Whether you’re currently struggling with an addiction, care about an addict or simply want to know more about what’s being done to deal with the opioid crisis, chances are good you’ve heard about methadone clinics.
In the United States, an estimated 350,000 people receive daily methadone doses from one of the 1,460 federally-regulated methadone clinics. In spite of the increased adoption of methadone as a treatment for addiction and the ever-growing opioid death rate in America, methadone clinics continue to be the target of protests and debates over the belief that methadone clinics are simply government-approved drug dealers.
What Is Methadone?
Methadone is a long-acting synthetic opioid analgesic that’s used to treat severe pain, for example, for patients with advanced forms of cancer. It’s also widely used to treat opioid addiction; in the right dose, methadone is highly effective in reducing cravings and withdrawal symptoms among people who are addicted to fentanyl, heroin, hydromorphone and oxycodone.
Unlike opioid drugs, methadone doesn’t produce the typical high that opioids do. Following the initial induction period, patients who receive methadone under medical supervision typically report that they feel normal. Because methadone has a much longer half-life than opioids, patients usually take a dose once daily.
Methadone was developed in the late 1930s by German chemists who were searching for a powerful nonaddictive painkiller that could be used as an alternative to morphine. First named Hochst-10820, methadone was successfully used to reduce heroin withdrawal symptoms among WWII soldiers in the United Kingdom during the 1940s, and it became legal as a prescription medication in the United States in 1947.
The Effects of Methadone
While methadone is chemically similar to addictive opioids such as heroin and morphine, the effects it has on users are significantly different.
The most notable characteristic of methadone is that it is highly effective in altering how the brain and the nervous system respond to pain — it lessens the perception of pain signals without producing the tell-tale euphoric high associated with traditional opioids. Methadone also blocks the euphoric effect of other opioids that may be taken concurrently, which provides people struggling with opioid use disorder a powerful deterrent against taking codeine, oxycodone or other opioids while on methadone.
When prescribed by a licensed addiction specialist and taken in the proper dose, methadone tends to produce few side effects; however, users may feel uncomfortable during the first week or so of their methadone treatment. Symptoms like light-headedness, nausea, constipation and diarrhea are relatively common, but the intensity of these symptoms is significantly milder than patients with OUD would experience if they went “cold turkey” off all forms of opioids.
Some people who use methadone report experiencing weight gain related to water retention and increased caloric intake, while others complain of dry mouth, difficulty urinating and vision problems — all issues usually resolved by modifying the dose of methadone.
Methadone and Addiction Treatment
Methadone has been widely used in addiction treatment programs since the 1960s following the establishment of the world’s first methadone maintenance treatment program in Vancouver, Canada, in 1959. During the 1960s, methadone was used to treat heroin addicts in New York.
In 1964, the U.S. Food and Drug Administration approved methadone for use in medication-assisted treatment programs for people diagnosed with OUD. Methadone is one of only three drugs (the others are buprenorphine and naltrexone) that are FDA-approved for the treatment of OUD.
In the United States, methadone is often distributed under the brand names Dolophine (tablets) and Methadose (concentrated liquid). When dispensed at a methadone or MAT clinic, methadone is often mixed with juice and consumed on-site. This ensures patient compliance with the prescription and prevents the resale of methadone on the street.
How Is Methadone Administered?
As stated, a methadone clinic is a facility that distributes methadone to individuals in need, often on a daily basis. You may be wondering why this is necessary, and why methadone can’t be picked up at the pharmacy counter like any number of other prescriptions – including opioids like oxycodone. This is a fair question, but the nature of methadone makes this concept a benefit to patients.
Methadone is a synthetic analgesic drug that’s similar in form and function to a low dose of morphine. As such, it’s addictive and must be managed by professionals to avoid ongoing addiction challenges. Those suffering with opioid addiction must visit the clinic every day to receive a dose of methadone.
This is usually nonnegotiable; patients can’t collect several days at once. Methadone must be given in single doses by a nurse, physician or physician assistant. Generally, methadone is administered in pill form but can also be an injection.
In theory, anyone with proof of addiction can go to a methadone clinic, but depending on the area, this pipeline can differ. Some clinics require a positive drug test, while others may require participation in a treatment program or diagnosis by a doctor.
Is It Possible to Abuse Methadone?
