widely used in the treatment of heroin addiction. Actual size of
with methadone in injectable form.
Methadone linctus contains methadone hydrochloride and may be prescribed to
control a distress cough
in terminal disease
Methadone mixture (BNF), a greenish-coloured liquid is two-and-a-half times stronger than methadone linctus and it is used in the treatment of heroin addiction. It contains an irritant which discourages injecting.
What is methadone?
Methadone belongs to the group of drugs known as opioids. Opioids are drugs (naturally occurring and synthetic) with chemical structures and actions similar to morphine. One subgroup of opioids is the family of opiates, which includes pain-relieving drugs such as codeine, morphine and heroin. Opioids are classed as depressant drugs as they work by slowing down the functions of the central nervous system. Alcohol, cannabis and benzodiazepines (including Valium, Rohypnol and Serepax) are examples of other depressant drugs.
Methadone is synthetically manufactured and used as a substitute for the treatment of people dependent on heroin and other opioids. Its effects are much longer lasting than heroin, a single dose being effective for approximately 24 hours; the effects of heroin may only last for a couple of hours. In a treatment program, methadone is usually given out in syrup form and drunk with cordial or fruit juice.
Generally, there are two types of methadone programs:
a maintenance or long-term program, which may last for months or years, that aims to reduce the harms associated with drug use and improve quality of life; and
a withdrawal (short-term) detoxification program, which lasts approximately 5-14 days, that aims to ease the discomfort of coming off heroin.
A person can only become a client on methadone treatment after being assessed by a doctor who is an approved methadone prescriber. In Victoria, doctors must apply to the Drugs and Poisons Unit of the Department of Human Services to become registered as a methadone prescriber. Generally the client should be 18 years of age or over and be physically dependent on opiates. The doctor’s assessment takes into account other characteristics such as alcohol or other drug use and psychological health.
For referral to a methadone prescribing doctor or methadone dispensing pharmacy, contact the alcohol and drug service in your state or territory.
The advantages of methadone treatment
Many people believe that it is preferable for heroin users to stop taking drugs altogether. Although for some heroin users this is achievable, for others there is a high risk of relapse into heroin use. Methadone maintenance has helped many people reduce the recurrence of compulsive heroin use.
Methadone treatment, like any other drug treatment, is not a ‘cure’ for heroin dependence. However, research has shown that it can improve the health of people dependent on heroin in a number of ways:
people are less likely to use heroin that may be contaminated with other substances;
methadone is taken orally, which makes it cleaner and safer than injecting heroin. This reduces the risks of sharing equipment and becoming infected with blood-borne viruses such as hepatitis B, hepatitis C (which may lead to long-term liver problems) and HIV – the virus causing AIDS;
the routine involved in methadone treatment encourages people to lead a balanced and stable lifestyle – including improved diet and sleep;
people are less stressed, as they do not have to worry about where their next ‘hit’ of heroin is coming from;
methadone lasts longer in the body than heroin, so it only has to be taken once a day;
it allows people to handle the withdrawal process with less discomfort;
criminal activities conducted to obtain illegal drugs are reduced;
it helps people cut their connections with the drug scene;
it’s cheaper – although there is usually a dispensing fee with methadone, this is relatively cheap compared to the cost of illicit drug use (the recommended dosage fee at the time of writing this information was $7.50, although this amount may vary between dispensers); and
under certain conditions, take-away doses of methadone are also available, which help clients return to a more stable lifestyle. To be eligible, clients must meet the criteria as outlined by the state/territory health department as well as those of the methadone prescriber. Some of these criteria include family commitments, illness and travelling long distances.
Other considerations with a methadone program
it is recommended that clients on a methadone program also receive professional counselling;
methadone, like heroin, is a potent drug and can be dangerous if used incorrectly;
while people are on methadone, they are still physically dependent on opioids;
there is no ‘high’ experienced from a methadone dose;
clients must commit to attending daily for their dose, therefore, holidays etc may be difficult to organise;
and there are side effects.
Some people on methadone programs will experience unwanted symptoms during their treatment. These may be caused by the dosage they are receiving being too low or too high, which can occur particularly at the beginning of treatment. Some symptoms may also occur due to the side effects of the drug itself.
Symptoms of the methadone dose being too low may resemble having a bout of the flu. They include:
runny nose, sneezing;
feeling physically weak;
loss of appetite;
muscle spasm and jerking;
back and joint aches;
high temperature but feeling cold;
irritability/aggression/feelings of uneasiness;
difficulty sleeping; and
cravings for the drug.
A person who suddenly stops taking methadone may experience many of the symptoms listed above. The withdrawal symptoms usually begin one to three days after the last dose, and peak around the sixth day, but can last longer.
Symptoms of too high a dose include:
below normal drop in body temperature;
slow blood pulse, lowered blood pressure;
problems with sexual functioning; and
poor blood circulation.
