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For decades, methadone was the primary line of treatment for pain management and addiction treatment. It seemed to answer every question about helping people feel better and helping them overcome their addiction to harder, more dangerous drugs. But now, hard questions are being asked about methadone, and it has become a source of controversy itself. What you need to know about methadone addiction covers how the drug works and why it has fallen out of favor with some specialists.
To understand the issues surrounding methadone, it is important to look at what the drug is. Methadone is a synthetic (man-made) opioid, a chemical compound that attaches itself to the opioid receptors in the brain once it is in the body. When a person takes methadone – either to help with pain, as part of a drug treatment program, or recreationally – the drug binds to opioid receptors and dulls communication between the brain, the central nervous system, and the rest of the body. The effect of this is that the person feels an incredibly pleasant, warm, and comfortable sensation; someone in physical distress might be able to simply fall asleep and obtain temporary relief from pain.
An additional effect of methadone is that it blocks the effects of other opioid substances, whether they are illegal and dangerous (like heroin), or legal and should be taken with care (like prescription opioids, such as OxyContin).
Despite both being opioids in design, methadone is not as instantly and powerfully addictive as heroin. However, methadone can be addictive in its own right, ironically because it does not work as quickly as heroin. Methadone is slow-acting, meaning that someone who wants to use the drug to achieve a similar experience as that of stronger opioids has to take more and more of it in order to do so. Thus, patients and recreational users alike may find themselves taking methadone increasingly frequently, never quite finding that bliss that compares to other drugs, but becoming hooked on methadone all the same.
As the now-defunct National Drug Intelligence Center explains, no amount of methadone will ever recreate the experience of heroin. Methadone, by design, cannot recreate the euphoric bliss that drives heroin users to desperation. On the face of it, this is positive; but methadone given to people who have already demonstrated a propensity for addictive behavior might encourage them to persist with the methadone intake (even beyond necessary treatment parameters) because they are mentally primed to seek out the feelings they got from heroin.
For this reason, the U.S. Drug Enforcement Administration has placed methadone on its Schedule II list of controlled substances. The drugs that go on the Schedule II list have to meet three criteria:
Other Schedule II substances include methamphetamine and opioid-based substances like morphine, oxycodone (sold under the brand names Percocet and OxyContin), and fentanyl (sold under the brand name Duragesic). By contrast, heroin is a Schedule I substance, meaning it has no accepted medical value.
Being addicted to methadone entails continuing to use the drug in spite of the problems directly related to its consumption. For example, this might mean spending exorbitant amounts of money to secure more methadone, to the detriment of other obligations that require financial investment. Similarly, responsibilities such as work, family, school and social activities will fall by the wayside, as the procurement of methadone becomes the primary focus of the person’s entire life.
Of course, the clearest sign of a methadone addiction is a person using the drug for no legitimate reason. If there are no doctor’s prescription, no pain to control, and no opiate addiction to overcome, but the consumption of methadone is occurring, a methadone addiction is likely in place.
If methadone is this addictive, why was it ever given to people – especially people already addicted to narcotics – in the first place? Besides the chemical process of blunting the effectiveness of stronger opioids, the Addictive Disorders and Their Treatment journal explains that methadone therapy helped recovering addicts engage with their communities and have better self-image. Psychology Today explains how low self-esteem is a big factor in the development of addiction; helping people see themselves in a better light is, therefore, a key component in their process of overcoming their addictive impulses. This is one of the reasons why methadone became the first line of defense (and attack) against heroin addiction.
Eventually, however, questions began to be asked about the wisdom of using a substance that encouraged higher rates of consumption to get high, to treat a drug that delivered an instant high. Sociological Forum, for example, published a study (entitled, in part, “Methadone Maintenance as a Last Resort”) that expressed concern that methadone drew focus away from helping heroin addicts develop and create their own lives, and instead made the methadone itself the focal point of recovery – to the point where methadone effectively replaced heroin.
To that point, The Guardian, writing about “Why Methadone Drugs Don’t Work,” says that despite methadone being more addictive than heroin (and thus harder to quit), it is despised by recovering heroin addicts and looked down on by a new generation of treatment professionals. A pharmacist tells The Guardian that, in one day, he dispensed a gallon of consumable methadone to 33 heroin and opioid addicts, all of whom will duly return for more methadone in a couple days.
