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Substance Overview: Methadone

Legality

Legal under prescription only

Cost

$120 per week

Annual deaths

3,500

Side effects

Difficulty breathing or swallowing, extreme drowsiness, nausea, vomiting

Also known as

Tootsie Roll, Fizzies, Dolls, Amidone, Mud

What is Methadone?

Methadone is a synthetic (man-made) medication that was developed by German scientists during World War II as an alternative to morphine. It belongs to a class of drugs called opiate (narcotic) analgesics.1  Methadone is a powerful pain reliever with effects similar to morphine. In the United States, methadone is used to treat moderate to severe pain. It is also used to treat opiate dependence in people with addictions to heroin and prescription opioid painkillers. 2 Methadone is available under various brand names, including Dolophine, Methadose, and Methadose Oral Concentrate.

Methadone is classified as a Schedule II drug by the Drug Enforcement Administration (DEA). 3 It has legitimate legal uses but has a high potential for abuse and addiction. Schedule II drugs are considered dangerous because their use can lead to severe physical and psychological dependence. Other prescription opioid pain medications, such as oxycodone (OxyContin), hydrocodone (Vicodin), and morphine, are also Schedule II drugs. The use of methadone without a prescription can lead to abuse and addiction. It is illegal to use methadone to get high.

Methadone is available as tablets, dispersible tablets, solution, and concentrated solution formulations. For the treatment of severe pain, methadone is usually prescribed to be taken every 8-12 hours. As part of an opiate addiction treatment program, the dosage schedule of methadone varies from patient to patient.

Street names include tootsie roll, fizzies, dolls, amidone and mud.

Why is Methadone Prescribed?

Methadone is a powerful pain reliever. It was introduced to the United States in the mid-1940s as a painkiller. At present, methadone is prescribed to provide around-the-clock pain relief to people with long-lasting severe pain that cannot be treated with other pain medications.

In the mid-1960s, methadone began to be used as a maintenance treatment for heroin addiction. A heroin epidemic was sweeping New York City after World War II ended. Methadone was found to reduce or eliminate heroin use, decrease death rates, and control criminal behavior associated with heroin use. 4

Over the past few decades, methadone continues to be used for addiction treatment of opioid drugs such as prescription painkillers and the street drug heroin. In such patients who are recovering from opiate addiction, methadone helps prevent cravings and withdrawal symptoms. It allows recovering opiate addicts to stop taking drugs or remain abstinent from opiate drugs.

Studies have shown that methadone treatment not only relieves cravings and suppresses withdrawal symptoms, but also leads to improved health and social productivity. Methadone maintenance in opiate addicts has been found to reduce transmission of infectious diseases like HIV/AIDS associated with injection drug use (heroin).

How Does Methadone Work?

Methadone provides pain relief by changing the way the brain responds to pain. It acts on the same opioid receptors as other opioid medications like oxycodone, hydrocodone, and morphine, as well as the illegal drug heroin. Although methadone acts on the same opioid receptors, its action is slower than other opioids. In other words, methadone takes longer to leave the body and its effects last longer. For this reason, it can be used to help people come off opiate drugs.

In people who are dependent on opioid drugs, such as heroin and prescription pain pills, methadone is used to relieve cravings and eliminate withdrawal symptoms without producing euphoria. 5One can think of it as a sort of replacement therapy where a highly-regulated medication like methadone is used to slowly taper a person off more dangerous opioid drugs like heroin.

Methadone has been successfully used for more than four decades now to treat opioid use disorders. However, since methadone itself is an opiate with a high risk of abuse and addiction, it is dispensed through specialized, tightly-controlled opioid treatment programs.

Costs of Methadone

• Methadone treatment costs around $120 per week. This covers the cost of medication and daily medical services for administration. 6

What is Methadone Abuse and Addiction?

