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February 13, 2019

Effects of Methadone

Methadone is a synthetic, long-acting opiate originally synthesized by German scientists as an alternative to morphine. The drug is credited with revolutionizing the opiate treatment industry by eliminating cravings for other opioid drugs—as evidenced by the success of methadone clinics in the 1970s. Methadone is considered a Schedule 11 narcotic by the Drug Enforcement Administration (DEA), a highly regulated class of medications subject to serious legal penalties for unlawful possession and trafficking. Methadone is generally cheaper than popular prescription painkillers such as oxycodone and enjoys “preferred status” with insurance companies in over 30 states.  Although methadone was once considered a ‘miracle drug’ by experts in the substance abuse treatment industry, it is increasingly abused and responsible for creating a deadly epidemic.

STATISTICAL OVERVIEW

Empirical data implicates methadone in a number of devastating effects upon the mind and body—especially when abused long-term. According to the Centers for Disease Control and Prevention (CDC):

  • Methadone overdoses kill approximately five thousand people annually.
  • Although methadone represents only two percent of opiate painkillers prescribed in the US, it has been implicated in a third of all accidental overdose deaths.
  • Many experts report that methadone is the most addictive, unpredictable, and deadly of all opiates. Mounting concerns about its dangers prompted the DEA to require a “black box” warning on all labels starting in 2006.

In 2008, the DEA also began pressuring manufacturers to limit methadone sales to hospitals and addiction clinics as part of a new initiative. The reason for this is simple: beyond its deadly potency and unpredictable interaction with other drugs, methadone is not well-tolerated by the human body or brain, and users regularly experience long-lasting—and potentially irreversible—side effects.

METHADONE AND THE BODY

Methadone is a potent opiate with immediate physical effects that can range from mild dizziness to nausea and disorientation. Like other opiates, methadone chemically alters the landscape and function of the central nervous system (CNS) and brain—producing a series of corresponding physical changes that decrease in severity as tolerance is gradually developed. Once a user becomes dependent upon methadone, it is only a matter of time before they experience a crash that accompanies their burgeoning addiction.  Although methadone was chemically engineered to combat the addictive effects of other opiates, the resulting physiological changes it produces become highly problematic.

Unlike other opiates, methadone’s extended half-life of approximately 22 hours makes it more difficult to immediately observe signs that someone has taken the drug. Although visible indicators are generally concealed in those taking medically authorized doses, the following symptoms may still be present:

  • Headaches
  • Weight gain
  • Gastrointestinal distress
  • Sore tongue
  • Flushing
  • Dry mouth
  • Sweating
  • Visual problems
  • Sexual issues
  • Dulled reflexes
  • Skipped menstrual periods
  • Urinary difficulty
  • Weakness
  • Muscle fatigue
  • Cognitive impairment

Methadone may also produce more severe side effects that may include: black outs, seizures, hallucinations, psychosis,  accelerated heat beat, oral edema, itching, hives, or rash, difficulty breathing, swallowing, increased anxiety, and swelling of the face and eyes.

METHADONE AND THE BRAIN

Methadone’s complex interaction with individual neurochemistry presents a unique set of cognitive challenges, the result of changes in the brain. In a 2012 study by the Norwegian Institute of Public Health, results showed that methadone treatment affected the nerve cells of rats used in the study.

For three weeks, rats were administered daily doses of methadone.  Following dosage, the areas of the brain controlling memory and learning were removed and studied for evidence of damage or neurobiological changes. The researchers found a 70 percent reduction in the signal molecule level of the frontal lobe and hippocampus—vital brain regions involved in the process of memory and learning.  This reduction was also reported in a previous study in 2011 where impaired attention in rats was discovered.  At the study’s conclusion, no methadone levels were detected in the brain. This significant finding indicating cellular changes affecting cognitive function after the drug is eliminated from the system is a major cause for concern.

Another study by the Southwestern University of Texas concentrated on investigating the effects of methadone on the hippocampus—the brain region responsible for memory and learning—and whether it inhibits the formation of new nerve cells. Researchers were unable to find any inhibition in the generation of new nerve cells after long-term methadone treatment, and were uncertain as to the effect methadone had on the nerve cells that had already been exposed to heroin, which methadone is commonly used to treat.  Many more conclusive studies are needed to understand the effect of methadone on the brain and if these changes are permanent. Regardless, conclusive evidence proves that methadone has the following adverse effects on the brain:

  • Memory problems
  • Learning difficulties
  • Changes in cognitive functioning
  • Behavioral and mood changes
  • Nerve cell and neurotransmitter changes
  • Addiction and withdrawal symptoms

PROFESSIONAL TREATMENT OPTIONS

When administered in high doses, methadone’s addictive potential explodes—which has unfortunately caused many polysubstance abusers to trade one addiction for another. Because of its extended half-life, methadone withdrawal has a stubborn, lingering effect when compared to other opiates. Before a drug rehabilitation program can be successfully started, it takes approximately one month of medically supervised detox to eliminate the toxic effects of methadone from the system and help clients return to physical and psychological equilibrium. Because the withdrawal process in extremely individual and variable, exact timelines for the safe removal of the drug from a user’s system are difficult—if not impossible—to establish.

