Methadone
Methadone is a synthetic opioid primarily used in the treatment of opioid addiction, particularly for individuals dependent on heroin. Developed in the 1930s in Germany, methadone was introduced in the United States in the 1950s as part of an effort to address opioid withdrawal symptoms. It functions by acting on the same brain receptors as other opioids, providing similar effects, which makes it valuable in supporting those transitioning from more dangerous drugs.
The medication is typically administered as part of a medication-assisted treatment (MAT) plan, which may include psychosocial support. While methadone is effective for detoxification and maintenance therapy, it can cause side effects such as constipation, dizziness, and more serious risks like respiratory depression and cardiac complications. Treatment often begins with a gradual increase in dosage to manage withdrawal symptoms, with typical maintenance doses ranging from 80 to 120 mg.
Methadone treatment must be provided through authorized opioid treatment programs (OTPs) that comply with federal regulations, ensuring that patients receive careful monitoring and comprehensive care during their recovery process.
Methadone
Category: Treatment
Also known as: Dolophine; methadose
Definition: Methadone is a schedule II medication used for the management of opioid dependence and withdrawal. Initial treatment is generally followed by the slow tapering of methadone at a timed interval, which is highly patient-specific. Additionally, methadone can be used for treating moderate to severe pain that is unresponsive to non-narcotic analgesics.
History of Use
Methadone hydrochloride is a synthetic opioid with mu (µ) agonist properties. It was developed in the 1930s in Germany, and by the 1950s methadone began to be used by the US government, specifically the Public Health Service, in the treatment of opioid abstinence syndrome.
Methadone acts on the same brain receptor as heroin and other opioids, producing similar effects. For this reason, it is used to help bridge users from more hazardous drugs. In the treatment of addiction in the United States, methadone is used primarily for the treatment of heroin addicts. Persons who stop taking heroin without taking medication for withdrawal, such as methadone, naltrexone, or buprenorphine, can experience severe withdrawal symptoms. These symptoms include agitation, anxiety, sweating, flu-like symptoms, and dehydration potentially leading to hospitalization or death.
When beginning therapy with methadone, those treated may experience common adverse effects, including constipation, dizziness, sedation, gastrointestinal distress (nausea and vomiting), and possibly itching, headache, and hypotension. More serious adverse reactions include cardiac and pulmonary complications and respiratory depression. Patients are monitored and undergo a complete medical history assessment to identify any significant medical conditions that may increase risks of developing complications from methadone.
Opioid Detoxification
Methadone is one of several possible drugs used for opioid detoxification, for treating opioid addiction, and for maintaining treatment for opioid addiction as part of a medication-assisted treatment (MAT) plan. Methadone is available orally in 5 and 10 milligram (mg) tablets and as a solution and in suspension. Patient response to methadone is highly variable, in part because of its broad range of bioavailability, because of the time to peak plasma concentration, and because of the drug’s half-life. Knowing methadone’s half-life’s variability is critical because respiratory depression, which occurs with methadone and other opioids as a class, generally lasts longer than pain control. Respiratory depression from methadone and other opioids can be severe and fatal.
Starting doses of methadone are generally between 20 and 30 mg and are gradually increased until withdrawal symptoms are controlled. This taper usually occurs during the first week of treatment. The typical maintenance dose is 80 to 120 mg, once daily. However, it is not uncommon for higher doses to be required.
Treatment generally continues for one year or more, followed by a slow taper. Tapering off methadone requires dose reductions of less than 10 percent within ten to fourteen days, often requiring an extended period before a patient is completely weaned off the methadone.
Patients also generally require a combination of psychosocial and behavioral counseling to be successful at staying free of opioids. During the first week of therapy and until the medication and side effects are fully realized, patients are advised to avoid activities requiring mental alertness. Additionally, while being treated with methadone, patients should avoid ingesting other central nervous system depressants (including alcohol and other medications) and should avoid discontinuing the medication abruptly.
Authorized Treatment
Methadone used for the treatment of opioid dependence can be provided only by authorized opioid treatment programs (OTPs), which are certified by the federal Substance Abuse and Mental Health Services Administration. Providers must meet specific criteria, including board certification in addiction specialties, to legally prescribe methadone for opioid dependence treatment. However, if a patient on methadone is admitted as an inpatient for reasons other than opioid addiction, therapy can be continued with provider certification if it can be verified that the patient is receiving treatment at an OTP.
Bibliography
Ball, John C. Effectiveness of Methadone Maintenance treatment: Patients, Programs, Services, and Outcome. New York: Springer, 2012. Print.
Connock, M., et al. “Methadone and Buprenorphine for the Management of Opioid Dependence: A Systematic Review and Economic Evaluation.” Health Technology Assessment 11.9 (2007). Print.
Fareed. Ayman M. Heroin Addiction: Prevalence, Treatment Approaches, and Health Consequences. New York: Nova Science, 2015. Print.
Gouldin, Winston, Daniel T. Kennedy, and Ralph E. Small. “Methadone: History and Recommendations for Use in Analgesia.” American Pain Society Bulletin 10.5 (2000). Print.
"A Guide to Methadone." The Fix. The Fix, 2 Aug. 2014. Web. 30 Nov. 2015.
"Medication-Assisted Treatment (MAT)." SAMHSA. Dept. of Health and Human Services, 25 Sept. 2015. Web. 30 Nov. 2015.
Nicholls, Lance, Lisa Bragaw, and Charles Ruetsch. “Opioid Dependence Treatment and Guidelines.” Journal of Managed Care Pharmacy 16.1 (2010): S14–21. Print.