Methadone Addiction: Risks and Treatment

Methadone is a synthetic opioid commonly used for pain relief and as a treatment in medication-assisted treatment (MAT) programs. While methadone is effective in treating opioid addiction, it has a high potential for misuse. A study written by Ball, J. C. and published in the Journal of Substance Abuse Treatment found that around 20% of individuals in methadone maintenance treatment misuse the medication. 

The risks of individuals using methadone for long-term pain management are the potential to develop physical dependence, leading to increased tolerance and withdrawal symptoms upon cessation. Moreover, methadone has a high potential for misuse, and improper use will result in overdose, respiratory depression, and death. According to the Centers for Disease Control and Prevention (CDC), methadone was involved in nearly 3,400 opioid-related overdose deaths in the United States in 2019.

Treating methadone addiction requires a comprehensive approach, combining medical, psychological, and social interventions. Behavioral therapies, such as cognitive-behavioral therapy (CBT) and contingency management, are crucial in addressing the psychological aspects of addiction and helping individuals develop healthier coping mechanisms. Support groups and 12-step programs provide ongoing social support, which is vital for long-term recovery. Medication-assisted treatment (MAT) is also be used cautiously to prevent relapse, but it must be carefully monitored to avoid substituting one addiction for another.

What Is Methadone?

Methadone is a long-acting synthetic opioid that is primarily prescribed to manage opioid use disorder (OUD) and chronic pain. It was first developed in Germany during World War II as a synthetic alternative to morphine, which was in short supply. Methadone was introduced to the United States in 1947 by Eli Lilly and Company as an analgesic (pain reliever) and later gained approval for use in treating opioid addiction. Initially named “Dolophine,” the drug was intended to be a painkiller with fewer addictive properties than morphine. However, its potential for treating opioid addiction was not recognized until the 1960s. In 1964, Drs. Vincent Dole and Marie Nyswander of Rockefeller University pioneered the use of methadone as a maintenance therapy for heroin addiction, marking a significant milestone in addiction treatment.

Methadone is available in several forms, including oral tablets, oral solutions, and injectable solutions. Oral tablets are used for both pain management and opioid addiction treatment, while oral solutions are preferred in methadone maintenance programs for easy dosage adjustment. Injectable solutions are typically used in hospitals for severe pain. Dosages vary by use: for opioid use disorder, initial doses range from 20 to 30 mg per day, adjusted based on patient response, with maintenance doses between 80 to 120 mg per day. For pain management, doses start low and are carefully increased to balance pain relief and side effects.

Methadone is known by several other names, both brand names and street names, including:

  • Brand Names: Dolophine®, Methadose®.
  • Street Names: Amidone, Fizzies, Jungle Juice, Metho.

How Is Methadone Used to Treat Addiction?

Methadone plays a big role in the treatment of opioid addiction by reducing withdrawal symptoms and cravings, allowing individuals to focus on recovery without the intense discomfort associated with opioid withdrawal. It works as a long-acting opioid agonist, binding to the same receptors in the brain as other opioids, but without producing the same euphoric high. This helps stabilize patients and reduce the harmful behaviors associated with opioid misuse.

Here are some benefits of methadone in MAT:

  • Reduction in Illicit Drug Use: Methadone maintenance therapy (MMT) significantly decreases the use of illicit opioids. Studies have shown that individuals on MMT are less likely to engage in illegal drug use and related activities.
  • Improved Health Outcomes: MMT has been associated with better physical and mental health outcomes. Patients often experience fewer infectious diseases and reduced mortality rates.
  • Social Stability: Patients in MMT programs tend to have improved social functioning, including better employment stability and relationships.

According to a study by Joseph J. Bell et al.2020, published in the “Journal of Substance Abuse Treatment” in 2020, methadone maintenance therapy has been shown to reduce opioid-related mortality by up to 50%. The study underscores the effectiveness of MMT in not only reducing opioid use but also in lowering the death rates associated with opioid addiction.

What Are the Risks of Methadone Addiction?

The Risks of Methadone Addiction

Methadone, while effective for treating opioid use disorder, carries significant risks of addiction and misuse. Methadone addiction will develop due to its opioid nature, which leads to physical dependence and psychological cravings. According to the Centers for Disease Control and Prevention (CDC), methadone was involved in nearly 3,400 overdose deaths in the United States in 2019, highlighting the potential dangers associated with its misuse. The risks of Methadone Addiction include:

  1. Physical Dependence and Withdrawal: Long-term methadone use leads to physical dependence, where the body becomes accustomed to the drug, requiring higher doses to achieve the same effect. Withdrawal symptoms are severe and include nausea, vomiting, muscle aches, anxiety, and insomnia.
  2. Overdose Risk: Methadone has a long half-life, meaning it stays in the body longer than many other opioids. This increases the risk of overdose, particularly if doses are not properly managed. Overdose symptoms include respiratory depression, extreme drowsiness, and loss of consciousness.
  3. Cardiac Issues: Methadone causes changes in the heart’s electrical activity, leading to a condition known as QT prolongation. This results in serious heart arrhythmias and potentially fatal cardiac events.
  4. Cognitive and Mental Health Effects: Methadone use impairs cognitive functions and mental health. Users experience confusion, memory problems, and mood swings. Chronic use can also exacerbate underlying mental health disorders.

