What is Methadone?

Illegal drug use costs the taxpayer nearly £22 billion each year, including NHS, prison and police costs. Opioid related hospital admissions in England increased by 48.9%, from 10,805 admissions in 2008 to 16,091 in 2018, research has shown. People who use illicit opioids have a high risk of premature mortality, with a mortality rate ten times that of the general population.

Methadone is a key element in the treatment of opiate addiction. Opiates are a group of psychoactive substances derived from the poppy plant that include opium, morphine and codeine. The term opiate is also used for the semi-synthetic drug diamorphine (heroin), which is produced from poppy compounds. Opioid dependence can cause a wide range of health problems and is often associated with the misuse of other drugs including alcohol.

Associated social problems of opioid dependence include marital and relationship breakdown, unemployment, homelessness and child neglect which often results in children being taken into the care system. There is also a clear association between illicit drug use and crime. Some opioid-dependent people become involved in crime to support their drug use.

What is methadone?

Methadone is a synthetic opioid agonist, which means it acts on the opioid receptors in the brain. These are the same receptors that other opioids such as heroin act on. People who become dependent on heroin or other illicit opioids often benefit from opioid substitution treatment (OST) and there is strong evidence that OST is effective at suppressing heroin use. Methadone is an opioid drug that is used in OST for opiate dependence. In the United Kingdom, it is the most widely used drug treatment for opiate dependence.

Methadone is one of the most researched medicines available, and if used correctly, is safe. Although it occupies and activates the opioid receptors, it does so more slowly than heroin. It produces some opioid effects like emotional detachment and relaxation, but in an opioid-dependent person, it does not produce the same high. It reduces opioid craving and withdrawal and blunts or blocks the effects of opioids.

Methadone is most commonly prescribed as a liquid that is swallowed (oral solution) but it is also available as a tablet or as a daily injection. It is safe and effective when taken as prescribed. Methadone medication is specifically tailored for the individual patient, and doses are often adjusted and readjusted, and it is never to be shared with or given to others.

This is particularly important for patients who take methadone at home and are not required to take medication under direct supervision.

Methadone is a Class A, Schedule II substance under the Misuse of Drugs Act 1971. It is illegal to possess without a prescription, or to supply or produce without a licence. Possession carries a maximum sentence of 7 years’ imprisonment and a fine. Trafficking offences carry a maximum sentence of life imprisonment and a fine.

Can methadone be addictive?

Because methadone has similar effects to heroin, you can easily become addicted, especially if you are taking methadone to get “high”. You can build a tolerance to it, needing higher doses to get the same effects. Once the body becomes reliant on methadone to function normally, a dependence has developed.

Methadone, like any other opioid, can be very challenging to quit. Even though the drug isn’t known for being as powerfully addictive as heroin, quitting methadone can lead to withdrawal symptoms, particularly if its use is stopped suddenly, which can be hard to overcome on your own.

Symptoms of withdrawal from methadone are similar to those of other opiates, such as heroin and morphine. Many users especially struggle with methadone withdrawal because the medication stays in the body longer. Methadone withdrawal symptoms are usually moderate and flu-like.

Common and severe withdrawal symptoms include:

• Chills.
• Fever.
• Anxiety.
• Muscle aches and pains.
• Nausea.
• Vomiting.
• Sweating.
• Rapid heartbeat.
• Stomach cramps.
• Irritability.
• Paranoia.
• Diarrhoea.
• Cravings.
• Insomnia.
• Hallucinations.
• Depression.

Those with more severe methadone addictions will likely experience more serious withdrawal symptoms. If the user is addicted to multiple substances, the withdrawal process may be longer and more intense. Quitting “cold turkey” will cause more severe withdrawal symptoms.

However, if methadone is used appropriately as part of the treatment of a painful condition, there is much less chance of becoming addicted. The patient is usually monitored by their doctor and the dose of methadone is reduced over time as the painful condition improves.

What is methadone used for?

The UK has a range of treatment services for opioid dependency. Pharmacological and psychosocial interventions are provided in the community and the criminal justice system, and include inpatient, residential, day-patient and outpatient services.

The interventions used for opioid-dependent people range from needle exchange to maintenance therapy, also known as “substitution” (OST), and abstinence.

The aims of the maintenance approach are to provide stability by reducing craving and preventing withdrawal, eliminating the hazards of injecting and freeing the person from preoccupation with obtaining illicit opioids, and to enhance overall function.

To achieve this, a substitution opioid regimen, that is a fixed or flexible dose of methadone or buprenorphine to reduce and stop illicit use, is prescribed at a dose higher than that required merely to prevent withdrawal symptoms. The aim is for people who are dependent on illicit opioids to progress from maintenance to detoxification and then abstinence, which is when a person has stopped taking opioids.

Methadone is also used for end of life care and severe pain. This is usually prescribed by a pain specialist and comes as tablets or injections. Because of the risks associated with opioid use, methadone should only be used for pain relief in people who are unable to take non-opioid pain-relief medicines, or in circumstances when pain cannot be managed with other options.

How is methadone abused?

Any time methadone is taken beyond its prescribed and medically necessary intent, it is considered abuse. The pills may be swallowed, crushed up and then snorted or smoked, or dissolved in water and then injected. Liquid methadone may be swallowed or injected when abused. Since liquid methadone is obviously already in liquid form, it is often considered easier to abuse than methadone in pill form.

