Methadone


"The mentality and behaviour of drug addicts and alcoholics is wholly irrational until you understand
they are

completely powerless over their addiction and unless they have structured help, they have no hope"

                                                                                                                                                                                                               -
Russell Brand

  What is Methadone?

  • Synthetic opioid developed in Germany in 1937.Initially developed to treat pain, while it is still used for this purpose it is more widely used for people suffering from opioid dependence.
  • Canadian, Dr Robert Halliday from Vancouver, set up the first Methadone program in the world for the treatment of opiate addiction.
  • It acts primarily on the µ opioid receptor and is considered a full agonist. In other words, it fully activates the receptor. Its molecular structure is similar to morphine and heroin with some important differences. It also has an effect on the Δ opioid, NMDA, and Serotonin receptors.
  • It is metabolized extensively by the liver with an elimination half life of 22 hours. However there is considerable variability between individuals with ranges between 5-130 hours.
  • While effective in suppressing the opioid cravings and withdrawals associated with discontinuing opiates it also blocks the euphoric effects associated with those opiates.
  • When used to treat opioid dependence studies have shown that it is effective in reducing and eliminating use of other opioids while also being much safer.
  • It has also been found to reduce use of other illicit drugs such as cocaine, amphetamines, sedatives, and illegal methadone.
  • It reduces criminal activity and risk of death while also improving social functioning and return to productivity.
  • Effective in retaining people in treatment programs.
  • Significant reduction in the transmission of infectious diseases such as hepatitis and HIV.
  • People addicted to opiates are three times more likely to die if they are not enrolled in a methadone treatment program.


Aren’t I just substituting one opiate for another?

  • While Methadone is an opiate just like heroin, morphine and oxycontin it is much safer and better tolerated. 
  • It does not produce the euphoria of other opiates and therefore allows people to function normally and reclaim their lives. This is something that is not possible with other opiates like morphine, oxycontin, and heroin.



Will I gain weight on methadone?

  • Another misconception of methadone is that one will gain weight on the program.
  • People suffering from addiction tend to neglect many aspects of their lives and very commonly will neglect eating a proper and healthy diet.
  • This, along with the fact that opiate drugs are known to cause a reduction in appetite can cause pronounced weight loss in people suffering from addiction.
  • If the individual also suffers from an addiction to stimulant drugs such as cocaine and methamphetamine the weight loss can be profound since these drugs cause an increase in metabolism and an even further reduction in appetite.
  • The goal of starting a methadone treatment program is to become abstinent from all drugs of abuse and return to a normal functioning life.
  • When this happens, a healthy appetite returns and one’s metabolism returns to normal.
  • Consequently, a patient regains the weight they lost when they were addicted to drugs.
  • If they are not careful they may even surpass their pre-addiction weight.
  • It is important to eat a healthy diet; high in fibre, fruits and vegetables and low in fat.
  • It is also important when a patient returns to normal functioning to start an exercise program in consultation with their physician..


FAQ’s

What are the Side Effects of Methadone?

  • Sedation is the most common side effect of methadone. However, when used appropriately, methadone has less sedation than other opiates.
  • Other side effects include nausea, vomiting, diarrhea, constipation, flushing, sweating, insomnia, dry mouth, loss of appetite, weight gain, and decreased libido.
  • Most side effects appear most pronounced during the initial dose stabilization phase of treatment. These side effect tend to lessen as the patient progresses in treatment.
  • The above list of side effects does not include ALL potential side effects. Please inform your physician of any and all side effects you may encounter.
  • Your physician may investigate and/or treat side effects such as insomnia, sweating, and decreased libido using other medications



When you start methadone is it hard (or impossible) to get off of it?

  • When (or if) a patient decides it’s time to get off methadone, it will be done on a scheduled taper of the methadone dose. It will be done in such a way that the effects of reducing the dose of methadone, such as opiate withdrawal, are minimized or eliminated. 
  • This usually requires a slow step-wise reduction of the dose over weeks to months. 
  • It can sometimes be difficult, and may take some time, but certainly not impossible. 
  • The same cannot be said of other opiates like morphine, heroin, and oxycontin. It is highly unlikely for someone to be successful tapering off of these drugs.





Will Methadone make me ‘High’?

  • Methadone was developed with the intention of minimizing the euphoria or ‘High’ one experiences with other opiates. As such, people usually report feeling ‘Normal’ on Methadone.
  • When someone first starts taking methadone it is common to feel sedated or sleepy after taking their dose. However, this effect usually stops fairly rapidly after progressing in the program.
  • If it does not, one should inform their physician as it may indicate the dose is too high.



​Will methadone rot my teeth?

  • There is a widely held misconception that methadone will rot your teeth.
  • While there is a higher incidence of tooth decay in people suffering from drug addiction there is no increased risk when starting methadone. 
  • Many people suffering from addiction tend to neglect many aspects of their personal health, and especially attention to dental hygiene. 
  • It is important to follow the same good dental care that is recommended for everyone: 
    • brush after every meal, floss daily, and see your dentist at least twice a year. 
  • Opiate drugs, including methadone, and especially stimulant drugs like cocaine and methamphetamine are known to cause dry mouth.
  • This can accelerate tooth decay, therefore it is always recommended when someone starts the methadone program that they drink plenty of water.







How does the Methadone Program Work?

  • New patients to our clinic will be assessed by our physicians and, together with the patient, agree upon the most appropriate treatment program. Methadone therapy is one treatment option.
  • It is difficult to determine the dose of methadone that will be required for a patient to discontinue illicit opioid use even when an accurate history of the amount of opioid use has been determined. This is due to the considerable variability in methadone metabolization between individuals.
  • As such, patients are started on a low dose of methadone and gradually increased over days to weeks: Usual starting dose is between 10-30 mg Methadone with dose increases of 5-15 mg every 3 to 4 days.
  • Starting at a dose that is too high and/or increasing too quickly can lead to overdose and possibly death.
  • Dose increases are determined by asking the patient how effective the dose of methadone is at curbing opiate cravings and withdrawals, as well as reducing illicit opiate use.
  • Usually people entering a methadone program will follow one of two courses:
    • Start methadone therapy and continue on therapy for years in order to abstain from illicit opioid use.
    • Start methadone therapy and once illicit opioid use has stopped start a program to reduce methadone dosing with the intent of eventual discharge from the program. It must be noted, however, that this usually caries a significant risk of relapse back into drug use.
  • Initially, patients are required to attend the pharmacy daily for observed methadone dosing. When the patient is clinically stable, abstinent form drug use, and has safe housing then take-home doses (Carries) will be granted at the discretion of the physician and in accordance with the guidelines set out by the College of Physician and Surgeons of Ontario.
  • Counselling, access to mental health and community services, and harm reduction strategies are also very important interventions in the health and recovery of our patients