The Drug
		Treatment
		Side Effects
		Overdose

Methadone is synthetically manufactured and used as a substitute for the treatment of people dependant on heroin and other opioids.
Methadone has been used as a treatment to deal with opiate addiction for about thirty years, although the way it is implemented has changed a lot in that time.

The drug user goes from using heroin to having a daily dose of methadone, usually taken at a pharmacy where methadone is dispensed.

Methadone is prescribed by medical doctors who have specialist training in the uses of methadone and have been granted a permit from the Department of Human Services.

The Drug

Although methadone is an opiate like heroin, it is unlike heroin in the following ways:

• Duration: Methadone is a longer acting drug than most other opiates. One dose of methadone lasts for about 24 hours, allowing for a dose once a day. The effects of methadone are felt within about one hour of a dose; however the peak effects are felt 4-8 hours after the dose. 
• Consumption: Methadone is drunk in cordial or fruit juice. 
• The Law: Methadone is legally available on a doctor's prescription, provided the doctor has first obtained a permit from the Department of Human Services. 
• Cost: Community pharmacies and specialist methadone services will charge a dispensing fee.

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Methadone Treatment

Generally there are two types of methadone programs:

• Maintenance or long-term program (the most common) where the goal is to reduce the harms associated with drug use and to improve overall quality of life; and
• Withdrawal or short-term program, generally lasting 5-14 days, where methadone is used to ease the discomfort of heroin withdrawal

Methadone is not a 'cure' for heroin dependence. However, it may improve the health of people dependent on heroin in a number of ways:

• Methadone is taken orally which makes it safer than injecting heroin. This reduces the risks involved with injecting drug use such as infection with hepatitis or HIV
• The routine involved in methadone treatment encourages people to lead balanced and stabilised lifestyles - including improved diet and sleep
• People are less stressed as they no longer have to worry about where their next 'hit' of heroin is coming from
• People are less likely to use heroin (which may be contaminated with other substances)
• Methadone lasts longer in the body, only needing to be taken once daily
• It helps people cut their connections with the drug scene
• Reduces criminal activities conducted to obtain illegal drugs

Methadone is as addictive as heroin and withdrawal signs and symptoms will be experienced as a patient's dose is reduced. By taking up the option of a methadone treatment, the patient may be breaking their own heroin habit, but will still be addicted to opioids as long as this treatment continues. Because methadone is such a long acting drug, the withdrawal symptoms are longer than for heroin withdrawal.
Methadone is prescribed in different doses for different patients, according to their individual needs. Some require high doses (for example, above 80 mg), whereas others do well on lower doses (for example, below 40 mg). In general, most patients feel more in control by knowing what dose they are on. However, some find it better not to know what their dose is, especially at times of reduction.
It is important for patients to talk to their doctor about whether they want to know what their dose is, and the advantages and disadvantages of this. Remember, agreement is required for the general timing and planned rate of withdrawal from methadone.

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Side Effects of Methadone

Many people on methadone will experience some unwanted symptoms during their treatment period. These are generally caused by the dose of methadone being either too low or too high, or by side effects of methadone.
Symptoms of the methadone dose being too low are similar to those of opiate withdrawal such as:

• runny nose, 
• abdominal cramps, 
• nausea, 
• vomiting, 
• diarrhoea, 
• back and joint ache, 
• sweating, and 
• irritable mood.

The symptoms of too high a dose of methadone are: 

• drowsiness, 
• nodding off, 
• nausea and vomiting, 
• shallow breathing, 
• pinpoint pupils, 
• lowered blood pressure and 
• dizziness.
  

These symptoms can be corrected by getting the dose adjusted. Patients should be encouraged to tell their doctor or pharmacist if they are experiencing these symptoms.

Methadone can also have side effects that may be unrelated to the dose.
The side effects and some of their treatments are:

• Aching Muscles and joints: this may be experienced by some people even when the dose of methadone is adequate. Some individuals report rheumatism type pains at various times. 
• Constipation: this is quite common. The treatment is to eat more fibre and drink plenty of water. This means eating more fruit, vegetables, wholemeal and bran products. 
• Fluid retention swelling or 'puffiness' of the hands or feet. 
• Lowered sex drive: this is experienced with the use of any opioid, including methadone and heroin, but may reduce with time. 
• Sedation for example, drowsiness, especially soon after a dose. This usually settles down within a week or so, but the dose may need to be adjusted. 
• Skin rashes and itching: are experienced by some people, and usually settle down. 
• Sweating: increased sweating, especially at night, is quite common. 
• Loss of appetite, abdominal pain, nausea and vomiting may occur but usually settle down quickly.
• Other side effects include an increase in tooth decay as a result of decreased saliva production, and changes in menstruation. Side effects go away once the person is off methadone.

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Overdose

Methadone deaths are rare.

Methadone related deaths have almost always been due to the use of other drugs whilst taking methadone, increasing the risk of overdose.

• Deaths involving those on methadone treatment in Australia have occurred mainly due to one of the following reasons:
• Accidental overdose: abuse of alcohol and benzodiazepines is common amongst people in methadone treatment. Any combination of sedative drugs such as alcohol, heroin or benzodiazepines results in an increased risk of respiratory depression, coma and death.
• Suicide: emotional disorders are common amongst methadone clients
• Accidents: including those involving motor vehicles.

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(Southcity Clinic acknowledges the assistance of the Australian Drug Foundation in compiling this information)