Individuals addicted to opioids, especially heroin, could be switched onto methadone, which allows them to avoid the intense cravings and intensely unpleasant symptoms associated with opioid withdrawal. They could then be gradually weaned off methadone with controlled doses of the drug until they didn’t need opioids at all. In severe cases, however, addicted individuals have been put on a permanent methadone replacement program. Going off methadone is still difficult, and relapse is always a possibility after the tapering treatment has ended. Though addicted individuals don’t typically experience a high on methadone, it does take care of the cravings for opioids.
However, it’s a different story for those who have not abused opioids and therefore do not have a tolerance to them. For these individuals, methadone can still create a powerful high if abused. Though it’s difficult to get the drug outside of a specialized methadone clinic due to its high potential for overdose, the drug has been making a comeback on the black market as it has recently become more popular for pain control. It’s been discovered to be more effective for certain types of chronic pain than other commonly prescribed opioids. As more prescriptions are given out, there are more chances for people to obtain and sell it illegally.
Like with any opioid, methadone abuse is dangerous, and addiction to the drug can lead to serious long-term health effects. Due to the unusual nature of methadone, overdose is a serious problem. Anyone who finds themselves addicted to it should seek professional addiction treatment as soon as possible.
Who Abuses It?
It’s common for methadone to be mixed with other drugs in order to increase the intensity of the high. This makes it more difficult to gather data on the demographics of methadone abuse. However, younger age groups appear to be among the most likely users, including high school students and people ages 18-34. According to the Substance Abuse Mental Health Services Administration (SAMHSA), those 18-25 years old make up about 12 percent of all emergency room visits involving recreational methadone use, and the 26-34 age group makes up 28 percent of these visits.
Chronic pain patients are also at a higher risk of methadone abuse and addiction.
Although there is less of a risk of becoming addicted to a prescription opioid if medication instructions are followed, it can still happen. Almost all patients will eventually develop a tolerance to an opioid, necessitating higher and higher doses of the drug to get the same relief from pain. If the medication is not changed or other forms of pain relief explored, it can get to the point that even the highest allowed dosage is not enough to stop the pain. At this point, a chronic pain sufferer may begin to abuse the drug by taking more than instructed or taking it on top of other intoxicants like alcohol or other opioids. This increases the risk of overdose, long-term health problems, and addiction.
People in older age groups and women are more likely to be diagnosed with chronic pain and prescribed opioid painkillers for the problem. However, it appears that men are more likely to abuse the drug, as they are more likely to end up in the emergency room for nonmedical methadone use. White people have also been more likely to abuse prescription drugs in general, including opioids, though the racial gap has been closing in recent years.
Health Effects and Overdose
The reason methadone can be so dangerous and why it’s highly controlled for addiction treatment is that it stays in the body for much longer than most opioids. However, the effects of the high don’t last for the entire 24 hours or more than it lingers in the system. The high will fade after just a few hours even if the pain-relieving effects remain. Not understanding this, people will take more doses of the drug, piling onto the amount already in the body. This can quickly lead to overdose, especially in new users with little to no tolerance.
Opioid overdose is dangerous due to the fact that these drugs depress the central nervous system, which controls essential bodily functions like the respiratory system. An overdose can cause a person to breathe so slowly and shallowly that not enough oxygen can reach the brain, resulting in a condition called hypoxia. This can rapidly lead to coma, brain damage, and death. Prescription opioid overdose deaths have been reaching alarming rates in recent years, reaching nearly 20,000 in the US in 2014 according to the National Institute on Drug Abuse.
Signs of a methadone overdose include:
- Pinpoint pupils
- Stomach or intestinal spasms
- Nausea or vomiting
- Low blood pressure
- Weak pulse
- Difficulty breathing
- Extreme drowsiness or fatigue
- Muscle twitches
- Cold, clammy skin
- Bluish fingernails or lips
Any of these symptoms in a person who just took methadone, especially if taken with alcohol or another opioid, should be cause to seek immediate medical help.
Even if overdose is avoided, opioids can cause a wide range of troubling side effects that can become severe long-term health problems. The slowing of the respiratory and gastrointestinal system increases the risk of infection and can lead to chronic constipation that can result in damage to the colon and other problems. This combined with the suppression of appetite can also cause issues related to malnutrition. Additionally, constant use of an opioid is hard on the liver and kidneys as they work to process the drug.
Addiction and Treatment
Most of the long-term health effects as well as the risk of overdose come from addiction. Addiction is classified as a mental illness or brain disease that occurs when medical or recreational drug use leads to a situation in which a person feels they can no longer get through the day without the substance. The key components are psychological and emotional dependence characterized by significant emotional distress if the drug is not available, and physical cravings and withdrawal symptoms if intake of the drug stops.
Addiction to methadone can be complicated by the fact that it’s used as a medication for addiction to opioids. Of course, those who are put on the drug for addiction treatment will be addicted to the opioid content, but it won’t be as enticing an intoxicant as something like heroin due to the lesser high or lack of a high altogether. At the same time, recreational use of methadone typically involves mixing it with other drugs, complicating the signs of abuse and addiction. However, there are some universal signs of substance addiction that can be watched out for, including:
- Frequent, dramatic mood swings
- Changes in social circles
- Changes in hygiene or grooming habits
- Reduced ability to meet responsibilities
- Withdrawn or secretive behavior
- Increased social, financial, and/or legal trouble
- Changes in appetite and/or sleep patterns
- Unwillingness or inability to quit
Most people will have serious difficulty quitting a drug without professional treatment if they are already addicted to it. There’s still considerable stigma around addiction despite the confirmation that it’s an illness and not a weakness of character. Because of this, only 11.2 percent of people who fit the criteria for an substance use disorder sought and received treatment in 2009.
Addiction treatment ideally involves three main steps: detoxification, rehabilitation, and aftercare. Detoxification or “detox” is the process of getting an individual off the drug. This is typically thought of as quitting all at once (“cold turkey”) and dealing with the withdrawal symptoms, the worst of which tend to last for a few days to a week. With methadone, it often makes more sense to taper off the dose in the same manner used when individuals addicted to opioids are treated with methadone.
This tapering treatment often occurs as part of the rehabilitation program. This part of treatment typically takes place on an inpatient or outpatient basis. Inpatient, residential rehab is thought of as the most effective because keeping addicted persons in a controlled facility eliminates the possibility of temptation and relapse. However, staying in a treatment center 24 hours per day for several weeks is not possible for some people. In outpatient rehab, clients can go in to the center once per day or a couple times per week, depending on their ability and needs. This way, they can still go to school or work, or take care of children during treatment.
Once rehab is complete, it’s very important to engage in aftercare. This can come in many different forms, most often some kind of long-term therapy or regular attendance at addiction support group meetings. Nearly all recovering persons will encounter temptation and craving triggers throughout the rest of their lives, but with the right self-care and support, they can be overcome.