What are the Factors that Contribute to Methadone Addiction?

  • Prolonged Use: Long-term use for chronic pain or opioid addiction treatment can lead to physical dependence.
  • Dosage Mismanagement: Incorrect dosing, whether intentional or accidental, can increase the risk of addiction.
  • Psychological Factors: Individuals with a history of substance abuse or mental health disorders are more susceptible to developing methadone addiction.
  • Lack of Supervision: Insufficient medical supervision and follow-up during treatment can contribute to misuse and dependence.
  • Accessibility: Easy access to methadone through prescription or illicit means increases the risk of abuse.

A study titled “Methadone-Involved Overdose Deaths in the United States Before and After Federal Policy Changes Expanding Take-Home Methadone Doses from Opioid Treatment Programs” written by Jones et al., 2022 and published in JAMA Psychiatry found that policy changes during the COVID-19 pandemic allowing for more flexible take-home methadone doses did not lead to an increase in methadone-involved overdose deaths, despite an overall rise in overdose deaths. This indicates that expanding access to methadone for treatment did not increase its misuse.

How Is Methadone Addiction Treated?

Methadone addiction is treated by incorporating detox, behavioral therapy and medically monitored treatment to ensure safe and effective recovery. 

Detoxification Process

The detoxification process is the first step in treating methadone addiction. It involves gradually tapering off methadone under medical supervision to minimize withdrawal symptoms. Detox should be done in a controlled environment, such as a hospital or specialized detox center, where healthcare professionals can monitor and manage withdrawal symptoms, which can include nausea, vomiting, muscle aches, anxiety, and insomnia. The goal of detoxification is to safely reduce the physical dependence on methadone, preparing the individual for further treatment.

Medication-Assisted Treatment (MAT)

Medication-Assisted Treatment (MAT) combines medications with counseling and behavioral therapies to treat substance use disorders. In methadone addiction treatment, MAT may involve the use of other medications such as buprenorphine or naltrexone to help manage withdrawal symptoms and cravings. Buprenorphine, like methadone, is an opioid agonist but has a ceiling effect that reduces the risk of misuse. Naltrexone is an opioid antagonist that blocks the effects of opioids and helps prevent relapse. MAT has been shown to improve treatment retention and reduce the risk of overdose.

Behavioral Therapies and Support Options

Behavioral therapies are pivotal in addressing the psychological aspects of methadone addiction. Cognitive-behavioral therapy (CBT) helps patients recognize and change negative thought patterns and behaviors related to drug use. Contingency management provides incentives for maintaining sobriety, and motivational interviewing enhances a patient’s motivation to change. Support groups, such as Narcotics Anonymous (NA), offer peer support and a sense of community, which are vital for long-term recovery. Combining these therapies with MAT can lead to better treatment outcomes.

Inpatient vs Outpatient Treatment of of Methadone Addiction

Choosing between inpatient and outpatient treatment depends on the severity of the addiction and the individual’s circumstances. A consultation with a healthcare professional will help determine what type of treatment is needed and will be most suitable for long-term sobriety. 

AspectInpatient TreatmentOutpatient Treatment
SettingResidential facilities provide 24/7 care.Patients live at home and attend treatment sessions at a clinic.
SuitabilityIdeal for individuals with severe addiction, co-occurring mental health disorders, or those who have not succeeded in outpatient programs.Suitable for individuals with milder addiction or those who have completed inpatient treatment.
AdvantagesProvides a structured environment with intensive support, reducing exposure to triggers and access to drugs.Offers greater flexibility, allowing patients to maintain work, school, and family responsibilities while receiving treatment.

What Are the Signs of Methadone Addiction?

The Signs of Methadone Addiction

What are the Behavioral and Physical Symptoms of Methadone Addiction?

Recognizing the signs of methadone addiction is crucial for early intervention and treatment. Behavioral and physical symptoms of methadone addiction include:

  • Increased Tolerance: Needing higher doses of methadone to achieve the same effect.
  • Withdrawal Symptoms: Experiencing symptoms like sweating, chills, nausea, vomiting, diarrhea, and muscle aches when not using methadone.
  • Neglecting Responsibilities: Ignoring personal, professional, or academic responsibilities in favor of obtaining and using methadone.
  • Doctor Shopping: Visiting multiple doctors to obtain additional prescriptions.
  • Physical Health Issues: Respiratory problems, drowsiness, and significant weight changes.
  • Track Marks: If methadone is injected, there may be visible injection sites on the body.

What are the Emotional and Psychological Indicators of Methadone Misuse?

Methadone addiction also manifests through various emotional and psychological indicators:

  • Mood Swings: Extreme changes in mood, from euphoria to irritability or depression.
  • Anxiety and Paranoia: Heightened levels of anxiety or paranoia, especially regarding drug use and obtaining methadone.
  • Depression: Persistent feelings of sadness, hopelessness, and lack of interest in previously enjoyed activities.
  • Cognitive Impairments: Difficulty concentrating, memory problems, and confusion.
  • Isolation: Withdrawing from social activities and relationships.
  • Obsessive Thoughts: Constantly thinking about methadone, how to obtain it, and when the next dose will be taken.

