Overload

Methadone

Category: Medicines

Type

Involuntary and voluntary

Introduction and description

 

All the paintings on this page are by Francis Bacon

Methadone also known as Symoron, Dolophine, Amidone, Methadose, Physeptone, Heptadon and many other names [ 6-(dimethylamino)-4,4-diphenylheptan-3-one] is a synthetic opioid, developed in Germany in 1937.

It is used medically as “a maintenance anti-addictive and reductive preparation for use by patients with opioid dependence”.

In effect one opioid drug is substituted for another. 

I have never been able to understand the logic of this, but methadone is of course produced by pharmaceutical companies, whereas street heroin generally isn’t.  Because it is an acyclic analog of morphine or heroin, methadone acts on the same opioid receptors as these drugs, and thus has “many of the same effects”.  Abuse of methadone results in about 5,000 overdose deaths per year in the United States.

Chen LH, Hedegaard H, Warner M. Drug-poisoning deaths involving opioid analgesics: United States, 1999–2011. NCHS data brief, no 166. Hyattsville, MD: National Center for Health Statistics. 2014.
The number of drug-poisoning deaths involving methadone increased from 784 deaths in 1999 to 5,518 deaths in 2007 in the United States; then it declined to 4,418 deaths in 2011

Methadone is listed under Schedule I of the Single Convention On Narcotic Drugs 1961 and is regulated in the same basic fashion as morphine in most countries as a result. In the United States, it is a Schedule II Narcotic controlled substance.

In Russia, methadone treatment is illegal. Health officials there are not convinced of the treatment's efficacy.

What are doctors prescribing methadone for?

 

It is the prevailing belief that methadone’s only use is for those who are on a drug like heroin and wish to be weaned onto something that can be given on prescription, and indeed if one looks at the figures on the eHealthme website, that is indeed one of its uses.  Called variously ‘Drug Abuse’, or ‘Addiction’, Opate withdrawal or ‘Drug dependence’, there are a number of reports of this use.  But unbelievable though it may sound, in the USA at least , it is also being used for pain - chronic pain, pain, back pain etc -  and gout!

Methadone is used in managing pain, principally because it is 'low cost', other reasons given are ‘its long duration of action and strong analgesic effect’.

Given the fact that Methadone is itself highly addictive, this would seem to be a rather risky form of prescribing for those who are not terminally ill.

On 29 November 2006, the U.S. Food and Drug Administration issued a Public Health Advisory about methadone:

Methadone Use for Pain Control May Result in Death and Life-Threatening Changes in Breathing and Heart Beat
the FDA has received reports of death and life-threatening side effects in patients taking methadone. These deaths and life-threatening side effects have occurred in patients newly starting methadone for pain control and in patients who have switched to methadone after being treated for pain with other strong narcotic pain relievers. Methadone can cause slow or shallow breathing and dangerous changes in heart beat that may not be felt by the patient

Hallucinations

Even when prescribed for pain, Methadone produces hallucinations, and it seems to produce them in a relatively short time.  Again the following is from eHealthme.

On Aug, 2, 2015: 2,110 people reported to have side effects when taking Methadone hydrochloride. Among them, 23 people (1.09%) have Hallucination.

Trend of Hallucination in Methadone hydrochloride reports

Time on Methadone hydrochloride when people have Hallucination  :

  < 1 month 1 - 6 months 6 - 12 months 1 - 2 years 2 - 5 years 5 - 10 years 10+ years
Hallucination 0.00% 50.00% 50.00% 0.00% 0.00% 0.00% 0.00%

Please note that this is not the total - the eHealthme site splits auditory, gustatory, tactile, mixed, hallucination [singular] and hallucinations [plural], aggravated,  synaesthetic, visual and so on, thus it is somewhat difficult to obtain a complete figure, but the trends are interesting.

The hallucinations experienced from prescribed drug abuse were also reported separately:

On Jul, 27, 2015: 2,110 people reported to have side effects when taking Methadone hydrochloride. Among them, 44 people (2.09%) have Hallucinogen Abuse.

Trend of Hallucinogen abuse in Methadone hydrochloride reports

Time on Methadone hydrochloride when people have Hallucinogen abuse  :

  < 1 month 1 - 6 months 6 - 12 months 1 - 2 years 2 - 5 years 5 - 10 years 10+ years
Hallucinogen abuse 50.00% 0.00% 0.00% 0.00% 0.00% 0.00% 50.00%

Other Side-effects

 

This LINK takes you to the eHealthme website where an up-to-date table of the side effects of Methadone can be seen.  The table was constructed from the Adverse Drug reports submitted by doctors to the FDA and SEDA.

Methadone causes all the side-effects of opiates and opioids in general, one of which is addiction and the second is an increasing tolerance requiring an increased dose. 

