Methadone

(Physeptone)

Methadone treatment has been used effectively and safely to treat heroin addiction for more than 30 years using it as a substitute for heroin. The Methadone is usually taken orally in the form of a sweet tasting green liquid, although you can get it in tablet and injectable ampoule form.  It suppresses withdrawal for 24-36 hours, relieves the craving associated with heroin addiction and patients are able to perceive pain and have emotional reactions. Combined with behavioral therapy or counselling and other supportive services, Methadone enables patients to stop using heroin and return to more stable and productive lives, as you will be able to see what a drug free life is like (having more money in your pocket, going out, etc.) be able to do more things, etc. 

Initially the medical staff will give you a starting dose dependent on how much heroin you have been using (usually they start you on 25-30ml) increasing it each day until you are on a dose that you are comfortable with, this is called stabilisation. The aim is for you to have no cravings or withdrawal symptoms and to be able to function normally.  You would then remain on this dose for a number of months, decided between you and your Doctor (approximately 3-6).  After such time the dose would be reduced gradually by around 5ml a fortnight/month, eventually being Methadone free.  When you get down to the lower levels of Methadone they may reduce at a lower level, it would depend on how you were coping.

To begin with you would be required to visit the treatment center to collect your Methadone and will have to take it in front of a staff member, you will also be required to give urine samples each fortnight to check that you are not using on top.  Once you have stabilised and have had a couple of clean drug tests, they will usually allow you to collect your Methadone from your local chemist, starting off with a daily pickup and progressing to being allowed to collect once a week.

If you find that you feel fine on your dose (and your Doctor has said that you are taking the correct amount) until early evening/night time and then your withdrawal symptoms kick in, this is probably due to you having a fast metabolism or perhaps you are pregnant.  The reason why your Methadone is not lasting the full 24 hours is because your body is breaking it down too fast and therefore it would be better for you to take your medication on a split dose.  For example, this means that instead of taking 60ml a day, you will take two doses of 30ml (one in the morning and one at night).  As many people end up taking huge amounts of Methadone, which could have been avoided if they had been told about split doses.

However, whilst you will normally be closely monitored when on a Methadone prescription it is still easy to use on top and this is the main drawback for taking Methadone.  Because it is an opiate substitute and has no blocking effect, using heroin on top would not cause you any major problems.  If you had completed a detox and were clean you know that using once could mean you getting addicted all over again and if you were also taking Naltrexone you know that you wouldn't get any effect from it anyway.  However when you are taking Methadone although you are not using heroin you are still addicted and won't therefore have any adverse effects to worry about.  This can make it very tempting to use now and again, especially when you know that as long as you don't use 4 days before your drug test, nobody will ever realise.

Don't let this put you off taking Methadone though, as many people manage to use it successfully.  This is just a warning to you if you feel that you don't have much willpower, that Methadone might not be the cure for you.  However, if you do feel quite weak but wanted to try Methadone as you have tried and failed at all other methods, you should be able to succeed if you are totally honest with your Doctor/Counselor.  Tell them your concerns about using on top and make arrangements to have more regular drug tests than just once a fortnight, perhaps even random tests.  You can always try it anyway and see how you feel.  As even though you might be quite weak and be worried about cheating when on your prescription, you may find that when you start on Methadone because you are feeling well and have no withdrawals etc.  Alternatively, speak to your Doctor about stabilising on Buprenorphine instead (see chapter below) as this drug contains a blocking agent which makes it harder for you cheat and use on top of your medication.

The drawback of Methadone is that whilst it is medically safe even when used continuously for 10 years or more, it is addictive.  Your treatment will involve the dose being reduced gradually so the body can adjust without serious withdrawal symptoms.  However, if you were to stop taking Methadone suddenly the symptoms are more severe that with a heroin withdrawal, start later and last longer.

Methadone & Safety

Methadone is a very dangerous drug.  The staying alive golden rules are:

• Don't use methadone with other drugs.  Mixing methadone with other opiates such as heroin and DF 188s or other depressant type drugs such as alcohol, sleeping tablets or tranquillizers greatly increases the risk of overdose.

• Take methadone as prescribed by your Doctor.  Methadone comes in different strengths: a spoonful of a stronger mixture could contain ten times the amount of methadone you are used to.  Methadone bought on the illicit market, even when supplied in a medicine bottle, could be much stronger. Alternatively it could have been 'watered down' making it difficult to judge your tolerance level.  If you have some illegally bought methadone or someone gave you some, don't take it.  Obviously this is easy to say but being realistic, an addict will NEVER through away something like that - so just be careful.  If you have to, only take a very small amount (i.e. instead of your usual dose of 50ml, take 10ml) to begin with.  Wait 45 minutes-1 hour and if you are still okay then the strength is probably genuine, if not take some more.

