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December 8, 2018

How Long Does Methadone Stay in Urine?

Learn How Long Does Methadone Stay In Your Urine

Since 1999, over 200,000 deaths have been reported in the United States attributable to prescription opiate overdose, and the trend does not appear to have slowed (CDC). Because of this, there is an emphasis with government officials and healthcare professionals alike to develop effective treatment systems to help curb this epidemic.

In clinical settings, it has become the standard to treat patients who suffer from opiate dependence in a holistic sense; taking into account the interaction between the various biological, psychological, and social aspects of addiction.

One treatment that is commonly employed in treating opiate drug abuse is known as Methadone Transition Treatment or MTT. When administered with care, Methadone replacement can be an effective treatment for opiate dependence and addiction.

What is Methadone?

Methadone is a synthetic opiate that is most commonly used for the treatment of moderate to severe pain. Originally developed during World War II, methadone was initially approved for use by the FDA in 1947. It has been used both in the field and in military hospitals, as well as in private practices around the world since its inception. Today, it has a number of other uses.

What is Methadone Used For?

As mentioned, methadone was originally developed as an analgesic (painkiller) and as an antitussive (cough suppressant) for the German military medical services. Today, it is still used for chronic pain and other pain-reducing capabilities but far more seldom as a cough suppressant as other, safer, drugs have been developed for the same purpose.

The most notable use for methadone at this time is as a treatment for dependence on other, more dangerous, opiates such as:

  • Heroin
  • Morphine
  • Fentanyl
  • Oxycodone (Brand Name: Oxycontin)

These drugs are known to be both highly addictive and extremely risky to use. Because methadone is somewhat less dependence-inducing, and less lethal, methadone is commonly used as part of holistic treatment plans for opiate addiction: particularly during the drug detox phase.

Therapeutic Index

The therapeutic index is the tool used to measure how dangerous a given substance is to human beings. It is measured by comparing the average effective dose of a substance (how much must be taken in order for effects to become noticeable) to the average lethal dose (how much must be taken to result in death). Substances that are deemed to have a high therapeutic index are considered to be safe. These include drugs such as:

  • Ibuprofen
  • Acetaminophen
  • Other over the counter drugs

It would take an extremely high dosage of any of these in order to become lethal, so they are deemed safe for sale over the counter.

Opiates, on the other hand, have a therapeutic index far lower than that of any of those you might find in a drug store and are considered much more dangerous; too dangerous to be administered without a prescription.

Government Classification

The Food and Drug Administration (FDA) and the Drug Enforcement Agency (DEA) classify methadone and other opium derivatives under the designation of “narcotics”—which refers to a class of drugs with intense psychoactive and analgesic effects. Regulation and Enforcement of such drugs are strict and heavily scrutinized, so they are not available without the prescription and direction of a licensed physician.

Therapeutic Index of Methadone

Methadone has a therapeutic index rating that is significantly lower than many of the more potent opiate drugs in its class. This means that it is a safer alternative to drugs such as heroin, morphine, and oxycodone, which have the potential to become lethal at relatively low doses. This is the quality that has led it to be used in the treatment of opiate addiction.

Regulation of Methadone

However, this does not mean that it is any less regulated than other opiates. Methadone carries many of the same physical and psychoactive effects as its cousins. It is an effective analgesic, and it works on many of the same opiate receptors in the brain that heroin and others do. Because of this, it is not rated for public use and recreational use outside the context of medical treatment is punishable by law.

Types of Testing for Methadone

There are a number of different ways to test for methadone in the body. According to the American Addiction Centers, the most common of these are:

  • Urine sample
  • Blood sample
  • Saliva tests

Typically, the only form of testing a patient will undergo in a clinic or treatment facility will be of the urine test variety. Urine tests are considered to be the best balance between reliability and lack of intrusion.

However, there are many doctors who are of the opinion that tests which measure concentrations of methadone in blood plasma are the gold standard; citing their increased level of accuracy.

For the most part, though, blood testing for methadone substance abuse is considered to be impractical, overly intrusive, difficult, and costly as it requires a licensed professional to draw the blood, conduct the testing procedure and analyze the results.

Methadone Screening Results

Urine testing for methadone uses a couple of criteria to indicate a “positive” sample. The first is the presence of methadone metabolites in the urine, specifically two of them. Two metabolites of methadone must be present for the test to come up positive. This is a safeguard to ensure that methadone cannot simply be added to a sample and thus test positive.

