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:
- Decreased disease rates in addicted individuals: One of the major hopes of using methadone maintenance programs is that individuals who are getting methadone legally will be at less risk to catch serious diseases, such as hepatitis or HIV, as a result of needle sharing.
- Decreased crime associated with addiction: Since individuals are getting drugs legally through methadone clinics, the hope is that this will result in a decrease of criminal activities associated with these individuals; however, as mentioned above, this has not always been the case.
- Less harm: Methadone use is considered to be less sedating and generally less harmful than abuse of other opioids. Some sources quote that it is safe for pregnant women and therefore its continued use is considered to be advantageous over the use of heroin or other very powerful opiate drugs.
- Physical dependence: Unfortunately, the chronic use of methadone does result in the development of physical dependence and certainly some individuals abuse methadone (use it outside the parameters of its prescribed purposes). Thus, many critics of long-term methadone maintenance programs simply point out that one addiction is being replaced with another.
- Other drugs: Others suggest that many individuals in methadone treatment programs continue to abuse other drugs, such as cocaine or alcohol. The distribution of methadone over the long-term to these individuals supports the impression that their substance use disorders are acceptable.
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.
- Physical signs: The physical symptoms associated with methadone abuse are similar to the symptoms of abuse for other opioid drugs. These include such things as slowed breathing, sweating, constricted pupils, nausea, vomiting, and issues with constipation.
- Doctor shopping: A sure sign of methadone abuse is an individual who attempts to get multiple prescriptions for methadone from different doctors.
- Stockpiling the medication: Many clinics require individuals to use the drug at the clinic; however, some individuals are able to skip their scheduled doses and stockpile them for later use.
- Getting the drug illegally: Individuals may find outside sources that have access to methadone and obtain the drug from them. Anytime an individual takes a drug without a prescription, it is a sign of abuse.
- Using methadone with other drugs: Obviously, individuals using methadone with alcohol, cocaine, or other drugs are abusing these drugs.
- Negative effects: If the person continues to use methadone despite suffering a number of negative ramifications, such as issues with work or school, relationships troubles, financial issues, etc., it is a sign of abuse.
Withdrawal from 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.
- Initial symptoms: Methadone has a relatively long half-life, and many individuals may not experience withdrawal symptoms for a day or two, whereas others may experience symptoms within the first 24 hours. The initial symptoms associated with withdrawal from methadone are similar to withdrawal from other opioid drugs, such as fever, chills, muscle aches, nausea, vomiting, rapid heartbeat, headache, and other flulike symptoms.
- Days 2-10: Flulike symptoms will continue, and other symptoms may surface, such as anxiety, irritability, and insomnia. In some rare cases, psychiatric symptoms, such as hallucinations and paranoid delusions, may occur. After the first week, flulike symptoms should begin to resolve.
- Days 11-21: Most of the physical symptoms will have significantly decreased but individuals may still experience cravings and issues with anxiety and/or depression.
- Beyond three weeks: Following three weeks after discontinuation, physical symptoms should be fully resolved. Individuals may still experience cravings, issues with motivation, and symptoms of clinical depression. In some individuals, these may continue for quite some time.
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.