, addiction.
It is necessary to point out that methadone maintenance treatment provides individuals with at least two options. A client can decide to stay on this plan for months, years, or a lifetime, or a client can decide to taper off methadone. A cold-turkey detoxification is never advised.
A study published in the journal European Addiction Research looked at two groups, each with 25 participants, who were in a methadone maintenance program. One group was working on a tapered approach and the other was not. The researchers found that certain factors and experiences influenced the group that did not want the taper. Compared to the tapering group, the stay-on-methadone/no-taper group had a long history of abuse of opioids and mixed drug use, received a higher methadone dose, tended to know people who had not succeeded with a methadone taper, did not feel confident about a taper for their situation, and were satisfied overall with their methadone maintenance program. The research was insightful and included a finding relevant to anyone who opts for methadone maintenance: Staying on methadone or tapering off it is a personal decision that should be made with a doctor’s advice.
If a person does decide to taper off methadone, withdrawal symptoms may emerge. It is important to understand that any risks associated with withdrawal can be managed. Healthline identifies the following methadone withdrawal symptoms:
- Flu-like symptoms (e.g., runny nose)
A methadone taper can help to ensure that severe withdrawal symptoms do not emerge. Again, it is not advisable to do a cold-turkey withdrawal, and it is reported that people who do so may have severe symptoms for several days or longer because methadone is a long-acting drug. During a medically supervised taper, attending medical and support staff can help to ease any physical and psychological discomfort that may arise. For instance, a doctor may be able to provide medications for gastrointestinal problems. Although there may be anxiety about the taper, methadone withdrawal can be safely managed and result in full detoxification.