As communities continue to combat a growing addiction crisis across the United States, understanding the efficacy of drug abuse treatments, addressing the root causes of Substance Use Disorder (SUD) and promoting long-term recovery are critical. While numerous strides have been made in the fight against addiction, some resources prove more effective – and safer – than others. The use of methadone in opioid addiction is an example of a treatment that, while helpful to some, presents a significant risk to many struggling with addiction and striving to escape substance dependency.
WHAT IS METHADONE?
Methadone is a synthetic opioid that is used in the treatment of Opioid Use Disorder (OUD). Prescribed as part of medication-assisted treatment (MAT) programs for people who are addicted to opioids such as heroin, methadone reduces craving and withdrawal symptoms and blocks the effects of opioids. Methadone is not a treatment for the use of substances such as methamphetamine, cocaine, alcohol or benzodiazepines, and can be life-threatening when combined with non-opioid drugs.
Methadone was introduced into the United States in the 1940s as a replacement for morphine. A few decades later, as various pain medications flooded communities, this synthetic substance was identified as a viable treatment for those who had become addicted to heroin. Shortly after methadone programs began, however, its use became controversial with concerns that those who used it were only replacing one narcotic for another and that there was risk of methadone addiction and misuse. This controversy still exists today and has led to strict government control over methadone, though some of those restrictions have been lightened in recent years.
WHAT ARE THE RISKS OF METHADONE?
While approved for use by the Food and Drug Administration and often referenced as a “safe and effective treatment,” methadone must be taken as prescribed and under the supervision of a practitioner. As a narcotic, methadone is not a risk-free treatment. Its history as a MAT substance is rife with health and safety concerns including breathing and heart rhythm problems. The FDA itself has issued warnings in the past about its use and methadone-related deaths began to skyrocket in the early 2000s because of misuse.
Though many people have successfully abstained from heroin and other opioids, there are several downsides to the use of methadone in addiction treatment.
- Methadone is addictive
Like the substances whose effects it is used to block, methadone itself is addictive. According to the Drug Enforcement Administration, the misuse of methadone can lead to psychological dependence. Even when used as prescribed, patients may grow tolerant to the drug, requiring a higher dose to maintain its effects. As dosage is increased, so too is methadone’s half-life, making it easy to overdose on if not carefully monitored.
Many who have used methadone, even as part of a MAT program, report stronger cravings for the substance than with other opioids. When the use of methadone is stopped, individuals are likely to experience withdrawal symptoms such as nausea, abdominal cramps, vomiting, tremors and anxiety. Restlessness, nausea and vomiting, slow breathing, itching, sweating, constipation and sexual problems are also common side effects of methadone use even when taken as prescribed. More serious side effects such as hallucinations are also possible.
- Methadone can be harmful or deadly when mixed with other substances
Not only is methadone ineffective in treating addictions to non-opioid substances, but it is extremely dangerous when combined with other substances such as alcohol and benzodiazepines.
This risk is particularly noteworthy as polysubstance use – or the use of more than one substance – is prevalent among those in addiction. This multi-substance use could come in the form of combining illicit substances with methadone doses, drinking alcohol or even taking other prescription medications. Pentazocine, nalbuphine, butorphanol and buprenorphine, for example, can reduce methadone’s effects and cause withdrawal symptoms. Combining alcohol or benzodiazepines with methadone could result in respiratory distress, coma or death.
- Methadone diversion is a concern
The wider promotion of methadone programs as well as its prescribed use as a lower-cost painkiller places communities at risk of increases in methadone addiction and misuse over time.
Even if a person is only using heroin, their prescription of methadone may not be enough to deter them from the habit of ingesting heroin and other opioids. They may still combine the use of heroin with methadone and increase heroin dosages in an attempt to reach or maintain a high. This places them at risk of overdose.
Methadone must be taken as prescribed and dosage is tailored to an individual based on several factors. Supervising these dosages at outpatient treatment clinics is imperative to keeping patients safe, but many programs allow patients to take methadone at home without direct supervision. This lack of supervision also increases the risk of methadone diversion.
- Long-term maintenance impacts successful recovery
The use of methadone in drug abuse treatment is not a “short-term” process, and this is a point anyone seeking recovery must carefully consider. According to the National Institute on Drug Abuse, the minimum length of time a person is on methadone to address opiate addiction is 12 months. It is very common, however, for methadone use to expand beyond that one-year mark. In some cases, those in treatment will rely on methadone for the rest of their lives. While these patients may function differently on methadone than when they were using heroin or other substances, they are still chained to an opioid to maintain their daily life.
The reason methadone treatment can last so long is that because of the drug’s potency and half-life, patients can end up being dependent on high dosages and weaning off of those doses safely is time-consuming and often very difficult.
WHAT ARE ALTERNATIVES TO METHADONE?
Comprehensive treatment plans are important to helping those with Substance Use Disorder successfully recover and live sober lives. While these plans may include medication-assisted treatments based on the needs of individuals participating in recovery programs, holistic treatment methods remain the most effective way to treat SUD. MAT should only be deployed in addition to other treatment and recovery supports.
- Addressing root causes of addiction and barriers to sobriety is key
Holistic addiction recovery resources comprise approaches that treat the whole person. Such programs assist clients with withdrawal management and substance abstinence as well as provide counseling, behavioral health therapies, peer support, skill-building and transitional resources.
There are multiple accredited programs in Kentucky that take a holistic and dual-diagnosis approach to addiction, addressing addiction, sober living barriers and mental health simultaneously.
Many people in addiction have co-occurring disorders such as depression or PTSD. The use of methadone in these instances without treatment for co-occurring disorders is likely to lead to self-medication and methadone dependency. Alternatively, holistic treatment addresses the root causes of addiction and equips those in recovery with the necessary skills and supports they need to live long-term sobriety.
- Other MAT options are available
When medication-assisted treatment is determined to be an appropriate approach for someone with opioid use disorder, there are less addictive and generally safer options such as buprenorphine, suboxone and Vivitrol to consider.
In recent years, some have termed methadone programs as the “Gold Standard” in treating opioid use disorder. However, methadone has been around for decades and yet overdoses – including opioid overdoses – continue to persist across the country. This could reinforce the idea that time is better spent on addressing addiction as a mental health issue and initiating prevention efforts rather than treating its symptoms through prescribed medications.
Medication-assisted treatment is only one tool in the array of resources that can and should be used in treating people with SUD and OUD. Combating addiction in communities should encompass initiatives that utilize holistic treatments and supports to produce optimal outcomes.
By prioritizing efforts that promote sober, independent living over potentially long-term chemical maintenance, recovery becomes more attainable, durable and meaningful for those wishing to break free from addiction.