Methadone can produce the same euphoric effects as heroin and morphine. Studies show that the effects and potency of methadone administered intravenously are indistinguishable from other opiates like morphine. 7

Although methadone is used to help people who need to quit opiate drugs, it is itself an opiate with a potential for addiction. Methadone reduces cravings for heroin and prescription pain pills, but it can still leave an individual dependent on opiates. People struggling to quit illegal opiates can get addicted to methadone, so much so that methadone addiction has become a problem itself. Nonetheless, methadone is deemed safer than heroin and prescription opioid painkillers.

When a person uses extra doses of methadone, more frequent doses of methadone, or uses methadone without a prescription to get high, they are said to be abusing methadone. Methadone is a habit-forming medication. Its abuse puts people at risk of developing physical and psychological dependence. The risk of methadone addiction is higher in those who are receiving it for addiction treatment because such persons already have opioid dependence.

To reduce the risk of methadone addiction, it is heavily regulated. People who take methadone for opioid addiction treatment need to enroll in a special program approved by state and federal governments. Patients who are prescribed methadone must go to a methadone clinic every day to get their dose. These programs provide methadone to patients under federal laws under the supervision of qualified staff. Take-home methadone doses may be permitted for patients who have been on an established methadone maintenance program for an extended time.

Methadone can be prescribed by any physician for pain relief. However, it is currently illegal for a physician in the United States to prescribe methadone to treat an opioid use disorder outside of a licensed opioid treatment program where methadone can be dispensed. 8

Trends in Methadone Use

Data from surveys, prescriptions, emergency room visits, and substance abuse treatment clinics reveals some interesting trends in methadone use in the United States over the past several decades.

Statistics up to 2010

  • The number of methadone prescriptions filled at pharmacies increased from about 860,000 in 2000 to 4,440,000 in 2008.
  • The most popular formulation of methadone is the 10-mg tablet which comprised 85% of all methadone doses in 2008.
  • Between 2000 and 2008, the U.S. Poison Control Centers reported roughly 4,700 methadone exposures and about 100 methadone deaths.The death rate from methadone exposures increased from around 25 in the year 2000 to more than 100 in 2008. 9
  • Between 2004 and 2007, the number of emergency room visits that involved methadone increased from around 48,000 to 69,000. There was also a roughly 80% increase in visits involving methadone use in combination with alcohol, street drugs, and other prescription drugs.
  • In 2007, more than 70% of methadone visits were by Caucasians, with the highest rate for those in the 21-24 years age group.
  • Roughly 80% of emergency room visits for methadone use involve non-medical use, including misuse and abuse.
  • The number of people admitted to addiction treatment centers for illegal or street methadone increased from around 1,200 in the early 1990s to more than 5,000 in 2007.
  • The rate of methadone overdose deaths increased by 600% from 1999 to 2006. 10

Statistics after 2010

  • In 2010, roughly 10% of all treatment facilities were certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) for the provision of medication-assisted therapy with methadone and/or buprenorphine.
  • Approximately 80% of OTPs (opioid treatment programs) provided outpatient treatment in the decade leading up to 2018. Only 24% provided residential treatment and about 5 percent provided hospital inpatient treatment. This indicates that most people with opioid use disorders receive outpatient addiction treatment with methadone. 11
  • In 2014, methadone accounted for nearly one-fourth of all prescription opioid deaths.  12
  • Methadone continues to be used extensively to treat opioid addiction. Various studies have shown that methadone maintenance in opioid addicts leads to a significant decline in illicit drug use and crime as well as health benefits, including reduced risk of HIV/AIDS. 13

Recognizing Methadone Addiction

Methadone is an opioid drug and there are serious concerns about its use in treating heroin and prescription painkiller addiction. One can think of methadone as a necessary evil for recovering addicts who want to overcome opiate addiction. But the use of methadone comes with a risk of becoming addicted to methadone itself.

