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Methadone is a synthetic opioid agonist with a long half-life. The drug binds to the same opioid receptors in the brain as other opioid narcotics, including heroin and OxyContin. However, for people with an opioid tolerance, methadone does not induce the same euphoric effects; instead, the drug helps people attempting to overcome a narcotic dependence or addiction by reducing cravings and withdrawal symptoms.
Methadone was first used to treat people struggling with opioid addiction in the 1960s in the US. It has been an integral part of maintenance therapy for people with narcotic addiction for several decades.
Because it is inexpensive and commonly found in generic form, methadone has recently been used to treat patients struggling with chronic pain. This treatment is most effective in patients who are “opioid naïve,” meaning they do not have an existing tolerance to narcotics. The long-acting properties of methadone make it an attractive prescription for low-income or elderly patients who need help with chronic pain conditions, since methadone can bind to the opioid receptors for at least eight hours.
Unfortunately, for people who are opioid naïve, or who combine methadone with other central nervous system depressants, like alcohol, benzodiazepines, or other opioids, the drug can induce a relaxed, narcotic euphoria or enhance the euphoria associated with other drugs. Methadone has long been a useful maintenance therapy, used under medical supervision, but it has also become a target for abuse and addiction due to its potency. The Centers for Disease Control (CDC) reports that methadone was involved in one-third of prescription opioid overdose deaths in 2009. About 5,000 people die annually in an overdose incident involving methadone.
Methadone was designed to bind to the opioid receptors in the brain for a long time, so the drug’s half-life is anywhere between eight and 59 hours, depending on the size of the dose. At typical doses given as maintenance therapy, methadone lasts 24-36 hours in the body. However, the analgesic effects may last 12 hours or less, so the person may begin struggling with cravings or mild withdrawal symptoms after that point. Since methadone is still active in the body, if the person takes other narcotics like heroin, they are more likely to experience an overdose because of the combination of opioid agonists.
Typical methadone withdrawal symptoms are like those of other opioid drugs, but can be more drawn out as methadone takes longer to exit the body. Symptoms include:
Generally, methadone withdrawal symptoms begin within 30 hours after the last dose. Although the symptoms of withdrawal can last for longer, due to the length of the drug’s half-life, the most intense methadone withdrawal symptoms last for 1-2 weeks, like with most other opioids. Without medical oversight or maintenance therapy, withdrawal symptoms can be intense, and that can lead to relapse.
Like other opiates, methadone withdrawal symptoms can be grouped into three categories: early, peak, and late. Here is the overview of what occurs during each stage.
Post-acute withdrawal syndrome (PAWS) is more likely to affect people who have struggled with methadone abuse for a long time or at high doses. Some experts say it is more likely to occur in people who struggle with methadone addiction, compared to other opioids, because methadone is so long-acting. PAWS is an extended experience of withdrawal symptoms, especially cravings, mood swings, and general aches and pains. With a doctor’s oversight, PAWS can be managed or avoided.
Long-term abuse of methadone can cause long-lasting physical symptoms, which must be cared for after the person detoxes from the drug. These symptoms include:
Getting medical oversight to gradually taper off methadone means that the individual can be in maintenance therapy for a year or more. Some people who use methadone as a maintenance therapy remain in these programs for several years. However, as long as the maintenance therapy stabilizes mental and physical health, and helps the person focus on treatment through a rehabilitation program, then it is considered useful.
A doctor may also switch the individual to a different maintenance therapy, such as buprenorphine. This medication was approved for use as a maintenance therapy by the Food and Drug Administration (FDA) in 2002, and it can be used as a replacement option for opioid narcotics, including methadone. A physician does not have to require their patient to go to a specific clinic to receive their dose of buprenorphine: instead, the patient can come into a doctor’s office and receive the dose there. This allows for more flexibility and greater treatment options for more people. The goal of buprenorphine treatment is specifically to taper the person’s physical dependence until their body no longer relies on the drug.