This medication is used to treat opiate substance use disorder. It’s also used to treat severe chronic pain in patients who need 24/7 pain relief. This medicine is prescribed by a doctor and dispensed to patients at a medication-assisted clinic. The drug can only be dispensed at a SAMHSA-certified opioid treatment program.
This drug is used in medication-assisted recovery programs to wean patients off of other opiates such as heroin, fentanyl, and morphine. It’s also used to maintain those with an opiate addiction on a stable dose of medication.
History of Methadone
German scientists at I.G. Farbenindustrie AG were working in 1937 to develop an easy-to-produce synthetic opiate to supplement Germany’s diminished opium supply. In 1941, they developed a synthetic formulation. They called it Hoechst 10820 or Polamidon.
Polamidon was marketed in 1943 and used by the German army during World War II. After the war ended, the Allies confiscated all information about Hoechst 10820. A U.S. study later reported that although the drug was potentially addictive, it produced less sedation and respiratory depression than morphine. It also had the potential to be marketed as a commercial drug.
In 1947, the American Medical Association named this drug methadone. It was introduced in the U.S. that same year by Eli Lilly and Company as a painkiller named Dolophine. Although the drug is an effective analgesic and pain reliever, it’s primarily used to treat opioid addiction. Dolophine literally means “an end to pain.”
When Was This Drug First Used for Opioid Treatment?
This medication was developed by German physicians Gustav Ehrhart and Max Bockmühl between 1937 and 1939. In the United States, it was approved for use in 1947. Initially, it was used to treat chronic, extreme pain. More recently, it’s been used as a treatment for those addicted to heroin and other opioid painkillers.
This drug has been designated as an Essential Medicine by the World Health Organization. It’s considered an effective and safe medicine, and it comes in tablet, powder and liquid form.
In the 1950s, treatment for heroin addiction usually meant going cold turkey while in prison. Over the next few decades, maintenance treatment was introduced as a more effective and humane treatment for opiate addiction. Heroin addiction was beginning to be seen as a medical problem that required treatment rather than as a moral failing.
Those with a substance use disorder can substitute this medicine for heroin and other opiates that may be dangerous to get and expensive to purchase. You don’t have to buy street drugs or doctor-shop to get a steady supply of prescription painkillers.
Instead of the erratic dosing experienced by those who use street drugs, this medicine can be dispensed daily with no variation in the dose. Rather than producing a “high” like other opiates, this medication simply keeps the withdrawal symptoms at bay so that you can attend to other matters and get on with your life.
Treatment works best when paired with a comprehensive medication-assisted recovery program. These programs typically include social support, education, counseling, and group therapy. Attendance at support group meetings like Narcotics Anonymous may be required.
How Does This Program Work?
This medication changes the way the brain processes pain. It reduces opiate withdrawal symptoms while blocking the sensation of “getting high.” The drug is taken once a day, and the effects can last from four to 24 hours. The dose is determined by the prescribing physician based on the patient’s history.
The more opiates you’ve been using, the higher your dosage will be. The dose can be raised or lowered at any time depending on the needs of the patient and the judgment of the physician. After a patient has been in the program for a while and stabilized on a reasonable dose, he or she may be allowed to take doses home for daily ingestion between clinic visits.
How Long Does Treatment Last?
The majority of treatment professionals agree that the most effective treatment lasts for at least one year, but some patients take this medicine for longer. If a patient wants to try life methadone-free, he or she should gradually taper off under the supervision of a doctor to minimize withdrawal symptoms and to maximize the possibility of success.
What Are the Side Effects?
Most side effects of this medication are well-tolerated. However, there are some symptoms that shouldn’t be ignored. Call for emergency services if any of the following symptoms appear:
- Breathing difficulties
- Chest pain
- Pounding or rapid heartbeat
- Feeling dizzy or faint
- Hives or rashes
- Swelling of the tongue, lips, face or throat
Some individuals experience other adverse side effects of this medicine. The most common are listed below:
- Intolerance to heat
- Sweating and perspiration
- Constricted pupils
- Dry mouth
- Vomiting and nausea
- Low blood pressure
- Missed menstrual periods
- Decreased libido
- Inability to achieve orgasm
What Are the Withdrawal Symptoms?
Withdrawal symptoms with this medication take longer to ease off than the withdrawal symptoms of other opiate drugs. However, these symptoms can be greatly reduced with a gradual detox. The most common withdrawal symptoms associated with this medication include the following:
- Sensitivity to light
- Tearing eyes
- Dilated pupils
- Runny nose
- Intolerance to cold
- Nausea and vomiting
- High blood pressure
- Hypersensitivity to pain
- Restlessness, agitation, and nervousness
- Rapid heartbeat
- Sore joints or legs
- Thoughts of suicide
- Possible relapse
- Visual and auditory hallucinations
- Chronic insomnia
- Anxiety and panic attacks
Addiction to opiates is thought to cause tooth decay due to the common side effect of a dry mouth. This symptom is exacerbated by the fact that many of those with a substance use disorder neglect oral hygiene and regular dental exams. Curiously enough, methadone seems to have a beneficial effect on reproductive health.
