Methadone

 

Medicinal uses

Although it was originally developed for use as an analgesic, methadone is mainly used today as a substitute for heroin in an attempt to relieve some of the problems associated with heroin addiction. It is usually prescribed as a liquid syrup to be swallowed but it is also manufactured as tablets and ampoules for injection.

Methadone mimics many of the effects of opiates such as heroin. Methadone maintenance programmes are intended to reduce the risks associated with heroin addicts who use illicit sources for their drugs. It is presumed that these risks - such as heroin overdose, HIV or hepatitis infection from shared syringes and risks associated with the need for criminal activity to fund illicit drug use - are reduced if addicts receive a daily supply of methadone as a substitute for illicit heroin. It is also presumed that - given a regular supply of a prescribed drug - addicts will be able to lead a more stable life as they will no longer suffer from repeated heroin withdrawal.
The effects of methadone last far longer than those of heroin or morphine. They can last up to 24 hours, which allows an opiate addict to take methadone only once a day in methadone maintenance programmes without experiencing withdrawal symptoms.

The effectiveness of methadone maintenance programmes has come under question in recent years and this remains a controversial practice. The central arguments involved in this debate are outlined in a following section of this page.

Methadone can also be used for a short period to help addicts get through the physical and psychological trauma of opiate withdrawal in detoxification programmes.

 

What effect does it have?

Methadone has a similar effect to that of opiates but not as intense. The fact that it is a slow-action drug that is usually prescribed as a liquid syrup means the pleasureable feelings derived from methadone are far milder than those produced by - say - injection of heroin.

Although methadone produces a mild sense of well-being and relief of stress similar to that of heroin, this does not mean that methadone is a weak alternative to that drug. For it to work effectively, methadone needs to be as powerful as heroin and many addicts have stated that withdrawal from methadone is worse.

 

Abuse of methadone

Abuse of methadone can take several forms:
- conning a doctor into prescribing a higher dosage than is required;
- taking more than the recommended dosage;
- taking methadone in combination with other drugs, including alcohol;
- using methadone as a 'top up' drug while continuing to take heroin;
- selling prescribed methadone in order to buy heroin.

A serious problem with much of the methadone prescription in the past was that heroin addicts were often given sufficient methadone to last one week - or even one month. As a result, addicts commonly sold their prescribed methadone in the illicit drug market. Schoolchildren have been found in possession of this drug and several have died. It is more common practice today to require addicts on methadone maintenance programmes to collect their prescription from a clinic or pharmacy daily - and to swallow this under observation. This is to prevent methadone from entering the illicit market.

In 1996 more than twice as many people died in the UK from methadone-related causes than died from taking heroin. This casts doubt on the usefulness of methadone maintenance programmes and illustrates the danger inherent in its abuse.

 

Consequences of methadone use and abuse

Consequences for health

Taking extra methadone above the recommended dose or mixing it with other depressants such as temazepam, alcohol or even heroin is very dangerous. This can - and does - commonly result in overdose and death of the user.

Withdrawal symptoms occur when a regular dosage of methadone is halted. Although these develop more slowly and are less severe than those associated with morphine and heroin withdrawal, they are more prolonged and in many respects more unpleasant.

Dependence
Tolerance to methadone - where more and more of the drug must be taken to achieve the same effect - and physical/psychological dependence on the drug may occur. Anecdotal evidence appears to suggest that methadone is equally as addictive as heroin, although the attraction of injecting a 'fix' (a large part of psychological addiction) is not present.

Legal consequences

The maximum sentence for unlawful possession of methadone is 7 years imprisonment and an unlimited fine. The maximum sentence for supplying methadone (including giving some to a friend) is life imprisonment and an unlimited fine.

 

Methadone maintenance programmes

The concept of methadone maintenance

The underlying rationale of methadone maintenance is that if patients are receiving methadone, they are not inclined to seek out and buy illegal drugs on the street, or engage in criminal activities to fund illicit drug use. Also, the health risks associated with injection of illicit drugs are removed.

This approach to heroin addiction is often referred to as 'harm reduction' or 'harm minimisation' as its primary aim is not so much to encourage addicts to stop using drugs but simply to attempt to reduce the damage that such use causes to addicts and society.

It has been demonstrated that the probability of a methadone maintenance programme helping a heroin addict to become abstinent from all drugs - or at least find a stable lifestyle - is increased if other help, such as counselling, advice and support is also accepted.

Problems associated with methadone maintenance

While methadone prescription for a short period to counteract the symptoms of heroin withdrawal must have a place in addiction treatment, its widespread use could increase the number of chemically dependent individuals.

Abuse of methadone maintenance programmes is common, particularly when the drug is dispensed on a weekly basis rather than daily. Prescribed methadone is frequently encountered on the illicit market and has recently been associated with a greater number of overdose deaths than has heroin. As previously mentioned, many addicts have stated that it is physically more difficult for addicts to stop using methadone than it is to stop using heroin.