The following list was obtained from eHealthme and shows the number of Adverse drug reports submitted by doctors to the FDA and SEDA.  It is somewhat unusual for a doctor to submit an ADR for an opioid as the side-effects listed below are known and often treated as ’normal’, as such to have this many is rather worrying, as it signifies these figures are the tip of the iceberg.

  • Pain in Methadone hydrochloride (141 reports)
  • Nausea in Methadone hydrochloride (121 reports)
  • Fatigue in Methadone hydrochloride (110 reports)
  • Stress And Anxiety in Methadone hydrochloride (101 reports)
  • Depression in Methadone hydrochloride (98 reports)
  • Nausea And Vomiting in Methadone hydrochloride (95 reports)
  • Weakness in Methadone hydrochloride (89 reports)
  • Headache in Methadone hydrochloride (83 reports)
  • Cardiac Arrest in Methadone hydrochloride (80 reports)
  • Constipation in Methadone hydrochloride (77 reports)
 

The body adjusts to the chemical if it is given regularly and thus reduces the number of receptors. 

In effect any pain relieving effects will cease to be effective after a while. 

If the cause of the pain is not or cannot be addressed, then even the slightest decrease in the dose will lead to truly agonising pain, as there are not the requisite number of receptors to help. 

Opioids and opiates also cause constipation and breathing difficulties.  They can lead to forms of COPD.

Respiratory depression is a significant threat for opioid-treated patients with underlying pulmonary condition or receiving concomitant central nervous system (CNS) drugs associated with hypoventilation. ….The different features of opioids regarding respiratory effects should be considered when treating patients at risk for respiratory problems. PMID:  18503626

Methadone also appears to indirectly affect the serotonin receptors and thus causes serotonin imbalance – which is why there is depression and addiction  – although pain at this level will lead to depression and anxiety anyway.

Another little reported feature is the effect all opioids have long term on the immune system, depressing the immune sysytem is not a good idea, it means you get more illness

The clinical relevance of the immunosuppressant effects of opioids in the elderly is not fully understood, and pain itself may also cause immunosuppression….. The immunosuppressive effects of most opioids are poorly described and this is one of the problems in assessing true effect of the opioid spectrum, but there is some indication that higher doses of opioids correlate with increased immunosuppressant effects. PMID:  18503626

The deaths caused by methadone overdose or use by drug addicts is reported separately, but it is rather intriguing to look at the figures for deaths of those who were being prescribed the drug for pain management.  According to eHealthme we have the following:

On Aug, 2, 2015: 2,110 people reported to have side effects when taking Methadone hydrochloride. Among them, 66 people (3.13%) have Death.

Trend of Death in Methadone hydrochloride reports

Age of people who have Death when taking Methadone hydrochloride  :

  0-1 2-9 10-19 20-29 30-39 40-49 50-59 60+
Death 10.00% 0.00% 3.33% 20.00% 28.33% 16.67% 5.00% 16.67%

 

Methadone and addiction

 

Methadone does not ‘cure’ addiction.  It is itself an opioid.  A person weaned off heroin, for example, onto methadone will be addicted to methadone.

Methadone maintenance was the first widely used form of opioid replacement therapy developed to treat heroin dependence….. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed………………. Based on the meta-analysis, methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patient in treatment ….and in the suppression of heroin use, but not statistically in criminal activity PMID: 12519570

In effect, the purpose of giving a purpose methadone is to stop them buying heroin on the streets and using needles for example, and to get them to the doctor.  If one is being cynical, they have simply switched supplier.

....... methadone programs have been strategically deployed to manage specific sociopolitical problems including illicit drug use, crime, and the spread of infectious diseases. The techniques, technologies, and procedures utilised in methadone programs and the 'disciplinary monotony 'of the methadone regime itself aim to produce a more compliant, conforming, and self-regulating subject. It is argued that the promotion of methadone maintenance as a 'treatment' modality obscures these disciplinary objectives and the political goals that have fostered them. PMID: 22329263

 The following description was on EROWID.  It is superbly written and says, we believe, all there is to say about Methadone.  The report has been copied directly no editing has been attempted......

 

Citation:   . "What Has Two Years of It Gotten Me?: An Experience with Methadone (ID 31219)". Sep 12, 2006. erowid.org/exp/31219

I've been taking methadone through a local maintenance program for over 2 years now, and I've consumed a varitable mountain of methadone pills. And I'm at the same place I started out. I sit here now sick with anticipation and also drug withdrawl.

You see I'm not the ideal maintainance patient, as there are days that I take more than I am supposed to. I am alotted 150 mg every day of the week, and, since I've been going for so long, I go to the clinic once every two weeks, get a dose there, and they bottle up the next 13 days and allow me to take it home. Which for me is a mixed proposition.