INPATIENT TREATMENT

This popular, evidence-based treatment method in which clients live at a designated residential facility—usually for a period of one month—but sometimes as long as three. In fact, evidence indicates that treatment outcomes dramatically improve with longer-term care. During their stay, clients receive ongoing medical management, behavioral therapy, and intensive clinical supervision. In addition to the elevated level of security and round-the-clock client monitoring, inpatient facilities feature a strong sense of camaraderie and community solidarity. Certain reputable facilities feature additional ancillary benefits and services that add significant value to the client experience. These include:

  • Incorporation of state-of-the-art technology into treatment
  • Alternative healing modalities such as yoga, meditation, and music therapy
  • Group outings, alumni networking, and recreational activities
  • On site gym, pool, and/or other recreational amenities
  • Aftercare planning and support
  • Close proximity to major airports and/or target destinations such as the ocean, mountains, etc.

OUTPATIENT TREATMENT

This treatment option represents a cheaper—although equally popular—alternative. In outpatient facilities, clients do not live on the premise, and medical and clinical services are provided on a strictly non-residential basis. However, in many outpatient facilities, treatment methods resemble those used in residential facilities. One of the primary advantages of outpatient treatment is the supreme flexibility it offers certain clients based upon their demanding personal and/or professional schedules. Outpatient treatment is also considered optimal for clients desiring longer-term maintenance therapy, or those who are highly motivated to seek treatment despite financial limitations.   

MEDICATION-ASSISTED TREATMENT (MAT)

MAT is considered the industry-trusted foundation of methadone detox and subsequent treatment and is based on a protocol that involves Food and Drug Administration (FDA) approved pharmacological interventions in combination with psychotherapy. Depending upon the findings of comprehensive psychiatric evaluations and medical assessments, clinicians implement a client-specific treatment plan using a variety of evidence-based therapies including:

  • Dialectical behavioral therapy (DBT)
  • Cognitive behavioral therapy (CBT),
  • Motivational interviewing (MI)
  • Trauma-informed therapy
  • Family therapy (as needed)

The aforementioned therapies help treat the underlying emotional and psychological factors associated with methadone addiction. Another key component of successful methadone treatment involves the identification and treatment of co-occurring mental health disorders such as major depressive disorder (MDD) and generalized anxiety disorder (GAD)—both of which are common precursors or exacerbating factors involved in methadone addiction. 

AFTERCARE

Simply completing medically managed detox is not sufficient to ensure long-term recovery success following methadone addiction. Long-term abstinence and recovery requires the implementation of and strict adherence to a multi-faceted approach. This should include:

  • Involvement in Narcotic Anonymous (NA)
  • Ongoing medication management
  • Random drug testing
  • One-on-one and group therapy
  • Life and job skills coaching (if necessary)
  • Continual sober peer support
  • Regular physical activity
  • A healthy, nutritious diet and lifestyle decisions
  • Community involvement and a spiritual program

Methadone is a particularly insidious drug that can affect anyone—even those for whom there is no known substance use disorder (SUD) or genetic susceptibility. Contrary to popular myth, methadone addiction does not depend upon addiction to other opiates, and can quickly spiral out-of-control. If you or someone you love are suffering from methadone addiction and in need of help, call a substance abuse professional today.

Also, remember that methadone overdose is considered a life-threatening medical emergency. In the event of an overdose—immediately dial 911 or go to your nearest hospital emergency room (ER).

For more about methadone addiction and recovery, check out these related articles:

Sources:

Post-Graduate Medical Journal. Methadone: applied pharmacology and use as adjunctive treatment in chronic pain. Vol 80, 2018.

Journal of Pharmacy and Pharmacology. Long-term methadone treatment reduces phosphorylation of CaMK11 in rat brain. Vol 64(6).

Journal of Pain. Methadone Safety: A Clinical Practice Guideline from the American Pain Society and College on Problems of Drug Dependence, in Collaboration with the Heart Rhythm Society. April, 2014.

Journal of Substance Abuse Treatment. Effectiveness of Methadone Maintenance Therapy and Improvement in Quality of Life Following a Decade of Implementation. Oct, 2016.

US National Library of Medicine. Pharmacotherapy in the Treatment of Addiction: Methadone. April, 2010.

Western Journal of Medicine. Use of methadone. Jan, 2000.

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