Symptoms caused by dosage can be corrected by talking to the pharmacist or prescribing doctor and getting the dose adjusted.
Some people may also experience certain side effects that are unrelated to the dosage including:
sweating (clients should drink at least two litres of water per day to avoid dehydration);
aching muscles and joints;
lowered sex drive;
skin rashes and itching;
loss of appetite, nausea/vomiting;
tooth decay; and
Side effects should diminish soon after the methadone program is completed. As with all opiates, methadone alone in its pure form will not cause any damage to the major organs of the body. Prolonged use will not cause any physical damage, apart from tooth decay. For those with pre-existing impaired liver function (following conditions such as hepatitis B, hepatitis C infection, or prolonged alcohol use), the methadone dose may require careful monitoring.
People who are not dependent on opiates who take methadone will experience some of the short-term effects similar to those on a methadone program receiving too high a dose (as listed above).
Giving methadone to a person who is not on a methadone program is very dangerous. Even small amounts of methadone taken by someone not used to opiates can lead to overdose.
Mixing methadone with other drugs
The use of other drugs with methadone, especially other depressant drugs such as alcohol, opiates (including heroin) or benzodiazepines (including Valium, Serepax and Rohypnol), increases the risk of overdose. Drinking large amounts of alcohol over days or weeks can also shorten the duration of methadone’s effects, causing the person to experience withdrawal symptoms before their next dose.
It is very important for clients to let their doctor and/or dentist know they are taking methadone, so that they don’t prescribe medication that could affect their methadone treatment.
Overdose and death
Methadone deaths are rare. Methadone related deaths have almost always been due to combining methadone with other drugs, particularly benzodiazepines such as Valium and Rohypnol, and/or alcohol.
It is generally accepted among health professionals that methadone treatment is effective in reducing deaths among heroin-dependent people. Deaths involving those in methadone treatment have occurred in Australia mainly due to the following reasons:
accidental overdose – research indicates that the abuse of alcohol and benzodiazepines is common among methadone clients. Any combination of sedative drugs, including opiates, such as heroin and methadone, alcohol, and benzodiazepines, results in an increased risk of respiratory depression, coma and death;
suicide – emotional disorders are common among methadone clients; and
accidents – including those involving a motor vehicle.
access to methadone by those not in a methadone program-children, for example – is very dangerous and can lead to accidental overdose. Take-away doses of methadone should be supplied in child-proof containers and stored in cabinets that cannot be accessed by children;
injecting methadone is a serious health risk as it increases the risk of overdose and can lead to blood clotting, collapsed veins and other medical complications
Pregnancy and breastfeeding
Pregnant women who are dependent on opiates are encouraged to enter a methadone program as early as possible into their pregnancy, as it is likely to result in fewer complications than the use of other opiates, such as heroin. This is because:
the unexpected periods of drug withdrawal experienced by pregnant women using other opiates (that can be harmful to the baby) do not occur when on a daily dose of methadone;
the lifestyle of women is often enhanced when on methadone treatment, resulting in improved nutrition and less stress, which all contribute to a healthier baby; and
methadone supplied by a pharmacy or treatment centre hasn’t been cut/mixed with any other potentially harmful substance that may be passed on to the baby.
Like all opiates, methadone crosses the placenta to the unborn child. Many of the babies born to methadone-dependent mothers go through withdrawal at birth. Their symptoms vary in length and strength. These can be successfully treated while the baby is still in hospital. Overall, women using methadone have fewer problems during their pregnancy than those who continue to use heroin.
As small amounts of methadone may be passed on through breast milk, mothers that are on a methadone program are often encouraged to breastfeed in order to help ease the baby’s withdrawal from methadone. Methadone has been found to reach its maximum level in breast milk between two and four hours after a dose, therefore feeding the baby just before a dose or taking the methadone just before the baby has a long sleep will reduce the amount available to the baby.
Injecting methadone, taking more than one dose at a time, or giving methadone to somebody else is illegal. In Australia, as in most other western countries, methadone is legal providing it is prescribed by a doctor who has been registered as a methadone prescriber.
If you are charged with any drug-related offence, seek legal advice.
Methadone and driving
It is illegal for anyone to drive if, by being under the influence of a drug/s, they are incapable of having proper control of a vehicle. This includes methadone and, if suspected, the driver can be subjected to a drug test. Breaking this law carries penalties including disqualification from driving, heavy fines and/or imprisonment. Mixing methadone with other substances further increases the risk of accident. For instance, even a small amount of alcohol taken with methadone can impair an individual’s driving skills and put them at risk of a serious accident. Methadone may also affect the client’s ability when operating heavy machinery or playing sport. Until a client is stabilised on a particular dose of methadone, it is safer if they avoid driving a car or operating machinery. This is particularly important during the first few weeks of treatment or when the methadone dose is changed.
If you suspect that any medication you are taking may affect your driving (or any other activity), avoid driving and talk to your doctor and/or pharmacist. It is important that you don’t stop taking your medication.