Can You Overdose on Methadone?

Yes, it is possible to overdose on methadone, particularly if it is misused or taken in higher doses than prescribed. Methadone overdose can be life-threatening and requires immediate medical attention.

Symptoms of methadone overdose can include:

  • Severe Respiratory Depression: Slow or shallow breathing, difficulty breathing, or stopped breathing.
  • Extreme Drowsiness: Unconsciousness or inability to wake up.
  • Muscle Weakness: Flaccid muscles and lack of coordination.
  • Pinpoint Pupils: Constriction of the pupils, which may not respond to changes in light.
  • Cold and Clammy Skin: Skin feels unusually cool and sweaty.
  • Low Blood Pressure: Hypotension, which can lead to shock.
  • Bradycardia: Slow heart rate.
  • Cyanosis: Bluish tint to lips and fingertips due to lack of oxygen.

Emergency Interventions and Treatments

Immediate medical intervention is crucial in the event of a methadone overdose. Key emergency interventions include:

  1. Call 911: Seek emergency medical help immediately.
  2. Administer Naloxone: If available, naloxone (Narcan®) temporarily reverses the effects of opioid overdose. It is crucial to administer it as soon as possible.
  3. Perform CPR: If the individual is not breathing or has no pulse, begin cardiopulmonary resuscitation (CPR) and continue until medical personnel arrive.
  4. Monitor and Support: Stay with the person, monitoring their breathing and heart rate until help arrives. Be prepared to administer additional doses of naloxone if necessary, as its effects may wear off before the methadone is fully out of the system.

What is the Role of Aftercare for Methadone Addiction?

Aftercare is essential in treating methadone addiction, providing ongoing support as individuals transition from intensive treatment back to daily life. It significantly reduces relapse risk and improves long-term recovery outcomes.

Support groups and continuous therapy are vital components of aftercare. Support groups like Narcotics Anonymous (NA) offer a platform for sharing experiences and challenges, fostering a sense of community and reducing feelings of isolation. Continuous therapy, including cognitive-behavioral therapy (CBT), helps individuals develop coping strategies, address underlying psychological issues, and manage triggers to prevent relapse. Regular therapy sessions ensure personalized care and adjustments to the recovery plan, enhancing its effectiveness

Can Methadone Use Lead to Dental Problems?

Yes, long-term use of methadone leads to dental problems, a condition often referred to as “methadone mouth.” This includes tooth decay, gum disease, and dry mouth. Methadone can reduce saliva production, which is crucial for protecting teeth and gums from bacteria and decay.

Is Methadone Safe During Pregnancy?

Methadone is considered safer than continued opioid use during pregnancy and is used as part of a comprehensive treatment plan for pregnant women with opioid use disorder. According to the American College of Obstetricians and Gynecologists [ACOG], et al. 2017, Methadone maintenance therapy reduces the risk of withdrawal symptoms and complications for both the mother and the baby. However, newborns could still experience neonatal abstinence syndrome (NAS) and require treatment after birth.

Does Methadone Interact With Other Medications?

Yes, methadone can interact with a wide range of medications, including antidepressants, antiretrovirals, antifungals, and certain antibiotics. According to the U.S. Food and Drug Administration (FDA). “Methadone Hydrochloride.” 2021, these interactions can either increase methadone levels, raising the risk of toxicity and overdose, or decrease its effectiveness, leading to withdrawal symptoms. It is crucial to inform healthcare providers about all medications being taken to avoid adverse interactions.

What is “Split Dosing” in Methadone Treatment?

Split dosing is a practice in methadone maintenance therapy where the daily dose is divided into two or more smaller doses taken at different times of the day. This approach is beneficial for individuals who metabolize methadone quickly, experiencing withdrawal symptoms before their next scheduled dose. Split dosing helps maintain stable blood levels of methadone, improving treatment outcomes and reducing the risk of withdrawal and cravings.

What are the Social Consequences of Methadone Addiction?

Methadone addiction often leads to severe social consequences, including strained relationships and social isolation. According to Healthline, individuals may withdraw from family and friends, leading to deteriorating personal and professional relationships. The addiction prioritizes drug use over responsibilities, causing significant disruptions in daily life.

Addressing these social impacts is essential for long-term recovery. Programs involving family integration can help rebuild trust and improve communication within the family unit. This support system is crucial for a stable environment. Additionally, understanding the social impacts of other substances, such as Restoril addiction, can provide insights into comprehensive recovery strategies.

The Grove Editorial Team is a dynamic group of professionals at The Grove, a leading addiction treatment center in Indianapolis, Indiana. Comprising experienced therapists, medical experts, and dedicated support staff, this team brings a wealth of knowledge and compassionate insight into the complexities of addiction and recovery. Their collective expertise shines through in each article, offering readers valuable guidance, the latest in addiction science, and inspiring stories of healing and transformation. The Grove Editorial Team is committed to educating, supporting, and empowering individuals and families on their journey toward a healthier, substance-free life.

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