Despite the advantages of methadone in helping those addicted to opioids such as heroin, oxycodone and morphine, methadone can be and is abused. This is the primary reason for the control of methadone in the clinic environment.
Methadone acts on the same receptors in the brain that are triggered by the ingestion of opioids. This provides a similar sensation to taking drugs, helping to stabilize the nervous system in a way that diminishes the need to use opioids for those attempting to overcome addiction.
When used properly, methadone can be a valuable tool, but abuse is possible. If available at a high level, methadone can be abused just like any other similar substance, including causing the intoxication for which opioids are known. Those who have trouble getting access to preferred drugs can turn to methadone if necessary, leading to abuse when left unregulated.
Side Effects of Methadone
While methadone has many benefits for those attempting to overcome their addiction to opioids, some side effects are associated with ongoing methadone use. Methadone can cause:
- Nausea and vomiting
- Heart palpitations
- Dry mouth
Not all users experience these side effects, but they are to be expected for those using methadone regularly.
The Stigma of Methadone Clinics
Despite the fact that the death toll from the opioid crisis in America continues to rise, methadone clinics continue to be highly controversial and stigmatized among lawmakers, government officials, the general public and even some members of the recovery community.
In general, biases related to methadone are largely due to ignorance rather than malice. As users take methadone to manage addiction, not get high, MAT doesn’t indicate continued addiction.
Instead, it’s a very effective tool to promote cessation of heroin or prescription opioids due to the ways in which methadone affects the brain. Long-term relapse rates are far lower for those receiving MAT than those who choose alternative forms of treatment; methadone users are 4.4 times more likely to remain in treatment and 33% less likely to test positive on future drug tests.
Methadone use as part of a medically supervised OUD program is similar to how nicotine patches and gum are used to help tobacco users quit smoking — something that is widely accepted among medical professionals and the public alike.
Unfortunately, the stigma around methadone clinics and MATs for opioid addicts has been linked to a number of deaths, including that of Robert Lepolszki of New York, who died of an opioid drug overdose in 2014 at the age of 28. In 2013, Judge Frank Gulotta, Jr. ordered that Lepolszki, who was arrested on drug-related charges, be terminated from his methadone treatment program — an order that Lepolszki’s parents feel deprived their son of the medication (methadone) he needed to save him from an opioid overdose.
Judge Gulotta defended his order to terminate Lepolszki’s access to methadone, stating that MATs “are crutches — they are substitutes for drugs and drug cravings without enabling the participant to actually rid him or herself of the addiction.”
Alternatives to Methadone
Methadone is a very popular and highly recommended way to treat opioids addiction, but it isn’t the only option. Some doctors are now encouraging opioid addicts to use alternatives to methadone, the most popular of which is Suboxone.
Suboxone is a relatively recent option to address opioid dependence. A combination of buprenorphine and naloxone, Suboxone can be seen as a safer and milder alternative.
As naloxone, a common antidote for overdose, is a component, suboxone is a beneficial way to address dependence without eliciting the high that methadone can provide. For this reason, Suboxone is less addictive while still targeting the opioid receptors in the brain.
In spite of this, Suboxone can be abused as well. Any substance that impacts opioid receptors in the brain can stimulate side effects that maintain addiction.
In extremely high doses, the impact of Suboxone can somewhat rival standard opioids. While the expected high is not generally available, the bodily response is, helping addicts to feel well again.
Subutex, the trade name for buprenorphine, is also an alternative to methadone. However, as Subutex doesn’t include the benefits of naloxone, it’s a less popular alternative for those who want to diminish the chemical draw to opioids because the consequences are generally on par with methadone.
Choosing a Methadone Management Plan
While methadone can positively impact the lives of hundreds of thousands of people annually, it’s not a choice that should be made by an individual. Due to the nature of methadone, a trained professional should guide treatment. If methadone is a potential option in your treatment, be sure to speak with those involved in your addiction management to find the right path forward.
Want to Learn More About Methadone? Call Us
To learn more about opioid use disorder, methadone and treatment options for people who are addicted to heroin, hydromorphone and other opioids, call us here at FHE Health, start a live online chat, or complete our online contact form. Our team of compassionate, professional addiction and mental health experts are available to take your call 24/7, 365 days a year.