Hardly a drug normally associated with the party scene, methadone deserves a mention because there’s just so bloody much of it about now. Methadone is an opioid, a synthetic opiate. Like the better-know opiates, morphine and diamorphine (heroin), methadone is a powerful analgesic, or painkiller. Although methadone is still occasionally used for pain relief, it’s far more common to find it being used to ‘treat’ people who are physically dependent on heroin. In the UK, the number of people using heroin has been steadily increasing. Methadone use has also been increasing.
Treatment, as in making you better?
Well, not exactly, no. Just stay with the idea for a moment that ‘drug addiction’ is more than a pharmacological problem. It’s not just about the chemical, the drug. The drug does tend to play a pretty significant part, and yet it’s never the whole story. Someone taking methadone instead of heroin can definitely let go of their dependent heroin habit. The methadone stopos the ‘withdrawal syndrome’. If I’m heroin dependent, and I’m withdrawing, and I take methadone…it stops. The methadone will get rid of cramps, and nausea, and vomiting, and diarrhea, and all the other nasties that make a heroin habit unpleasant. If I keep on taking it, I don’t get ill. If I stop taking it, I get…errrr…well…an opioid withdrawal syndrome.
Treatment, as in getting you hooked?
Well, you don’t have to put it quite like that. It’s true that regular, dependent methadone use does of course fit neatly into the ‘addiction’ model described in our ‘reducing the risks’ pages. And methadone dependence has some benefits over heroin dependence, for some people. If you’re living in the UK and can get methadone on the NHS it won’t cost you all the money you can raise each day just to stay on top of the habit. Even if you pay for a private consultation and ‘script it’ll be a lot cheaper than the brown. Methadone is available as a liquid – linctus or methadone mixture – which is swallowed, meaning you don’t need to inject. Some people of course do inject, and injectable ampoules are sometimes prescribed. Tablets are also available. Like many other medicines some of these prescribed drugs are diverted and become available illegally.
Treatment, as in getting stoned?
The guidelines for prescribing methadone indicate that enough should be given to prevent physical withdrawal symptoms – when you are prescribed methadone it is not supposed to give you a buzz, or make you feel stoned, or however else you describe it.
The physical effects of methadone are similar to other opiates (like heroin); suppressed cough reflex, contracted pupils and drowsiness. Regular use will cause constipation. Some methadone users feel sick when they first use the drug. If you are a woman using methadone you may not have regular periods – but you are still able to conceive.
Methadone is a long-acting opioid; it has an effect for up to 36 hours and can remain in your body for several days.
In terms of ‘treating’ an opioid withdrawal syndrome the medication is very attractive to many prescribers – it last a long time, is stable in liquid form and is cheap to produce.
Most treatment services that offer prescribing will want to manage a ‘reducing’ dose of methadone. The idea behind a reducing script is that you stabilise the ‘patient’, then gradually reduce the dose until they aren’t using methadone anymore.
This style of ‘community detox’ doesn’t work for everybody. The people for whom it works least well are the people who ‘top-up’ their ever-decreasing medication with either illegally-bought methadone, or heroin.
Some people see little point in drawing it all out, and find it easier to reduce or just stop using heroin without ever taking methadone. Methadone’s primary benefit to the user is that it manages physical opiate dependence legitimately. In the UK, it’s very difficult to find anyone who will prescribe heroin, or morphine, to treat opiate dependence.
Treatment, as in safe?
Not as such. For several years now, methadone has been the cause of more accidental poisonings (overdoses) in the UK than heroin. It’s really worth reading that last sentence again…
Methadone is a very potent drug, and individual doses vary for each person. What’s prescribed for my friend could kill me, easily. If you are using methadone that you have bought illegally be aware that you could overdose on an amount that would seem ‘normal‘ to somebody else – especially if you are not using opiates regularly, and have a low ‘tolerance’ (it doesn’t take very much to affect you). Differences in tolerance are caused by how often you use a drug. If you are using methadone regularly – prescribed or not – taking a higher dose than normal, or using other depressant drugs (like alcohol, heroin, tranquillisers or sleeping tablets) at the same time could cause you to overdose. If you do lose consciousness and vomit you may well choke.
If you become drowsy you should not try to drive or operate machinery – you could easily have an accident.
Methadone is very dangerous for children. An ordinary daily dose for an opioid-dependent adult is likely to kill a child. If you store methadone at home it should be kept where children are not able to get to it – in a high cupboard, not by your bed or in the fridge. If a child does swallow methadone they should be taken to the Accident and Emergency Department at your local hospital immediately – let the doctors know what has been taken, and if possible at what time and what quantity.
Treatment, as in legal, right?
Sometimes. Methadone is controlled by the Misuse of Drugs Act 1971 as a Class A, Schedule 2 drug.
Other Class A drugs include heroin and cocaine.