Methadone is an opioid (synthetic opiate) first synthesised and manufactured by the German Army in World War II because of their lack of a sufficient supply of opium. Its been used here in state approved and closely watched 'methadone clinics.' It is tyically given to someone coming off heroin or morphine, although it can be used for any opiate addiction, from codiene (weak opiate) to dilaudid (strong opiate). Don't let those labels fool you, the weakest opiate in the world is just as addictive as the strongest. And the clinic is completely volunteer. I have to go in there myself and ask for help, the courts won't tell me that I have to go. Most drug treatment programs actually do not use methadone, some are dry-out places with no drugs, others will provide you with some benzodiazepenes (anti-anxiety drugs).

When I started the methadone program back in november of 2001, I had been using morphine (primarily), heroin, and occasionaly oxycodone when nothing else was available. I would steal my family's prescription painkillers, or anyone else's for that matter; but mostly I just bought drugs from friends.

When I admitted myself, I was desperate for any drug at all. The morphine supply just dried up where I was living, and I figured I might as well get the state to sponsor my addiction. Who wouldn't want a legal drug addiction? Like I said, I was desperate for anything that would quell this horror that continued to rise up inside of me when I wasn't on opiates.

I started out just taking one or two hydrocodones two summers before, when I was still in high school, and even before that I was drinking bottle after bottle of Robitussin (the first 'drug' I ever did), sitting in my room by myself, listening to music for hours, just enjoying 'the feeling.' I knew as soon as I first tryed opiates, when I was drinking some of my little brother's prescription cough syrup (with hydrocodone), which I thought had the same active ingredient (dextromethorphan, an opiate relative, but completely non-opiate in its actions) as OTC Robitussin.

I knew as soon as the feeling started to hit me, 15 minutes after I downed 2 ounces of 'M-End Solution' (I think that was what it was called), that it was something very different, but so much better, than what I had been taking. I thought 'I don't know what I took, I could die.' but the opiates had already captured my love and affection. I was happy as a clam, but in an extremely subdued fashion, realizing that if I did this every day, my life would be a wonderful journey, without pain or sorrow, where I could be the person I've always hoped I could be.

Looking back, being free from the bonds of pain hasn't been exactly what I thought it would be. I started taking 30mg of methadone my first day at the clinic, and I was in awe of its power. Now, somedays I cut into my doses for the rest of the two weeks and take sometimes up to 400 miligrams, and I still get high.

I think that crap about methadone patients not getting high is a total lie. True, I don't get as high as I did when I would put a needle in my arm, but even with my 150mg dose, i feel serene and the world looks beautiful. But the last time I took any methadone was Saturday night, so I'm sitting here sweating and shaking wishing that tomorrow morning was here.

My clinic day is Wednesday (tomorrow), and I can go as soon as it opens at 5:30 am. I have some xanax and klonopin on me, just in case things get too hairy before then, I can take one of those and sleep the rest of the night off. And when you're as dope hungry as I am, waiting is almost impossible. Time drags and drags, and I can't find anything to take my mind off my own stupid suffering that refuses to let up.

But even with this pain, which I continue to cause myself week after week by digging into my methadone reserves, I'll concede that it has been great, but it is deffinately bitersweet in many ways.

I used to absolutely love music, art, my wife, but being on as much methadone as I am, my emotions are dulled to a point where I finally feel like they can't overwhelm me, but I lose the feelings of happiness and joy. I also lose most of my ability to be empathetic, and I can't understand what others are feeling.

These dull brown eyes just look coldly from my face, overrun by that emotional apathy I used to find so appealing. I just don't care anymore, as long as I can get my methadone and no one stands in my way. My wife doesn't even know I'm on methadone, and I continue to keep it from her because I am afraid she will ask me to stop taking it. And I love her so much, but when given the choice, my answer would be obvious. And I don't want to have to choose methadone over her, so I just keep lying. Lying about where I'm going at 5:30 in the morning, lying about where the $77 a week just to pay for the methadone is going, I even lie about why somedays I just keep nodding off, and then somedays, I just lie in bed all day, tossing and turning, my skin crawling off my body, just existing in what I feel like is my punishment for getting to feel so good so much of the time.

And if there is one thing I believe in, it is balance in this world. To get high, you gotta get low, to feel pleasure, you must experience an inverse amount of pain.

I was naive in thinking that I could fight that balance, by feeling good all the time, without even looking down from my tall tower in the clouds to even consider what was happening outside this body. I cannot escape that one truth. I know that now.

 

But now I'm stuck here, almost 2 and a half years on methadone. And I know that I'll be on this for life. For me, there is no other way. I've tasted what life can be like, and how am I supposed to turn back now?

I've found a cure for lonliness, for sorrow, for boredom.

I can't turn back now.

So consider what I've said before you follow the path I've taken, and the path countless others before me have traveled.

I have found that there really is no way back.

 But there may be, see the healing observations.

Related observations