The second is the threshold, or amount that must be present in order to test positive. A positive urine test for methadone will show a concentration of no less than 300 nanograms per milliliter. Additionally, should an initial test result come back positive, a follow-up screening will be conducted. The concentration must be at 300 ng/ml in the follow-up result as well for the overall screening result to be “positive”.

How Long Does Methadone Stay in Urine?

In general, it can take several hours for opiates to leave your system. The duration of drug detection in the urine is dependent upon its elimination half-life. The elimination half-life of methadone is between 8-59 hours. Now the duration of the analgesic effects of methadone is only 4-8 hours, which means that it can be detected in the urine far longer than the physical effects are noticeable.

Once administered, the effects of methadone can be detected within the first 30 minutes. Ultimately, it can be detected up to 3 days after it has been ingested.

How is Methadone Administered?

Methadone is most commonly administered as an oral solution and may also be offered as a liquid concentrate, oral tablet, or powder. In any case, the route of administration in any clinical setting will be oral. Any other route of administration, be it snorting, injection or otherwise, is widely considered to be an indicator of misuse or abuse of the pain relief drug, and is not a route used in treatment.

Methadone Characteristics

One of the defining characteristics of methadone is the manner in which it affects the body. Methadone is a depressant, and as such can have some rather negative effects when administered concurrently with other drugs. For this reason, it is never recommended that methadone is used in conjunction with any other drug. This can cause issues for patients undergoing outpatient treatment who may also use alcohol, for example.

Why is Methadone Used?

While recreational methadone use is a punishable offense, prescription use is relatively common, particularly in the context of substance use treatment. Many people are familiar with the first stage of methadone treatment, which is essentially geared to mitigate the effects of opiate withdrawal in opiate users. However, for methadone treatment to be effective, it must actually be administered in four separate phases, each with its own treatment goal.

Methadone Treatment: Phase One

The first phase of methadone treatment (MMT) is referred to as Initial Induction. The primary goal of initial induction is to relieve withdrawal symptoms due to heavy opiate use. This phase is absolutely critical, as the withdrawal symptoms associated with opiate use are extremely uncomfortable and can be lethal. These symptoms include:

  • Aching Muscles
  • Heavy Anxiety
  • Difficulty with sleep
  • Racing Heart
  • Hypertension
  • Fever
  • Cold Sweats
  • Nausea
  • Vomiting
  • Diarrhea
  • Stomach Cramps
  • Depression
  • Strong Cravings

Not only are these conditions uncomfortable, distressing, and potentially dangerous, they are also detrimental to treatment if they are not addressed. The distress and discomfort caused by these symptoms will often lead a patient to use again, in order to counteract them. This reinforces the pattern of use and delays detox and recovery. This is why it is important that the symptoms be addressed, in this case with phase one of methadone treatment.

Methadone Treatment: Phase Two

The second phase of methadone treatment is referred to as Early Induction. In this phase, the primary goal is to establish a tolerance level and reduce cravings. After all, no two users are exactly the same. The level of dependency in a given patient depends on a number of factors:

  • Type of opiate used
  • Frequency of use
  • Quantity used
  • Route of administration

Each of these factors must be weighed into the equation that determines the level of tolerance that has developed and how best to treat it. Heavier users will typically require higher dosages of methadone to be administered in the second phase. Ideally, treatment professionals want to administer the minimum effective dosage in order to reduce the likelihood that methadone dependence develops, so it behooves them to take in all available information and establish an accurate baseline.

Methadone Treatment: Phase Three

The third phase of MMT is known as Late Induction and Stabilization. In this phase, the key goal is to establish an adequate dosage of methadone which is effective in stabilizing a patient and supporting his or her physical and emotional wellbeing. Essentially, this is done through a process of trial and error. However, so long as the patient has reported his or her habits of usage accurately, and their treatment specialists have done their due diligence in establishing a baseline, this part of the process should not be overly difficult.

The main indicators of success in the late induction stage are the physical and emotional wellbeing of the patient. Caregivers will observe whether or not physical indications of withdrawal and dependence have been reduced, and if not, adjust dosages accordingly. They will also document the patient’s emotional well-being by taking note of physical affect (appearance and mood) as well as through interviews and interactions.