• Stick to your familiar routine.  Overdoses often happen in unfamiliar surroundings.  New or unhappy places may be dangerous simply because you act 'differently' and abandon previous safeguards.

• Watch your starting levels.  Be cautious about dose levels during your first few weeks on methadone.  Exaggerating you opiate intake to get more methadone from a Doctor may get you more that your body can tolerate.  If you start using opiates again after a break, start low - tolerance doesn't survive for more than a few days.

• Safe storage.  Keep your methadone (and any other drugs) where children can't get at them.  Ask your pharmacist to dispense your methadone with child-resistant caps.  As little as 5mg could kill a baby (e.g. a teaspoon full).

• Tolerance means so much.  Understanding what 'tolerance' means could be a life-saver.  Think of it as your body getting used to having a drug around all the time - 'tolerating its presence'.  Without tolerance, 50mg of methadone can kill an adult.  Tolerance is literally the difference between life and death.  For methadone and other opiate-type drugs tolerance builds up in about two weeks - but only if you take the drug most days of the week; no amount of weekend binges will have the same effect...

... but, AND THIS IS THE KEY POINT - tolerance fades as quickly as it develops.  Months of regular use will have increased your tolerance level.  If you stop using regularly, your tolerance falls and a comparatively small amount could kill you.

Methadone & Your Body

An organ by organ run down of how methadone affects your body

IT DEPENDS ...

Opiate drugs such as methadone, heroin and DF 118s have similar effects.  The effects will be influenced by: your mind and body; how much you take; how used you are to opiate drugs and how it is taken.  Injectable methadone will work quicker than oral methadone.  So, most statements about the effects of methadone should really start, 'It depends ...'

The good news is that the unpleasant effects highlighted will stop once you stop taking opiates.  Methadone does not cause any lasting damage to any organs of the body.

• Scratch and Sweat - Like all opiates, methadone increases the flow of blood to the skin, which causes itching and sweating.  Itching is often most irritating in the nose but it can be all over your body.

• Pinned pupils - Methadone makes the pupil of the eye smaller.  There is no noticeable effect on eyesight.

• All dried up - Methadone reduces the secretion of tears, snot and saliva.  When coming off opiates the 'rebound' effects are usually very noticeable - runny nose and liquid eyes.

• Brush those teeth - The sugar in oral methadone won't help keep your teeth healthy.  Regular brushing and less sugar in drinks will help.  Methadone is a pain killer and it may be masking tooth ache.  Sugar-free methadone is now available and whilst it isn't as sweet to drink, it's a lot better than having your teeth fall out.  If your chemist doesn't stock it, ask them to get you some in when they get their next stock delivery.  Also, make sure your prescription states that you want the sugar-free variety as some chemists will only prescribe to the letter what is on the script.

• A bit chesty? - Methadone can suppress the cough reflex so chest infections can get worse more quickly.  If you use methadone and get a 'bad chest', seek medical advice.

• Loaded Liver - Methadone does not damage the liver.  However, if your liver has been damaged by alcohol or hepatitis, your liver may not be able to cope with the extra burden.  Seek medical advice.

• That queasy feeling - Methadone acts on a part of the brain that can make you feel sick.  Methadone will also slow the passage of food through the intestines.

• Constipation - Like all opiates, methadone slows down the muscular contractions that push food through the gut, sometimes leading to constipation.  Laxatives should only be used in the short term.  It's better to: eat fruit, veg and wholemeal bread; drink lots of alcohol-free fluids; get some exercise.  Constipation can cause serious problems in later life.

• What about sex? - If you've been 'wrecked' on street heroin, straightening out on methadone could increase your sexual appetite.  Opiates may reduce men's ability to get and keep an erection and reduce the level of the male sex hormone testosterone.

• Pregnancy is possible - Women who use opiates may stop having periods.  There is no evidence that this is due directly to opiates.  It is more likely to be caused by weight loss, poor diet or stress.  If your periods do stop, you can still get pregnant. It is vital that you use contraception.  Read the women' pages for more details.

Click here to read the handbook 'Treatment Choices: Methadone' by HIT.

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Last updated: 9 November 2003