Britain’s Centre for Policy Studies has said that using methadone as a counter to heroin addiction is effectively government-sponsored drug dealing. In 2011, the Centre calculated that the cost of issuing methadone to former heroin addicts in recovery was £3.6 billion (approximately $5.13 billion), a policy it called “an expensive failure,” because methadone does not free people from addiction; it merely makes them addicted to a legal substance.
A writer for xoJane in Miami says that her methadone addiction was a worse physical and mental experience than when she was on heroin; instead of saving her, it made her spiral even further out of control. Instead of being the fix for heroin, it became a fix in itself, planting the mental obsession of addiction in her mind, making even the craving for heroin seem weaker than wanting another gulp of methadone.
Despite the controversy and skepticism around methadone, some addiction treatment specialists claim that the drug receives a bad reputation from people who misunderstand it or misuse it. Speaking to the Washington Post, an addiction medicine physician, former president of the Association for Medical Education and Research in Substance Abuse, and the internal medicine specialty director on the American Board of Addiction Medicine, says that despite all the horror stories of methadone, the “tens or hundreds of thousands of people” who receive methadone treatment as part of a larger therapy program don’t receive any media coverage, because there are no scandalous and shocking stories to tell. Those people have mostly overcome their harmful habits, and live productive and healthy lives.
To the doctor’s point, methadone taken without proper clinical oversight will almost certainly push a person to the brink of addiction. Since methadone is inherently addictive, it will either outright replace a heroin addiction, or it could be the start of a substance abuse episode in itself. On the other hand, if methadone is only one part of a treatment program, a person may not end up addicted to it. Regular sessions with a psychotherapist, group therapy, and aftercare support will go a long way in keeping harmful urges and cravings at bay, and contribute to keeping methadone intake to a minimum.
When methadone addiction is in full swing, how can it be treated? The first step involves physically cutting off the methadone consumption. A cold-turkey termination is rarely a good idea, as the body has become so dependent on the methadone in its system that the sudden loss might prove traumatic and distressing. As a result of withdrawing from methadone, an individual might experience:
Depending on how long the person had been taking methadone, and at what doses, withdrawal effects could last for a week or perhaps longer. Since there is always an element of physical or mental danger associated with withdrawal (to say nothing of the strong temptation to relapse when symptoms are at their worst), attempting to go off methadone without proper medical supervision is never a good idea. The safest way to kick any drug habit (and especially a methadone habit) is to do so at a hospital or treatment center, where doctors and medical staff are present to guide clients through the worst parts of the process. When withdrawal is conducted in this kind of context, it is known as medical detox.
This guidance can entail offering moral support, providing nutritious foods (very vital, given the upheaval of the digestive system during detox), and even administering anti-anxiety medication. This may seem counterintuitive – giving a drug to get people off a drug that they had been using to get off another drug – but it is a widely practiced dynamic of addiction treatment. The Fix writes of how Suboxone – a prescription medication combination of two opioids, with a “substantially lower abuse potential than methadone,” according to Psych Central – is offered at methadone treatment clinics, to help people who have difficulty weaning off methadone.
Without the right therapy, using Suboxone can easily become a source addiction itself, especially for clients who have demonstrated a propensity towards substance abuse. To ensure that Suboxone is taken properly, and that cravings for methadone are controlled, a client should begin a psychotherapy program very shortly after the conclusion of the medical detox process.
Therapy is an inherent part of substance abuse treatment, because of how it helps a person deal with the mental damage of an addiction. Living a better life after a methadone addiction entails understanding how to cope without methadone, how to manage the urge to abuse methadone, and how to live more positively, productively, and healthily. Some of the people who start taking methadone as treatment for heroin addiction never receive this therapy, assuming (or being told) that all they have to do is stick with methadone and their addiction goes away.
But, as WebMD explains, therapy is essential in treating addiction. Merely giving a client Suboxone for methadone addiction (or methadone for a heroin addiction) does not address the underlying psychological issues that drive addiction. Therapy addresses those issues, and even though therapy sessions can be emotional, embarrassing, and exhausting for clients, they are a necessary part of post-addiction healing.
Healing can be a lifelong process after an addiction, so aftercare support programs (like 12-Step groups, Methadone Anonymous, and other unofficial networks) provide a foundation of accountability and support for clients who are looking to live clean, methadone-free lives.
In this way, a methadone addiction does not have to be the end of someone’s story. With care and guidance, recovery and healing are possible. It won’t always be easy, but a clean and refocused life after methadone addiction is possible.