Methadone Addiction

Rehabilitation specialists prescribe methadone as part of drug replacement therapy, or DRT, for the treatment of opioid dependency or addiction. Methadone contains a mild opioid that reduces withdrawal symptoms but this drug does not cause euphoria like other opioids. It is possible to become physically dependent or addicted to methadone, even when used as prescribed.

The effects of methadone last longer than other opioids. One dose of methadone lasts about 24 hours, as compared to a dose of heroin which may last for only a couple of hours.

The definition of addiction

Individuals may be on drug replacement therapy for months or even years. Using methadone for a long time may cause physical dependence or addition, two separate and independent medical conditions.

Addiction is a chronic, primary condition that affects the cells of the central nervous system, or CNS. Opioid addiction is not the result of other illnesses. This disease requires long-term, professional treatment.

A family history of addiction increases one's risk for developing an addiction. Psychological, social and environmental factors influence the development of addiction and these same factors influence the ways addiction affects each individual. No two addictions are alike; a person may also experience different symptoms and challenges overcoming his addiction to methadone than he did with his initial addiction.

Doctors diagnose a person as being addicted to a substance based on the patient's behavior. An addicted person seems unwilling or unable to control his methadone consumption, uses methadone compulsively or has cravings for methadone. Addiction is closely associated with dependence but there are distinct differences between these conditions.

The Definition of Dependence

Physical dependence on methadone means the body needs to maintain a certain level of methadone to feel normal. If methadone dips below that level, the body struggles to regain chemical balance. The patient experiences this battle for chemical stability through uncomfortable, flu-like withdrawal symptoms.

Medical professionals diagnose a patient as being physically dependent if he suffers symptoms once levels of this opioid drop radically. This rapid decline in opioids levels happen either by missing a dose, taking an insufficient dose or through the administration of certain drugs, such as naloxone, that reduce opioid levels.

Addiction versus Dependency

Both addiction and dependence cause real changes to the brain and body, but methadone addiction and dependency manifest themselves differently. Dependence is a state where a person's body needs methadone in order to feel normal, whereas addiction is the compulsive use of methadone. Addiction and dependence on drugs such as methadone are separate and independent from one another; a person can be physically dependent on a drug without being addicted to it and vice versa.

For example, a person may need anti-hypertensive medication to keep her blood pressure within a safe range; if she were to stop taking the drug, her body would struggle to maintain a healthy blood pressure but the patient would not experience cravings for her medicine.

Conversely, a person could be addicted to cocaine without being physical dependent on it. A cocaine addict will feel cravings once he runs out, but the drop in cocaine levels will not result in physical withdrawal symptoms.

Addiction: What Family Members Should Know

Addiction is a disease, not an indicator of low moral character. In fact, your loved one probably developed this addiction while using this medication as prescribed by a doctor. In this case, addiction is a risk associated with treatment for opioid dependence.

Like other chronic diseases, addiction affects the whole family. Researchers believe addiction may be genetic, at least in part, passed from one generation to the next. Environmental factors within the family unit, such as marital problems, financial hardships and other relationship issues, increase the risk for addiction for everyone living within that home.

Family members should be aware that methadone addiction might result in a return to illicit opioid use. Illegal drug use causes collateral damage within the home, including legal issues, expenses, loss of income, relationship breakdowns and other problems.

Addiction to methadone and other opioids is a terrible event but recovery from addiction can have a positive effect on a family. The family plays an important role in recovery from illicit opioid or methadone addiction, driving the individual to counseling sessions or helping him pay for medication. Overcoming the challenges of addiction strengthens the bond between individuals. Each person is a valuable partner in the supportive family network.

It is important that family members know it is possible to arrest the disease's progression at any time. As long as the individual is still alive, he can still work towards recovery from methadone addiction.

Recovery from methadone addiction works best when the individual feels physically, emotionally and spiritually safe within his home environment. Family members should recognize addiction as a disease and avoid blaming the individual for his illness.

Family members should know that opioid addiction affects every person in the household equally. Researchers believe addiction is hereditary, passed from one generation to the next; young family members should recognize an increased risk for addiction if one or both parents suffer from addiction.