Methadone Treatment: Phase Four

The fourth phase of methadone treatment is known as the maintenance phase in which the established effective dosage is administered consistently in order to preserve and maintain the desired effects; namely the “steady-state occupation” of opiate receptors. Essentially this means that there are no detectable fluctuations in the excitation of opiate receptors in the brain, which tends to result in stabilized mood and behavior for the patient. Achievement of this state allows patients and treatment providers to focus on the various other elements involved in the treatment plan.

When discussing all these stages, it’s important to note that Methadone addiction can form at any time, especially the longer it is taken. Although it may be helpful in the beginning to lessen withdrawal symptoms from heroin or other opiates, it also has highly addictive qualities, making it a new danger for addicts seeking sobriety.

Methadone Addiction

While methadone is significantly less addictive than many of its opiate cousins, that does not mean that it offers no risk of dependence. Methadone drug abuse can, and has been known to be, habit forming. This is one of the reasons that it is so crucial for treatment providers to properly establish an accurate level of tolerance and administer the lowest effective dosage during methadone replacement therapy.

Should a patient with a substance abuse problem and their treatment team mismanage the administration of methadone, during either pain management or replacement therapy, the risk of dependence can carry some repercussions. It is possible that over-administration could lead to the development or renewal of opiate dependence and all of the consequences entailed therein. This illuminates just how important it is for patients and care providers to communicate honestly and openly, and to undertake the proper testing to minimize risk.

Some rehab centers won’t even use methadone in their treatment programs because of the drug’s potential for abuse. Sadly enough, there are many cases where an individual goes into rehab for one addiction and comes out with a new one. Although methadone can be a life saver for some, it can also surface a whole new problem for others, resulting in an endless cycle of addiction and dependence.

Signs of Methadone Addiction

As with all addictions, an addict dependent on Methadone may exhibit a number of different symptoms. Potential signs of a Methadone addiction may include:

  • Tolerance: If you are taking Methadone and require more and more of the drug to feel the same effect, your body has developed a tolerance. Once a tolerance has formed, an addict will seek hire doses of the drug to achieve the same high.
  • Psychological and physical dependence: If withdrawal symptoms occur, it is highly possible that the individual is dependent on Methadone. Common symptoms that users may experience on the drug include anxiety, mood swings, cramping, and more.

Methadone Treatment Programs

For individuals exhibiting symptoms of methadone addiction, rehab will be the next proactive step towards recovery. Although Methadone may not be as dangerous as other drugs, it can still be highly addictive, which means any user who is going through rehab that uses this treatment is at a higher risk for developing a dependence.

Methadone treatment helps to detox a user from the substance and reduces withdrawal symptoms in a safe and monitored setting. A trusted rehab provider will try to make the detox process as comfortable as possible for the methadone addict. In some cases, the rehab provider will also assess whether a different short-term MAT (medically-assisted treatment) should be used, like clonidine or Suboxone, to wean users off Methadone.  

In order to achieve long-term recovery from a Methadone addiction, you will want to go to a rehab center that combines an effective detox strategy with long-term inpatient care. Living in a secure environment free of triggers, temptations, and other emotional distractions is an effective way for all addicts to achieve a sober life.

Seeking Treatment

There is no question that methadone, when administered properly, can be extremely helpful in the treatment of both pain relief and substance use disorder for opiates. It offers a number of benefits, predominantly its status as a safer, yet effective alternative to other opiates in its family. This is not to say that methadone is completely safe, as there is still a significant risk for the development of dependence.

Unfortunately, far too often an individual with a heroin or opiate addiction will seek treatment for their problem and come out of rehab battling a new monster. Due to it’s highly addictive properties, Methadone is commonly abused, resulting in another spiraling addiction for the individuals seeking sobriety.

If you or a loved one is suffering from a Methadone addiction, just know you are not alone and help is available. There are many rehab options for methadone addiction that help to alleviate withdrawal symptoms and ease a user into a substance-free life. Contact Beach House Recovery today for more information on our Methadone detox program.

Sources:

https://www.cdc.gov/drugoverdose/data/prescribing.html

https://americanaddictioncenters.org/methadone-addiction/how-long-in-system/

https://medlineplus.gov/druginfo/meds/a682134.html

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