To reduce the risk of methadone addiction, it is dispensed through special methadone clinics in a tightly regulated manner. Nonetheless, friends and family members of people receiving methadone for pain relief or addiction treatment should know how to recognize methadone addiction. Some of the signs and symptoms of methadone addiction include:

  • Tolerance, i.e., needing more methadone to obtain pain relief or reduce opiate cravings and withdrawal symptoms. This is usually the first sign of methadone addiction. The dosing schedule of methadone should always be changed by the prescribing physician. Increasing the dose or taking more frequent doses of methadone without medical authorization is a red flag for methadone addiction.
  • Withdrawal symptoms. Habitual methadone abusers may experience unpleasant withdrawal symptoms if they do not have access to the drug.
  • Behavioral changes, such as prioritizing methadone use over everything else, trying to obtain methadone from illegal sources, failing to meet work or home responsibilities, or cutting back on social and recreational activities are all worrisome signs of methadone addiction.

Side Effects of Methadone

Like all medications, methadone can cause a variety of side effects. People who are using methadone should be vigilant for the following adverse effects:

  • Headache
  • Stomachache
  • Dry mouth
  • Sore throat
  • Flushed skin
  • Weight gain
  • Difficulty urinating
  • Vision problems
  • Mood changes
  • Sleep difficulties
  • Irregular menstruation in women
  • Erectile dysfunction (impotence) in men
  • Decreased libido (sexual desire)

Occasionally, people using methadone can experience more serious adverse effects that require immediate emergency medical help. Some of the serious side effects of methadone include itching, hives, rashes on the skin, swelling of the eyes, face, tongue, mouth or throat, and hoarseness. There can be difficulty breathing or swallowing, extreme drowsiness, nausea, vomiting, weakness, and dizziness. The person may have seizures, agitation, and hallucinations. Fever, chills, sweating, fast heartbeat, muscle twitching, stiffness, confusion, and loss of coordination are other methadone side effects that require immediate medical attention. 14

Deaths from Methadone

  • Methadone has been shown to reduce the risk of death when used as a treatment following a nonfatal overdose, in one example by nearly 60% 15
  • In 2014, methadone was responsible for around 3,500 deaths. 16

Methadone Addiction Risks

Anyone who uses methadone is at risk of abuse and addiction. For this reason, it is important to take methadone exactly as directed by the prescribing physician. People with a history of alcoholism, street drug use, or prescription drug abuse are at higher risk of developing methadone addiction. Also, individuals who currently have or have previously had depression or other mental illnesses are at increased risk of developing an addiction to methadone. Those with family members who have struggled with alcohol or drug abuse are also at a higher risk of methadone addiction.

People who abuse methadone or are addicted to it are at risk of life-threatening breathing problems. The risk is especially high in those with lung conditions, such as chronic obstructive pulmonary disease (COPD), emphysema, and bronchitis. Also, conditions that cause increased pressure in the head, such as a head injury, put an individual at high risk of breathing problems with methadone abuse. The risks are also greater in older individuals and those who are malnourished or weak. In people who are taking methadone, symptoms like slowed or shallow breathing, long gaps between breaths, or shortness of breath require immediate medical treatment.

Methadone addiction can lead to serious heart problems, such as fainting, irregular heartbeat, and sudden death. This is because methadone causes prolongation of the QT interval in some people. This is a rare condition in which the heart’s electrical system takes an abnormally long time to recharge between heartbeats. The risk is higher when methadone is used along with certain medications like antidepressants, antifungals, water pills, laxatives, and medications for irregular heartbeat. Studies have shown that despite recommendations for cardiac risk monitoring, many patients who are prescribed methadone do not receive ECG assessment. 17 If a person who is addicted to methadone or abusing methadone experiences symptoms like fainting, lightheadedness, dizziness, or a pounding heartbeat, they should seek immediate medical attention.

Methadone and Other Drugs

Taking methadone with certain other medications increases the risk of serious, potentially life-threatening adverse effects, such as breathing problems, coma, and death. That’s why it’s important to tell your doctor about all the other prescription and over-the-counter medications and supplements you are taking. Methadone can interact with a range of medications, including benzodiazepines (Xanax, Valium, Ativan), muscle relaxants, sleeping pills, and cough or pain medications that contain opiates. Drinking alcohol or using other street drugs during methadone use also increase the risk of life-threatening health complications.