U.S. FDA Black Box Warning
The following risks are outlined in the Food and Drug Administration’s black box warning included with this drug:
- Opioid withdrawal symptoms can be present in children of pregnant women.
- This drug can be addictive.
- Accidental lethal overdose is possible.
- This medicine can be risky when taken with alcohol or benzodiazepines.
What Are the Overdose Symptoms?
The symptoms below have been observed in people who have overdosed on this drug:
- Pinpoint pupils
- Sedation and unresponsiveness
- Limp muscles
- Nausea and vomiting
- Slow and shallow breathing
- Cool, clammy and damp skin
- Unconsciousness and coma
Although deaths related to this medication can occur, most result from mixing it with other drugs, particularly CNS depressants.
Opiate overdose can be treated with an opioid antagonist like naloxone or naltrexone. Administering an opiate antagonist is tricky. Too little will be ineffective, and too much could activate a sudden detox with severe withdrawal symptoms. Naloxone is the preferred treatment because it has a short half-life. If you administer too much and the patient goes into withdrawal, the effects will be short-lived.
Naloxone leaves the body quickly, so multiple dosing may be necessary to keep the patient out of an overdose. This is especially true with methadone. It stays in the body for a long time, and its effects can last for up to 24 hours. When the antagonist wears off, the person returns to a state of overdose and another dose must be given.
Does This Drug Produce Tolerance and Dependence?
The more of an opiate you ingest, the more your tolerance builds. Although tolerance to the pain-killing effects of this medication may build slowly, tolerance to the euphoric effect develops quickly. On the other hand, tolerance to sedation, constipation and respiratory depression may not develop at all.
Who Qualifies for Methadone Treatment Coverage?
Although brand-name formulations can be expensive, generic tablets are relatively cheap. Treatment at an outpatient clinic may be covered by private insurance or by Medicare or Medicaid. When prescribed for pain and dispensed at a pharmacy, the cost of this medicine is covered under Medicare Part D.
Part D Medicare does not, however, cover this medication when it’s dispensed in a clinic and used for medication-assisted recovery of opioid dependence. Eligibility for medication-assisted recovery with methadone is usually contingent on participation in a substance use disorder treatment program. Veterans in the Veteran’s Administration health care system may be eligible for medication-assisted recovery.
What Are Medication-Assisted Recovery Programs?
Medication-assisted recovery programs are clinics that dispense methadone, naltrexone, buprenorphine, and Suboxone. These drugs can help you to quit heroin and other opiates and are provided as part of treatment. This treatment is designed for patients who are now dependent on opiates or who have been dependent on them at some point in the past.
Overall, people who participate in medication-assisted recovery programs may be more successful in quitting heroin than those who do not. People who quit heroin without methadone are more likely to relapse. They also have a higher risk of an overdose after a period of abstinence or lower daily doses.
Methadone is considered a Schedule II opioid painkiller that’s used for pain management as well as opioid substance use disorder. This medicine treats pain and reduces heroin withdrawal symptoms. It’s particularly effective because of its long-acting properties. When the drug is taken in the morning, its effects can last all day.
Patients must report to the clinic daily to receive their dose. Because many clinics are closed on Sunday, however, take-home medication for one day is often provided. Patients may be required to undergo drug testing. They may also be required to attend substance use disorder groups and outside support meetings through organizations like Narcotics Anonymous.
With daily treatment, patients are relieved of opioid withdrawal symptoms as well as the feeling of being “high.” They are able to regain some stability in their lives and to learn new ways of living. All the time and energy that used to be spent finding and using drugs is now free. That energy can be channeled into recovery activities, checking out employment opportunities and spending quality time with friends and family.
How Can I Tell if I’m Addicted?
You know you’re addicted to opiates if you get unpleasant withdrawal symptoms whenever you try to quit. If you’ve been using heroin regularly for six or more months, you may be addicted.
Patients who take methadone may be more successful in quitting heroin than those who don’t. Opiates are highly addictive, and if you’re hooked, your body needs these drugs to function properly. Tapering off gradually under a doctor’s supervision is highly recommended. Going “cold turkey” can produce such intolerable side effects that you set yourself up for a relapse.
People who quit heroin while participating in a drug-assisted treatment program are less likely to relapse. If you’ve been clean for a while, your tolerance will be lower. You could be at risk for an accidental overdose if you resume using.
Methadone maintenance is not a cure for heroin addiction. Rather, it allows you to stabilize yourself and your life so that you can attend to the business of living. A methadone detox at some point in the future may be pursued.
If you want to quit heroin or any other opiate drug, don’t do it alone. Speak with your doctor and if necessary, get help. Many of those with a substance use disorder have quit using heroin and then entered drug rehab for addiction treatment. They now live clean, drug-free lives in recovery without having to use opiates.