What is Methadone?

Methadone is an opioid medication. Methadone is similar to other opioids such as morphine, codeine, and heroin however, it produces less euphoric ("high") effects and therefore may be easier to stop taking. Methadone blocks the effects of opioids such as morphine, codeine, and heroin. If methadone is injected, will block the effects of methadone lead to withdrawal symptoms in a person with an opioid addiction. When administered under the tongue as directed, will not affect the actions of methadone. Methadone is used to treat opiate addiction. Methadone may also be used for purposes other than those listed in this medication guide.

How should I take Methadone?

Take methadone exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. The methadone tablets should be placed under the tongue and allowed to dissolve. Do not chew or swallow the tablets. The medicine will not work this way and you may get withdrawal symptoms. Do not change the dose of methadone or take it more often than prescribed without first talking to your doctor.

Possible side effects from Methadone

Methadone can cause drug dependence. This means that withdrawal symptoms may occur if you stop using the medicine too quickly. Withdrawal symptoms may also occur at the start of treatment due to dependence on another drug. Methadone is not for occasional ("as needed") use. Do not stop taking methadone without first talking to your doctor. Your doctor may want to gradually reduce the dose to avoid or minimize withdrawal symptoms. Seek emergency medical attention or contact your doctor immediately if you experience any of the following serious side effects: an allergic reaction (difficulty breathing; closing of the throat, swelling of the lips, tongue, or face; or hives); slow breathing; Or constipation.

Cautions when taking Methadone?

Use Methadone with caution when driving, operating machinery, or performing other hazardous activities. Methadone may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities while taking methadone. Do not take more methadone than is prescribed. If you symptoms are not being adequately treated, contact your healthcare provider.

What happens if I overdose with Methadone?

Seek emergency medical attention if you suspect overdose with Methadone. Symptoms of a methadone overdose may include slow breathing, seizures, dizziness, weakness, loss of consciousness, coma, and small pupils.

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Drowsiness
• Nausea and vomiting
• Dry mouth
• Constipation
• Difficulty passing urine
• Slow, shallow breathing (respiratory depression)
• Low blood pressure (hypotension)
• Feeling of unease, restlessness, agitation or being unwell
• False perceptions of things that are not really there (hallucinations)
• Mood changes
• Decreased heart rate
• Awareness of your heartbeat (palpitations)
• Rash or itching
• Decreased sex drive
• Contracted (pinpoint) pupils
• Addiction to the medicine (dependence)
• Excessive sweating
• Abnormal heartbeats (arrhythmias)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

Based on literature and analysis of mortality figures Dr Russell Newcombe concluded that methadone programmes as a form of harm-reduction possibly cause more victims than they prevent. We have doubts whether the conclusion about methadone is fully justified. Looking at the mentioned literature gives a one-sided view at the problem. Moreover, the conclusions drawn are beyond those justified by the results of the analyses. Several points of debate come to mind:

Methadone is not an innocent substance; 'one's methadone maintenance dose is another's poison'. A regular user of opiates develops a certain tolerance. Therefore, it is possible that a tolerant person can function normally with dosages which can be fatal to a non-tolerant person. Also, methadone dosage in the case of first entry to the programme has to be evaluated carefully. It is wise to begin with a low dosage that has to be increased slowly in the course of weeks or even months. At entry to the programme it has to be carefully evaluated whether a patient has a clear and unambiguous heroin dependence. In methadone maintenance programmes, methadone is dispensed to tolerant persons, moreover, this tolerance remains high because of daily use of methadone. Therefore, it is not surprising that deaths at the King's College Hospital caused by methadone were not those of participants of a methadone maintenance programme but were those of 'recreational' users of illicit methadone.

In cases where more than one drug is used, the drug responsible for death due to overdose is difficult to establish. Moreover, the same drug prescribed by physicians can also be bought on the street. In seventy percent of the deaths due to overdose studied in Glasgow and Edinburgh a combination of different drugs was found.

Prescribed drugs such as temazepam were often encountered in deaths in Glasgow. However, among only 14 of the 34 persons who died in 1992 and where temazepam was found, this was prescribed by their physician. Because of the presence of other drugs it is not clear whether temazepam really caused the death of these people. Probably the combination of these different drugs was fatal to them. This was also the case with the methadone deaths in Edinburgh. However, in Edinburgh, the authors could not determine whether methadone was prescribed or not. Both Hammersley and Obafunwa report that heroin/morphine deaths seldom occur in Edinburgh. 'The fall of the deaths due to overdose in the Lothian and Borders Region of Scotland (LBRS) after 1984 reflects in part the strict policing that took place, in particular in the Edinburgh area'.

'The increase of methadone deaths is probably due to the introduction of a street trend to use this agent as a substitute to heroin'. The author suggests that methadone deaths are mainly caused by the use of illicit methadone.

Therefore, these figures suggest that participants of methadone programmes are at lower risk of death due to overdose. However, this does not mean that methadone is an innocent substance. The high and increasing number of methadone deaths in Britain is alarming and certainly needs more attention. The first priority should be to establish whether the methadone causing death has been prescribed within a methadone programme or bought on the street. It also should be evaluated at what point during the course of the methadone programme death takes place. Further instruction doctors prescribing methadone could be necessary. The use of non-prescribed methadone without medical supervision can lead to high risks, especially when it is used as a substitute for heroin in order to get a 'high' instead of to prevent withdrawal symptoms. Physicians have to be aware of this danger and they should make sure that the prescribed methadone (as well as other psycho-active drugs) does not end up in the 'grey market'.

By Drs Marcel Buster & Giel van Brussel, MD Municipal Health Service Amsterdam