What Is Methadone?

Can it help me quit heroin?

drug addict receiving his daily dose of methadone
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Methadone is a synthetic opioid medication or drug, which is commonly prescribed as a treatment and harm reduction approach for opioid use disorder, in particular, to help people overcome heroin addiction. A powerful painkiller, methadone is also sometimes prescribed to treat severe pain. The main therapeutic effects of methadone are to reduce heroin withdrawal symptoms, prevent heroin and other opiates from producing euphoria and reduce pain perception.

Methadone can appear as tablet, powder, or liquid, and is typically administered as a measured oral dose in the form of a green syrup, or in a sweet orange or cherry flavored drink. Methadose, a relatively new methadone formula, is ten times stronger than methadone, requiring a much smaller dose to be given.

Why Use Methadone?

There are three main reasons that people who are addicted to heroin use methadone—to quit heroin, to cope with pain, and to reduce the harm caused by injecting heroin.

As a treatment, methadone does not actually stop the opioid addiction; instead, it is a substitute for heroin. People who take methadone as prescribed are still addicted to opioids on a physical level, as the methadone blocks the opioid receptors in the brain that are usually blocked by heroin. This stops the craving that people feel for heroin when they have been taking it in large doses for a long time, and stops them from feeling ill from heroin withdrawal.

Methadone for Pain Management

Methadone can sometime be prescribed for severe acute or chronic pain, such as the pain sometimes experienced by people suffering from cancer. Although there is a wide variety of other pain relief options, there are clinical reasons why methadone might be a good choice. Methadone can be helpful for addressing the severe emotional and mental anguish sometimes suffered by people with cancer and other painful conditions, as well as the severe physical pain.

As people who become addicted to heroin have high rates of emotional pain, often resulting from past trauma, methadone is also helpful for blocking the emotional pain that can be overwhelming during withdrawal. There is a good deal of overlap in the body's signals for emotional and physical pain, and, as methadone takes care of both types of pain, this can allow people to feel "normal," and get on with their lives without being distracted with such pain that could result in them seeking out heroin.

This is consistent with the self-medication hypothesis, which is a theory that explains drug use in terms of people having an underlying untreated problem or pathology—for example, untreated pain or untreated post-traumatic stress disorder (PTSD). Heroin can have the effect of numbing out the symptoms of both of these conditions, making life more bearable. Thus, according to the self-medication hypothesis, people who use heroin are "self-medicating" their pain or PTSD symptoms with heroin, and can do so more effectively with methadone.

Dealing With Underlying Problems

As methadone is only working on a physical level to block out pain, unpleasant feelings, and cravings, it is only a partial treatment for heroin addiction.

Methadone does not help address the cause of the underlying condition the person may have, and, although it can flatten emotion, it does not address the causes of the negative feelings the person might be experiencing, such as shame, fear, anger, or regret. Therefore, it is important that if you do decide to take methadone, that you also find a way in the longer term to address the emotions that may underlie your addiction.

There are several ways to do this. One of the most common ways of addressing your emotional problems is by participating in a treatment program, once you are stabilized on methadone, and your life is reasonably settled and not chaotic.

There any many therapeutic approaches which have been developed to treat the psychological symptoms of addiction, including cognitive behavioral therapy, emotion-focused therapy, family therapy, and couples therapy. Treatment can be provided in individual, one on one therapy sessions with a doctor, psychologist, counselor, or other mental health professional, or in groups of people who are all at the same stage of treatment, and many effective treatment programs include both individual and group therapy, in either an outpatient day program, or a live-in or residential treatment program.

Another problem that can underlie heroin addiction is untreated mental illness. Mental health problems in people who use heroin range from depression, anxiety, attention deficit disorder, and post-traumatic stress disorder, to serious but treatable psychotic disorders such as schizophrenia. These conditions are all treatable through medication, psychotherapy, or a combination of the two, and can greatly improve the well-being of people who use heroin, and their ability to cope without drugs.

Methadone as a Harm Reduction Approach

Harm reduction approaches are ways of helping people who use drugs, such as heroin, without requiring them to quit the drug. Instead of focusing on treating the addiction, harm reduction focuses on minimizing the harm caused by the ways that people use drugs. These harms can be physical, psychological, or social.

