Methadone has been a generational treatment for heroin dependence and addiction. It has long been a controversial option ever since it was first utilized to address heroin addiction in the 1960s.
Federal agencies such as the National Institute on Drug Abuse (NIDA), the National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMHSA) endorse methadone as an effective treatment option for opioid addiction.
The World Health Organization (WHO) includes it on its List of Essential Medicines. These are medicines deemed to be the most effective and safe to meet the most important needs in a health system.
Despite methadone’s usefulness in the war against opioid addiction, it remains a drug of abuse that is capable of ensnaring users into addiction or worse, death.
Methadone, which was first produced by German scientists in the 1930s, is a synthetic opioid used to treat opioid dependency. When it was first developed, however, it was intended to be a pain medication. It was also hailed as a less addictive alternative to morphine.
Then heroin use and addiction raged in the 1960s and 1970s. This scourge brought about a need for a viable treatment solution. A New York Timesarticle from April 15, 1962, provides a window into the menace that heroin was becoming in urban communities.
“Narcotics deaths, which have increased here from ninety-nine in 1957 to 311 in 1961, indicate the possibility that criminals are diluting heroin with poison,” declared former New York City mayor Robert F. Wagner Jr. at the time.
Methadone became that answer. Thanks to a pilot program established in 1964, addicted persons were treated with the maintenance medication. Doctors discovered that methadone could replace heroin, allowing patients to eventually taper off any opioid altogether.
In 1972, the U.S. Food and Drug Administration (FDA) officially approved methadone to treat heroin addiction.
“In 1964, the effectiveness and usefulness of using methadone maintenance (i.e., using it as a substitute narcotic to prevent withdrawal) was [sic] realized, according to the Center for Substance Abuse Research (CESAR).
Available as a tablet, solution, or dispersible tablet, methadone stimulates opioid receptors in the brain. In this way, it works like other opioids. However, one distinguishing feature of this methadone is that it also has a remarkably long half-life compared to other substances in its class. Its half-life is between 15 to 55 hours, and it can offer pain relief for up to eight hours.
It also acts more slowly in the body and does not produce the intense euphoria of heroin, oxycodone, and other notorious opioids of abuse.
These attributes make methadone ideal as a replacement drug, but that does not mean it is safe to abuse.
In fact, methadone can be lethal. In 2009, for example, prescription painkiller overdoses were responsible for 15,500 deaths. However, more than 30 percent of those deaths involved methadone despite the fact it only made up two percent of those prescriptions that same year, according to the U.S. Centers for Disease Control and Prevention (CDC).
At one point, the methadone overdose death rate increased by 600 percent from 1999 to 2006, from 0.3 persons per 100,000 (784) to 1.8 in 2006 (5,518). However, that rate declined by 39 percent in 2014.
Any way you slice it, methadone can be an effective medicine or a lethal poison, depending on how it’s used.
Addiction to any substance is usually marked by the following behaviors, signs, or effects, according to the Mayo Clinic:
Withdrawal symptoms from methadone occur when the drug exits your system. It means that you need it in your body to feel normal. When you experience withdrawal, it is one of the surefire signs that addiction is imminent.
Like other opioids, once you stop using methadone, you will begin to have flu-like withdrawal symptoms. With methadone, those withdrawal effects typically show up between 24 to 36 hours after the last use.
According to Healthline, the following withdrawal symptoms can occur:
Other withdrawal symptoms include:
If you are exhibiting any of the signs, behaviors, or effects that were mentioned above, then it is critical that you consider professional treatment. Because methadone addiction can result in a fatal overdose, treatment can be lifesaving.
Ironically, people who are addicted to heroin or prescription pain medicines use methadone to get off those opioids. However, you can get addicted to methadone in the process. If this is you, the worst thing you can do is attempt to quit it “cold turkey.”
Quitting on your own can leave you prone to debilitating withdrawal symptoms, which can be enough to drive you back to abusing methadone. When you quit methadone but relapse, you usually reencounter the drug with a lower threshold. This increases your chances of having an overdose.
This threat is why detox, where a medical team oversees your process, is best. With medical detox, this team will gradually taper you off methadone and use approved medications to treat your withdrawal symptoms.
Once you are stabilized, you can enter into professional treatment where the mental and emotional aspects of your addiction are addressed.
After detox, the most common path toward recovery is through inpatient or residential treatment.
In this setting, you are provided with comprehensive, full-time care at a treatment facility where you will also live. You will have access to evidence-based therapy and counseling that help you get to the root of your methadone addiction.
After residential treatment, clients typically enter an outpatient treatment or intensive outpatient program (IOP), which allows you to live independently as you receive ongoing care. Clients with severe cases of methadone addiction typically enter residential treatment. Those with mild cases of addiction are usually recommended for an outpatient program.
The U.S. Drug Enforcement Administration (DEA) designates methadone as a Schedule II substance, meaning that it has a high potential for abuse that can lead to severe psychological or physical dependence.
It also is capable of producing life-threatening overdose effects such as:
High doses of methadone can bring on respiratory depression. The lack of oxygen can also result in brain damage, hypoxia, coma, and death.
Bennett, C. G. (1962, April 15). Heroin Poisoning Studied By City. from https://timesmachine.nytimes.com/timesmachine/1962/04/15/issue.html
Center for Substance Abuse Research. (n.d.). Methadone. from http://www.cesar.umd.edu/cesar/drugs/methadone.asp
Drug Enforcement Agency (DEA). (n.d.). List of Controlled Substances. from https://www.deadiversion.usdoj.gov/schedules/
Faul, M., Bohm, M., & Alexander, C., MD. (2017, March 31). Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States, 2007–2014 [PDF File]. Atlanta, GA: US Department of Health and Human Services/Centers for Disease Control and Prevention. from https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6612a2.pdf
Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder). from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
National Institute on Drug Abuse. (2018, June 19). Methadone and buprenorphine reduce risk of death after opioid overdose. from https://www.drugabuse.gov/news-events/news-releases/2018/06/methadone-buprenorphine-reduce-risk-death-after-opioid-overdose
National Institute on Drug Abuse. (2019, January 22). Opioid Overdose Crisis. from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
U.S. Centers for Disease Control and Prevention. (n.d.). Prescription Painkiller Overdoses | VitalSigns | CDC. from https://www.cdc.gov/vitalsigns/methadoneoverdoses/index.html
World Health Organization Model List of Essential Medicines, 21st List, 2019 [PDF File]. (2019). Geneva, Switzerland: World Health Organization. from https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-EMP-IAU-2019.06-eng.pdf?ua=1