Do You Know... Methadone

Updated July 06, 2005 1:02 PM

Street Names: juice, meth (also used to refer to methamphetamines)

What is it?
Methadone belongs to the opioid family of drugs. It is used most commonly to treat dependence on other opioid drugs such as heroin, codeine and morphine.

Methadone is a "synthetic" opioid, which means that it is made from chemicals in a lab. Other opioid drugs include the "opiates," such as morphine and codeine, which are natural products of the opium poppy, and "semi-synthetic" opioids, such as heroin, which is morphine that has been chemically processed.

Methadone was developed in Germany during the Second World War and was first used to provide pain relief.

Methadone maintenance treatment, which prevents opioid withdrawal and reduces or eliminates drug cravings, was first developed in the 1960s. For many years, Canadian regulations around the prescription of methadone were so restrictive that few doctors offered the treatment. People who wanted methadone treatment often had to wait months or years. In the 1990s, the need to reduce the harm of drug use was more clearly recognized, and changes were made to make it easier for doctors to provide methadone treatment. This has led to an increase in the number of people receiving treatment, and a decrease in the number of heroin-related deaths.

Methadone maintenance is not a "cure": it is a treatment. Through treatment, people who are dependent on opioids receive the medical and social support they need to stabilize and improve their lives. They are encouraged to stay in treatment for as long as it helps them.

What does methadone look like?
Pure methadone is a white crystalline powder. The powder is dissolved, usually in a fruit-flavoured drink, and is taken orally once a day.

Who uses methadone?
Most people who are prescribed methadone are being treated for dependence on opioid drugs. This includes people who are dependent on illicit opioids, such as heroin, and also prescription opioids, such as codeine.

Women who use opioid drugs regularly and who are pregnant are often treated with methadone to protect the fetus. Short-acting opioids such as heroin must be taken frequently to avoid withdrawal. Opioid withdrawal increases the risk of miscarriage or premature birth. Methadone maintenance, combined with medical care, improves the chances of having a healthy baby. There are no known long-term effects of methadone on the baby.

People who use opioid drugs regularly, and who are infected with HIV or hepatitis C, are prescribed methadone treatment to help protect their health, and to reduce the risk of spreading infection through needle sharing.

Methadone is sometimes used to provide pain relief for people who have severe chronic pain or pain associated with terminal illness.

How does methadone make you feel?
When people begin methadone treatment, some experience the euphoria and sedation that are common to all opioid drugs. As treatment continues, and a stable dose of methadone is established, tolerance to these effects develops. Those in treatment often describe the feeling of being on methadone as "normal." Methadone treatment does not interfere with their thinking. They can work, go to school or care for family. Methadone also blocks the euphoric effect of heroin and other opioids, and in this way reduces the use of these drugs.

Most people experience some side-effects from methadone treatment. Possible side-effects include sweating, constipation and weight gain.

How long does the effect last?
A person who is opioid-dependent is kept free of with-drawal symptoms for 24 hours with a single dose of methadone. In contrast, a person who uses heroin to avoid withdrawal must use three to four times a day.

Daily treatment with methadone may continue indefini-tely. If, however, the person taking methadone and his or her doctor agree to move toward ending treatment, the methadone dose is tapered down gradually over many weeks or months, easing the process of withdrawal.

If methadone is stopped abruptly, symptoms such as stomach cramps, diarrhea and muscle and bone ache will occur. These symptoms begin within one to three days after the last dose, peak at three to five days, and then gradually subside, although other symptoms such as sleep problems and drug cravings may continue for months.

Is methadone dangerous?
When methadone is taken as prescribed, it is very safe and will not cause any damage to internal organs or thinking, even when taken daily for many years. On the other hand, methadone is a powerful drug and can be extremely dangerous to people who do not take it regularly, as they have no tolerance for its effects. Even a small amount may be fatal for a child. For this reason, the dispensing of methadone is carefully monitored and controlled.

An important benefit of methadone treatment is that it reduces heroin use. The dangers of heroin use include death by overdose, and becoming infected, through needle sharing, with viruses such as HIV and hepatitis C. Methadone treatment helps to protect people from heroin-related tragedies.

Is methadone addictive?
Modern definitions of "addiction" look at many factors in assessing a person's drug use. These include "tolerance," or the need to use increasing amounts to achieve the same effect; "physical dependence," resulting in withdrawal symptoms if drug use is stopped; and "compulsive use," despite the negative consequences of continuing to use the drug.

Some people say that methadone is just as "addictive" as heroin. People in methadone treatment do become tolerant to certain effects of the drug, and will experience withdrawal if they do not take their regular dose. But methadone fails to meet a full definition of "addictive" when we look at how and why the drug is used.

First of all, methadone maintenance is offered as a medical treatment, and is prescribed only to people who are already dependent on opioid drugs. For these people, methadone provides a safe alternative to the routine danger and desperation of securing a steady supply of street drugs such as heroin. It frees them from the nagging compulsion to use, and allows them a chance to focus on improving their lives.

Methadone is sometimes used as a street drug, but when it is, it is usually taken to prevent symptoms of heroin withdrawal. The effects of methadone come on too slowly and last too long to give it much appeal as a substance of abuse.

What are the long-term effects of methadone?
Methadone maintenance is a long-term treatment. Length of treatment varies, from a year or two to 20 years or more. This prolonged treatment with proper doses of methadone is medically safe and is the most effective treatment currently available for opioid dependence.

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©2003 Centre for Addiction and Mental Health. A PAHO/WHO Collaborating Centre.
Fully affiliated with the University of Toronto.

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ID#P13486 published April 10, 2006 10:52 AM