Caring for a Family Member with an Addiction

Addiction to methadone or other opioids is extremely difficult for every member of the family but it is important to remember that your loved one relies on support for a successful recovery. A family can work together to develop a treatment plan, with every member participating in recovery. The family unit should meet frequently, with or without the addicted individual, to discuss progress.

Family members should learn everything they can about methadone addiction and the treatment for this chronic disease. Visit websites, ask questions and seek referrals from other people who have supported a loved one during a battle to overcome methadone addiction. While addictions differ from person to person, family members can learn quite a bit from the experience of others.

It is okay to talk about opioid addiction, within the home and even with people outside the family unit. Communication between family members should be encouraged, even if the addicted person does not want to talk about his disease. Trained rehabilitation counselors can teach family members how to open lines of communication between themselves and the person struggling with methadone addiction.

Signs of addiction: For those around

Addiction changes a person's behavior, thoughts, emotions and relationships with others. These changes may or may not be obvious to friends, neighbors or co-workers. Addiction to opioids including methadone changes the way a person thinks in a way that causes him to have trouble perceiving, learning, controlling impulses and making rational decisions.

A friend or co-worker may notice changes in a person addicted to methadone, such as:

  • Abnormal, Illegal or Anti-Social Actions
  • Arguments or Violent Outbursts
  • Child Neglect
  • Excessive Methadone Prescriptions
  • Frequent Emotional Crisis
  • Legal Trouble
  • Neglect of Social Commitments
  • Prioritizing Activities Involving Methadone
  • Separation or Divorce
  • Unexplained Absences from Home
  • Unpredictable Behavior such as Inappropriate Spending
  • Withdrawal from Relationships, Family or Friends

Addiction Symptoms: Physical and Psychological

Methadone addiction, like other opioid addictions, makes changes to the brain and body in a way that causes specific physical and psychological symptoms. Because the individual used methadone to overcome his previous addiction to other opioids, it may be difficult to tell whether these changes are due to his addiction to methadone or to the other drugs.

Physical symptoms of drug addiction include:

  • A Change in Sleep Patterns
  • Bloodshot Eyes with Large or Small Pupils
  • Body or Clothing May Have an Unusual Odor
  • Deteriorating Physical Appearance - Looks Sickly
  • Diminished Hygiene Care
  • Nagging Cough
  • Slurred Speech
  • Tremors
  • Unexplained Weight Gain or Weight Loss

The patient's first addiction to opioids and subsequent addiction to methadone causes "hard-wired" changes in the reward circuit of brain. These changes are responsible for the uncontrolled, compulsive behaviors associated with opioid and methadone addiction.

Nature provided psychological rewards to reinforce certain behaviors that ensure the survival of the species. Rewards cause animals to repeat behaviors more frequently and with more intensity. Natural rewards, such as eating or mating, ensure the species' success by encouraging individuals to do something that might be otherwise difficult, boring or unsavory.

The change in the reward circuit causes the addicted individual to incorrectly associate methadone with a rewarding experience. This incorrect reward pattern makes the individual lose interest in things he used to find pleasurable and focus solely on things involving methadone.

Methadone addiction alters the reward circuit in a way that causes psychological symptoms, including:

  • An Inability to Stop Using Methadone Consistently
  • Cravings for Methadone or Other Opioids
  • Dysfunctional Emotional Response
  • Impairment in Behavioral Control
  • Inability to Recognize Significant Personal or Relationship Problems

Behavioral, Cognitive and Emotional Changes

Addiction to methadone affects the way a person acts, thinks and feels. These changes may appear slowly or abruptly, and may last long after the individual has stopped using methadone. Left untreated or poorly treated, these changes increase the risk for returning to opioid abuse after the individual has overcome his addiction to methadone.

A person with a methadone addiction may take higher doses of his medication or use it more frequently than he realizes. He may seem to lack the interest or ability to quit using methadone or other opioids permanently.

Opioids change the way a person thinks and, since doctors prescribe methadone as drug replacement therapy, it may be difficult for the individual to see that she has merely traded one addiction for another. She may blame all her problems on other people or events, rather than as the consequence of her methadone addiction.

