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Methadone belongs to the group of drugs known
as opioids.
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)
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