The use of methadone with other drugs can lead to symptoms like lightheadedness, dizziness, drowsiness, slowed or difficult breathing, and loss of consciousness. These symptoms warrant emergency medical care. Family members of people who have methadone addiction should be aware of these symptoms so that they can contact a doctor and get emergency help.

Methadone Use in Pregnancy

Opioid use in pregnant women has increased dramatically in recent years, mirroring the opioid epidemic in the general population. In 2012, healthcare providers in the United States wrote nearly 260 million opioid prescriptions, enough for each American to get their own bottle of pills. 18

Methadone addiction in a pregnant woman can lead to many complications for the mother and baby. Regular use of methadone during pregnancy can lead to life-threatening withdrawal symptoms and neonatal abstinence syndrome (NAS) in the baby after birth. Symptoms of NAS include hyperactivity, irritability, high-pitched crying, abnormal sleep patterns, diarrhea, vomiting, uncontrolled shaking, and failure to thrive or gain weight.

Breastfeeding is encouraged in women taking methadone as it can decrease the severity of neonatal abstinence symptoms and reduce the length of hospital stay for the infant. 19

Methadone Withdrawal

People who are abusing methadone or have developed an addiction to the drug can experience withdrawal symptoms if they suddenly stop using it. Withdrawal symptoms of methadone may include:

  • Watery eyes
  • Runny nose
  • Restlessness
  • Yawning
  • Sweating
  • Chills
  • Enlarged pupils
  • Muscle and joint pain
  • Anxiety
  • Irritability
  • Backache
  • Stomach cramps
  • Weakness
  • Sleep difficulties
  • Nausea, vomiting, diarrhea
  • Decreased appetite

To avoid these uncomfortable and potentially dangerous withdrawal symptoms, people with a methadone addiction should undergo a medically-supervised detox from the drug.

Symptoms of Methadone Overdose

It is possible to overdose on methadone by taking a large dose in a short period. Symptoms of methadone overdose include:

  • Slow or shallow breathing
  • Pinpoint pupils (the small black circle in the center of the eye)
  • Drowsiness
  • Limpness of muscles
  • Cool, clammy skin
  • Loss of consciousness (unresponsiveness)

A methadone overdose can be treated with naloxone. Naloxone reverses the complications of a methadone overdose by blocking the effects of opiates. Family members, friends, and caregivers of people with methadone addiction should keep naloxone on hand and should learn how to use it. This drug can be life-saving in the event of a methadone overdose until emergency help arrives. Sometimes, a second dose of naloxone is necessary if methadone overdose symptoms return.

How Should Prescription Methadone Be Used?

Before taking methadone, tell your doctor and pharmacist about all the prescription and non-prescription medications and herbal supplements you take. Also, tell them about any allergies to medications. Inform your doctor about all your medical conditions and any planned surgeries, including dental procedures. Keep all appointments and complete all lab tests requested by the physician who prescribes methadone.

It is extremely important to take methadone exactly as instructed. Patients should discuss their symptoms with the doctor if they do not have adequate pain control. The doctor may change the methadone dose or prescribe additional medications to control pain.

Do not take extra doses or more frequent doses of methadone than prescribed even if your pain is uncontrolled. Never share your methadone with others or obtain the drug from unauthorized sources. Also, do not stop taking methadone without speaking to the prescribing physician. The dose of methadone needs to be reduced slowly. Suddenly stopping methadone use can lead to uncomfortable withdrawal symptoms. If you miss a dose, take it as soon as you remember and then continue the schedule. If it is almost time for the next dose, skip what you missed and continue as normal.

Dispersible methadone tablets should not be chewed or swallowed. If a part of the tablet is to be taken, it should be carefully broken along the scored lines. The dispersible methadone tablet should be dissolved in half a glass (roughly 120 mL or 4 ounces) of water or citrus juice. The entire contents of the glass should be consumed right away. Any remaining tablet residue in the glass should be mixed with a little more water and ingested immediately.