Addiction and gender: how women and men are affected differently

Results from the 2010 National Survey on Drug Use and Health show more males over the age of 12 use illicit drugs, such as marijuana and cocaine, than females of the same age. Females between the ages of 12 and 17 years, however, were more likely to abuse pain relievers than males in that same age group.

Many studies reveal older women are more likely to abuse prescription drugs, such as opioid painkillers. Females are also more likely to abuse multiple substances than are men. This puts females at special risk for developing opioid and subsequent methadone addictions.

Treatment options

Methadone is perhaps the best-known treatment for opioid addiction but it is possible to become addicted to methadone itself. Rehabilitation specialists will need to plan treatment options carefully for those addicted to replacement drugs like methadone.

The American Society of Addictive Medicine warns that addiction can cause "disability or premature death, especially when left untreated or treated inadequately." This is even true for methadone addiction. Almost 15,000 people die in the United States every year from overdoses on prescription painkillers. Countless more suffer physical, emotional, social, economic and criminal affects from opioid addiction and many do not get adequate treatment for their disease.

According to the National Institute on Drug Abuse, more than 23 million people in the United States over the age of 12-years needed treatment for alcohol or substance abuse in 2010; of these, only about 11 percent received treatment at a specialty facility.

A large number of people receive methadone to help them overcome addiction to opioids. Just over 5 percent of admissions to publicly funded substance abuse programs were for treatment of opioid abuse; because patients can take methadone therapy as an outpatient, they do not need to be admitted to an inpatient facility.

Self-Detoxification

After they successfully overcome addiction to the first opioid and participate in behavioral modification, the individual must then wean himself from methadone. Many individuals try to quit alone, without the help of medicine to reduce withdrawal symptoms because they feel they have gained everything possible from the professionals. This is known as self-detoxification or "going cold turkey," named for the cold, clammy, bumpy and pale appearance the skin takes on during detoxification.

During self-detoxification, the individual experience uncomfortable withdrawal symptoms commonly associated with opioids, such as diarrhea, abdominal pain, cold sweats and muscle pain. Methadone withdrawal symptoms usually begin 1 to 3 days after the last dose and peak on or about the sixth day but can last longer.

Without proper medical assistance, the addicted individual may suffer dangerous complications. For example, she can vomit and inhale stomach contents, a complication known as aspiration. Aspiration may result in pneumonia or lung infections. The methadone addict also faces dehydration from excessive vomiting and diarrhea. The complications and overwhelming symptoms of withdrawal cause many people who attempt self-detox to relapse to methadone or other opioid use.

Other people use a variety of products that reduce the withdrawal symptoms during self-detoxification. Once such homemade treatment plan is The Thomas Recipe, in which a person takes prescription medication to reduce anxiety and induce sleep, a product to ease diarrhea plus vitamins and supplements to soothe muscle aches and fatigue.

While these recipes can reduce withdrawal symptoms associated with methadone addiction, the person risks the same dangerous complications as he would without medication. Furthermore, self-detoxification addresses only the physical aspects of methadone withdrawal; self-detox does not deal with the behavioral aspects of opioid addiction. This gap in the treatment plan increases the risk for relapse to methadone or other opioids.

Overdose

Relapse is the largest complication associated with quitting methadone and other opioids. Someone who has recently experience withdrawal symptoms is at a greater risk for overdose, as the detoxification process lowers the body's tolerance to the opioid component of methadone. This means she can accidently overdose on a lower dose of methadone than she used to take before she attempted detoxification.

Overdose symptoms include:

  • Extreme Drowsiness
  • Pinpoint Pupils
  • Nausea
  • Vomiting
  • Diarrhea
  • Confusion
  • Ringing in the Ears
  • Cold, Clammy Skin
  • Muscle Weakness
  • Fainting
  • Weak Pulse
  • Slow Heart Rate
  • Coma
  • Blue Lips
  • Shallow Breathing or No Breathing

Overdose is a serious, life-threatening emergency that requires professional care. In the emergency department, doctors administer naloxone and other medications to reduce opioids to non-toxic levels quickly. Once the patient's methadone levels are within safe levels, she may continue her behavioral therapy program as an outpatient.