The physical harms that can occur from heroin use, particularly injection heroin use, are numerous. In particular, injecting a drug such as heroin—especially on a daily basis—can damage veins, and can even cause the veins to collapse. Injecting can also lead to the transmission of diseases, such as hepatitis and HIV, through sharing needles and equipment with other drug users. Re-using equipment, and injecting impure drugs can also lead to various kinds of infections and poisonings, which can be life-threatening.

Another very real physical harm that can occur from heroin use is overdose. Once a dose of heroin has been injected, the body has to cope with the effects of the drug on the body, which can include slowing the breathing and heart rate to the point where the person falls unconscious. This is the most common way for heroin users to die from overdoses.

Although overdoses can be reversed, using the drug naloxone, this is only possible if the person using heroin is given the drug by another person. In most cases, this will be done by a paramedic, if an ambulance is called on time, although naloxone can be administered by a fellow-user, friend, family member, or another first aider, if they have access to the drug. Unfortunately, if the person is using heroin alone, they are unable to call for help once they are unconscious, meaning the overdose can only be reversed if they are discovered in time.

Because methadone is typically administered in oral form at a methadone clinic, and is not usually injected, HIV transmission risk is reduced. Thus methadone is considered a form of harm reduction.

Benefits of Methadone

Methadone has a longer duration than heroin, so it only needs to be taken once a day. This can be very helpful for people who have been taking many doses of heroin per day, making finding and injecting the next dose of heroin the main focus of daily activities. Because methadone levels out the high and the withdrawal of heroin, it is easier for people to get on with other aspects of their lives.

Overall, people who are on methadone tend to be more successful in quitting heroin than those who do not have the medication. People who quit heroin without methadone are much more likely to relapse, and have a higher risk of overdosing after a period of abstinence or lower daily dose.

Methadone also appears to be relatively beneficial to reproductive health, compared to heroin. Research shows an improvement in the normalization of the menstrual cycles of women who have been negatively affected by heroin addiction. Men on methadone have fewer semen abnormalities than those on heroin.

Drawbacks of Methadone

Although methadone maintenance helps thousands of people quit heroin, it is an addictive drug. The addiction to heroin or another opiate is simply transferred to a less problematic drug. Many people taking methadone do not like attending methadone clinics for their daily dose. But when methadone is given to addicts for use at home, the risk of overdosing and/or selling the drug illegally to purchase heroin increases.

This is one example of the ongoing difficulty with trust between addicts and professionals who want to help them—addiction seems to be such a powerful psychological force that people will often act against their own interests in order to get their drug of choice, even if it means selling the methadone that helps them quit.

Methadone is not the only medication that can help you to quit heroin. Other options include buprenorphine and Suboxone.

A Word From Verywell

The decision to take methadone to help you to quit heroin is a personal one, and depends on a number of factors, including how long you have been using heroin, how severe your addiction is, whether you have already tried to quit without methadone. It can also depend on whether you used heroin by smoking or by injection. In an ideal world, you would be able to quit heroin without worrying about relapsing and overdosing, and some people, especially those who only use heroin occasionally and in low doses, are able to do this. However, if you have been taking heroin for at least 6 months on a regular basis, you may find it quite difficult to quit.

Talk to your doctor about how to get help with the right prescription for you. And remember: Although methadone may help control the physical side of your addiction, in order to to complete your recovery you will still probably need support to help with the psychological side of your addiction.

Sources:

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Miller, W. and Carroll, K. Rethinking Substance Abuse: What the Science Shows, and What We Should Do About It. New York: Guilford. 2006.

Ragni G, De Lauretis L, Gambaro V, Di Pietro R, Bestetti O, Recalcati F, and Papetti C. "Semen evaluation in heroin and methadone addicts." Acta Eur Fertil. 16(4):245-9. 1985.

Schmittner, J., Schroeder, J., Epstein, D., and Preston, K. "Menstrual cycle length during methadone maintenance." Addiction 100:829836. 2005.

Strang J., Marsden J., Cummins M., Farrell M., Finch E., Gossop M., Stewart D., and Welch S. "Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6-month outcome." Addiction 95:1631-45. 2000.

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