Methadone Storage and Disposal

Methadone should be stored in its original container with the lid tightly closed. Many containers are not child-resistant, so it’s important to keep methadone out of sight and out of reach of children to prevent poisoning. It is recommended to store methadone at room temperature and avoid exposure to excessive heat and moisture, so the bathroom is not a good idea. Any expired methadone or methadone that is no longer needed should be taken to the take-back program or flushed down the toilet.  Your pharmacist can advise you on the best way of disposing of methadone.

Treatment of Methadone Addiction

Methadone addiction can be somewhat difficult to identify and treat because it is a drug that the medical community accepts. Methadone is a legitimate pain treatment. It is also a necessary aid for recovery from heroin and prescription painkiller addiction. But, addiction to methadone is an all-too-common side effect of these legitimate treatments. Many people begin using methadone as part of an opioid addiction treatment program but go on to misuse methadone. Some individuals start abusing methadone recreationally to get high.

It can be challenging for a person to quit methadone. Drug rehab centers offer supervised detox and withdrawal for people with methadone addiction to safely come off the drug. During addiction treatment, the dose of methadone is gradually reduced. The recovering methadone addict may be switched to other medications, such as buprenorphine, to make the withdrawal easier. In the long-term, counseling and behavioral therapies are utilized to treat methadone addiction, similar to alcohol and other illicit drug addictions.

Methadone Addiction and Mental Health

Many people with methadone (opioid) addiction have co-occurring mental health disorders, such as anxiety, depression, PTSD (post-traumatic stress disorder), bipolar disorder, and schizophrenia. 20People with mental illnesses are more likely to self-medicate for symptoms of opioid addiction. It is important to get comprehensive care for methadone addiction and mental health disorders at the same time. Psychiatrists and other healthcare professionals can help people who are addicted to methadone overcome their dependence and manage mental health symptoms.

An opioid treatment program where methadone is dispensed daily is an ideal setting to initiate and monitor treatment for co-occurring psychiatric illnesses. Patients attend the methadone clinic every day and physicians have the chance to monitor their response to psychiatric medications along with providing methadone addiction treatment.

Last updated: July 21, 2020

References

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  8. The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. No date. Available online. https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf
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  13. Institute of Medicine (US) Committee on Federal Regulation of Methadone Treatment; Rettig RA, Yarmolinsky A, editors. Federal Regulation of Methadone Treatment. Washington (DC): National Academies Press (US); 1995. 1, Introduction.Available from: https://www.ncbi.nlm.nih.gov/books/NBK232114/
  14. S. National Library of Medicine. Medline Plus. Methadone. No date. Available online. https://medlineplus.gov/druginfo/meds/a682134.html
  15. NIDA. Methadone and buprenorphine reduce risk of death after opioid overdose. National Institute on Drug Abuse website. https://www.drugabuse.gov/news-events/news-releases/2018/06/methadone-and-buprenorphine-reduce-risk-of-death-after-opioid-overdose. June 3, 2020 Accessed July 20, 2020.
  16. Faul M., Bohm M., Alexander C. Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States, 2007–2014. Centers for Disease Control and Prevention.
  17. Macey TA, Weimer MB, Grimaldi EM, Dobscha SK, Morasco BJ. Patterns of care and side effects for patients prescribed methadone for treatment of chronic pain. J Opioid Manag. 2013;9(5):325-333. doi:10.5055/jom.2013.0175
  18. Centers for Disease Control and Prevention. Opioid painkiller prescribing: where you live makes a difference. Available at: https://www.cdc.gov/vitalsigns/opioid-prescribing. Retrieved July 20, 2020
  19. Bagley SM, Wachman EM, Holland E, Brogly SB. Review of the assessment and management of neonatal abstinence syndrome. Addict Sci Clin Pract. 2014;9(1):19. Published 2014 Sep 9. doi:10.1186/1940-0640-9-19
  20. Center for Substance Abuse Treatment. Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 43.) Chapter 12. Treatment of Co-Occurring Disorders.Available from: https://www.ncbi.nlm.nih.gov/books/NBK64163/