The number of opioid poisoning deaths has risen for several years; as compared to other opioids, methadone has had the largest relative increase. The Centers for Disease Control and Prevention, or CDC, shows methadone-related poisoning deaths in the United States skyrocketed 468 percent between 1999 and 2005.

Drug Replacement Therapy

Doctors regularly prescribe methadone as part of outpatient drug replacement therapy, or DRT. Other DRT medications include Suboxone or buprenorphine. These drugs bind to the same opioid receptors in the central nervous system as opioids and methadone do in a way that reduces withdrawal symptoms. DRT medications including methadone last longer than other opioids, such as oxycodone or codeine, and do not produce the euphoric effects. DRT medications allow addicted individuals to participate in treatment without a hospital stay.

Supporters of using methadone as DRT recognize the flexibility of outpatient treatment while opponents say it is merely trading one addiction for another. After methadone helps the patient overcome his initial addiction, the individual must address his need for methadone.

After the individual changes the behaviors associated with his initial addiction, he weans himself from methadone. Some patients struggle with their methadone for years, unable to free themselves from drug addiction.

After the individual changes the behaviors associated with addiction, he must wean himself from methadone. Harvard Medical School cites estimates that 25 percent of methadone DRT patients eventually abstain, another 25 percent continues to take the drug and 50 percent go on and off methadone.

Methadone is just one type of Medically-Assisted Treatment, or MAT, in which physicians administer drugs to lower opioid levels and reduce withdrawal symptoms. Standard detoxification and rapid detox are other types of MAT.

According to the Substance Abuse and Mental Health Services Administration, or SAMSA, methadone or DRT intervention:

  • Improves Survival Rates
  • Increases Retention in Treatment Programs
  • Decreases Illicit Opioid Use
  • Decreases the Risk for Hepatitis and HIV
  • Decreases Criminal Activities
  • Increases Employment
  • Improves Birth Outcomes for Pregnant Women Battling Addiction

Inpatient MAT programs use medicine that ease withdrawal and facilitate detoxification from methadone use. During detoxification, physicians administer some medications to decrease the level of methadone, plus other drugs that relieve the resulting symptoms of withdrawal. Medical personnel observe patients for dangerous complications, such as dehydration or aspiration, and take lifesaving measures whenever necessary. While detox eases the physical aspects of addiction, individuals must still endure the demoralizing process of detoxification from the effects of methadone.

Rapid detox is the most humane method of detoxification from methadone addiction. During rapid detox, board-certified anesthesiologists administer standard detoxification and anti-withdrawal medications alongside anesthesia and sedatives so that the patient dozes in a comfortable "twilight sleep" rather than battle uncomfortable withdrawal symptoms. When the patient awakens a few hours later, he will have no memory of the grueling and demoralizing detoxification and withdrawal period. He can now complete the rehabilitation process.

Rehabilitation

Successful recovery from methadone addiction includes continued rehabilitation and behavior modification. Methadone addiction is a complex disease that affects brain function and behavior. Individual, family and group counseling, along with other behavioral therapy are a large part of successful treatment for methadone addiction. While no single therapy works for everyone, treatment does needs to be readily available to be effective.

The most effective treatment must attend to the complex and multiple needs of the individual, and not just focus on his addiction to methadone. Many drug-addicted individuals also have other mental disorders that prevent or slow the recovery process.

Methadone is an important element of treatment for many patients, especially when therapists combine methadone with counseling and other behavioral therapies. Methadone is only one aspect of treatment for opioid dependence and, by itself, does little to change long-term drug abuse.

Miscellaneous Information

About 9 percent of people abuse opiates at some point in their lives. Many of these individuals ultimately use methadone to overcome dependence on these opioids.

German scientists first synthesized methadone in 1939. The United States Public Health Service hospitals began administering methadone as part of an opioid abstinence program by the 1950s.

Methadone comes as a syrup, injection or tablet. Treatment programs typically administer methadone syrup mixed in fruit juice.