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What Is Methadone?
Methadone, sold under the brand names Dolophine and Methadose among others, is a synthetic opioid agonist used for opioid maintenance therapy in opioid dependence and for chronic pain management. A powerful synthetic analgesic drug which is similar to morphine in its effects but less sedative and is used as a substitute drug in the treatment of morphine and heroin addiction.
Detoxification using methadone can be accomplished in less than a month, or it may be done gradually over as long as six months. While a single dose has a rapid effect, maximum effect can take up to five days of use. The pain-relieving effects last about six hours after a single dose. After long-term use, in people with normal liver function, effects last 8 to 36 hours. Methadone is usually taken by mouth and rarely by injection into a muscle or vein.
Methadone was developed in Germany around 1937 to 1939 by Gustav Ehrhart and Max Bockmühl. It was approved for use in the United States in 1947. It is on the World Health Organization's List of Essential Medicines. In 2013, about 41,400 kilograms were manufactured globally. It is regulated similarly to other narcotic drugs. It is not particularly expensive in the United States.
Methadone is used for the treatment of opioid use disorder. It may be used as maintenance therapy or in shorter periods for detoxification to manage opioid withdrawal symptoms. Its use for the treatment of addiction is usually strictly regulated. In the US, outpatient treatment programs must be certified by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and registered by the Drug Enforcement Administration (DEA) in order to prescribe methadone for opioid addiction.
A 2009 Cochrane review found methadone was effective in retaining people in treatment and in the reduction or cessation of heroin use as measured by self-report and urine/hair analysis but did not affect criminal activity or risk of death.
Treatment of opioid-dependent persons with methadone follows one of two routes: maintenance or detoxification. Methadone maintenance therapy (MMT) usually takes place in outpatient settings. It is usually prescribed as a single daily dose medication for those who wish to abstain from illicit opioid use. Treatment models for MMT differ. It is not uncommon for treatment recipients to be administered methadone in a specialist clinic, where they are observed for around 15–20 minutes post-dosing, to reduce the risk of diversion of medication.
The duration of methadone treatment programs range from a few months to several years. Given opioid dependence is characteristically a chronic relapsing/remitting disorder, MMT may be lifelong. The length of time a person remains in treatment depends on a number of factors. While starting doses may be adjusted based on the amount of opioids reportedly used, most clinical guidelines suggest doses start low (e.g. at doses not exceeding 40 mg daily) and are incremented gradually.
Methadone maintenance has been shown to reduce the transmission of bloodborne viruses associated with opioid injection, such as hepatitis B and C, and/or HIV. The principal goals of methadone maintenance are to relieve opioid cravings, suppress the abstinence syndrome, and block the euphoric effects associated with opioids.
Chronic methadone dosing will eventually lead to neuroadaptation, characterised by a syndrome of tolerance and withdrawal (dependence). However, when used correctly in treatment, maintenance therapy has been found to be medically safe, non-sedating, and can provide a slow recovery from opioid addiction. Methadone has been widely used for pregnant women addicted to opioids.
Methadone is used as an analgesic in chronic pain, often in rotation with other opioids. Due to its activity at the NMDA receptor, it may be more effective against neuropathic pain; for the same reason, tolerance to the analgesic effects may be less than that of other opioids.
Methadone changes the way your brain and nervous system respond to pain so that you feel relief. Its effects are slower than those of other strong painkillers like morphine. Your doctor may prescribe methadone if you’re in a lot of pain from an injury, surgery, or long-term illness.
It also blocks the high from drugs like codeine, heroin, hydrocodone, morphine, and oxycodone. It can give a similar feeling and keep you from having withdrawal symptoms and cravings. You may hear this called replacement therapy.
Methadone Side Effects
Restlessness
Upset stomach or vomiting Slow breathing Itchy skin Heavy sweating Constipation Sexual problems Weight gain Sleep changes Appetite changes Headache Stomach pain Dry mouth Flushing Mood changes Vision problems
Some side effects are more serious.
Trouble breathing
Fainting or lightheadedness Hives or a rash Swollen lips, tongue, throat, or face Chest pain or a rapid heartbeat Hallucinations or confusion Seizures A hoarse voice Trouble swallowing Severe drowsiness Unusual menstrual periods
Methadone Risks
Heart disease
A heart rhythm disorder An electrolyte imbalance Breathing problems or lung disease A history of head injury, brain tumor, or seizures Liver or kidney disease Problems urinating Gallbladder, pancreas, or thyroid problems A condition for which you take sedatives
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