People who start using methadone to overcome their heroin addiction are at a higher risk of abuse because they already have a history of opioid dependency. Some addicts, in fact, prefer methadone as their substance of choice. Any time someone uses more methadone than they are prescribed, or uses it without a prescription, they are abusing the medication.

Since methadone is a treatment for opioid addictions, its symptoms of abuse are similar to the warning signs of other opioids. However, they set in slowly. Due to these symptoms, it becomes easy to identify an individual who abuses methadone.

Such symptoms include the following:

• Diarrhoea.
• Lack of sleep.
• Runny nose and aching muscles.
• Shaking and mild tremors.
• Sweating profusely.
• Depression.

How does methadone affect the body?

The effects of methadone on the body include:

• Slowing down body functioning and reducing physical and psychological pain.
• Feelings of warmth, relaxation and detachment.
• Relieving feelings of anxiety.

However, the side effects of methadone should be taken seriously, as some of them may indicate an emergency. If so, patients should stop taking methadone and contact a doctor or emergency services right away.

Common side effects of methadone include:

• Restlessness.
• Nausea or vomiting.
• Slow breathing.
• Itchy skin.
• Heavy sweating.
• Constipation.
• Sexual problems.

Serious side effects of methadone include:

• Experiencing difficulty breathing or shallow breathing.
• Feeling lightheaded or faint.
• Experiencing hives or a rash; swelling of the face, lips, tongue, or throat.
• Feeling chest pain.
• Experiencing a fast or pounding heartbeat.
• Experiencing hallucinations or confusion.

Methadone is a drug that can cause psychological damage as well. Some people experience hallucinations from taking methadone and some may develop sleep disorders or delusions from it. For some, methadone side effects include thoughts of suicide and mental health disorders like depression and anxiety.

What are the risks of methadone?

There is an increased risk of opioid overdose death during induction into methadone treatment, as opioids, including methadone, induce respiratory depression and hypoventilation.

Mixing methadone with alcohol, or with other sedatives such as benzodiazepines, can have serious consequences; an overdose is more likely, and this can lead to a coma or respiratory failure and death.

Other medications may interact with methadone and cause heart conditions. Even after the effects of methadone wear off, the medication’s active ingredients remain in the body for much longer so unintentional overdose is possible if patients do not take methadone as prescribed.

Methadone treatment may not be suitable for some people and may present risks, for example if you:

• Have had an allergic reaction to methadone or any other medicines in the past.
• Have a lung problem or breathing difficulties.
• Are addicted to alcohol, or other drugs that are not opioid.
• Have a head injury or get bad headaches.
• Have ulcerative colitis.
• Have seizures or fits.
• Have heart rhythm problems (arrhythmia) or low blood pressure.
• Have problems with your thyroid, adrenal glands, kidneys or liver.
• Have myasthenia gravis (a rare condition that causes muscle weakness).
• Are pregnant, trying to get pregnant or breastfeeding.

In rare cases, it is possible to have a serious allergic reaction (anaphylaxis) to methadone.

Deaths from black-market methadone remain common. In 2021, 663 deaths were recorded from methadone drug poisoning in the UK.

Short-term and long-term effects of methadone

As with most drugs, the effects of methadone use vary depending on factors that are unique to each person, such as how much of the drug is taken, how it is consumed, and how long it has been used.

Short-term effects of methadone include:

• Drowsiness.
• Sedation.
• Euphoria.
• Pain relief.
• Relaxed feelings.

Regular and prolonged use of methadone can harm the body. Using methadone for a long time can lead to lung and breathing problems. Women users may notice a change in their menstrual cycles, and using it while pregnant can lead to complications.

Drugs.com reports that repeated dosing can cause methadone to build up in the liver, which releases the drug slowly over time. Such a build-up can increase the drug’s potency and prolong the duration of its potential toxicity, it says.

What are the different forms of methadone?

Methadone maintenance involves taking daily medication. When methadone comes in tablet or wafer form, it can either be swallowed whole or mixed in liquid if it is a dissolvable tablet.

Dissolvable tablets should not be chewed or swallowed. Instead, the whole tablet or part of it is placed in at least 120 millilitres of liquid to dissolve, such as water, orange juice or another citrus beverage, and the entire mixture is then taken immediately. However, you should not use grapefruit, as grapefruit juice inhibits the metabolism of methadone, raising its serum levels.

Another form of methadone medication is a methadone oral solution, usually a green liquid that is swallowed.

Methadone also comes in an intravenous form that can only be given by a medical professional. Methadone injections generally treat moderate-to-severe pain when a long-lasting option is needed. However, some opioid treatment programmes use methadone injections for patients who cannot take oral medication.

Doses and forms of methadone medication will vary from person to person.

A starting dose is based on:

• The amount of heroin they are using.
• Whether they are using other drugs or alcohol.
• A urine sample (to test for heroin and other drugs).
• Their physical and mental health.
• Whether they have had treatment for drug addiction before.

Patients will usually start on 10mg to 30mg, taken once a day. This can be increased slowly, until the withdrawal symptoms are under control and the cravings stop. Many people then take a regular dose of between 60mg and 120mg a day. However, each individual’s dose may be different and will be detailed in their treatment plan.

Final thoughts

Use of opioids can quickly escalate to misuse and then to dependence.

Anyone who is concerned about their own opioid use or about the use of opioids by others can contact:

• FRANK on 0330 123 6600.
• HealthUnlocked hosts a forum for methadone users.
• Turning Point.
• Recovery on 0203 553 0324.
• NHS Direct on 111.

To report drug offences, contact the police on 999 or CrimeStoppers on 0800 555 111.