Methadone (Encyclopedia of Medicine)
Methadone is a powerful narcotic drug in the same class as heroin. This class is known as the opioids.
Methadone, formerly known as dolophine, is a psychoactive drug, meaning that it affects the mind or behavior. It belongs to the class of opioids, drugs that share some of the analgesic properties, and mimic the action of some of the body's naturally occurring chemicals called peptides, such as endorphins and enkephalines.
Methadone is used to relieve chronic pain in cancer patients and as a maintenance drug to control withdrawal symptoms in people undergoing treatment for opiate addiction.
In opiate addiction treatment, methadone blocks the opioid receptors of the brain that bind opiates such as heroin. The blocking of these receptors leads to two major effects:
- because these chemical receptors remain blocked by methadone for up to 24 hours, even if a person addicted to heroin takes heroin after the administration of methadone, this person is not likely to feel the same effects of the heroin as he or she previously felt;
- because the action of methadone is associated with slower and less intense withdrawal symptoms than those of heroin, the patient can experience milder opiate effects while the addiction...
(The entire section is 1145 words.)
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Methadone (Encyclopedia of Mental Disorders)
Methadone is classified as an opioid (an analgesic that is used for severe pain). In the United States, methadone is also known as dolophine, methenex and methadose.
Methadone is used in the long-term maintenance treatment of narcotic addiction. Both heroin and methadone are opioids; as such, methadone and heroin bind to the same places in the brain. Methadone, however, is the opioid of choice for the treatment of narcotic addiction since it is longer lasting and patients don't experience the "high" associated with the drug of abuse. In opioid maintenance therapy, a person addicted to heroin receives methadone instead of heroin. Essentially, the person is switched from an opioid that gives a "high" to an opioid that does not. The dose of methadone may then be decreased over time so that the person can overcome his or her opioid addiction without experiencing withdrawal symptoms, or, after a person has received methadone for a period of time, he or she may choose to go through detoxification with clonidine. In the United States, methadone treatment is associated with a significant reduction in predatory crime, improvement in socially acceptable behavior, and psychological well-being.
Methadone may also be prescribed for pain...
(The entire section is 1089 words.)
Methadone (Encyclopedia of Drugs and Addictive Substances)
- What Is It Made Of?
- Methadone Chronology
- Usage Trends
- Alternative to Methadone
- Treatment for Habitual Users
- For More Information
What Kind of Drug Is It?
Methadone is a synthetic drug, meaning that it is made in a laboratory from chemicals. It behaves like an opiate drug in the brain. Opiates are drugs, derived from the opium poppy plant, that tend to decrease restlessness, bring on sleep, and relieve pain. The natural opiatesuch as codeine, heroin, morphine, and opiumre known for their painkilling properties, but also for their addictive nature. Such substances encourage abuse because they induce euphoria, or feelings of extreme happiness or enhanced well-being.
Methadone works differently. Its slow onset and long-lasting impact lessen the chances that the user will get high from taking it. At the same time, it blocks the receptors in the brain that are stimulated by opiates, so those using methadone do not get high even if they take heroin or morphine too. (Entries on codeine, heroin, morphine, and opium are also available in this encyclopedia.) Methadone is best known as the medication prescribed to help opiate addicts end the destructive behavior associated with drug addiction.
People with opiate addictions often use drugs such as heroin and morphine more to avoid withdrawal symptoms than to achieve a high. Withdrawal is the process of gradually cutting back on the amount of a substance being taken until use can be discontinued entirely. Indeed, withdrawal from opiatesven prescription drugs such as OxyContin and Vicodinan be difficult and challenging. Methadone eases all symptoms of opiate withdrawal, including anxiety and insomnia, a sleep disorder. Those who receive methadone treatment from trained, licensed doctorsnd who follow the treatment schedule carefullyace little danger of overdose, infectious disease, or organ failure. When used properly, it is a medicine that helps users end their addictions and get on with their lives.
When Methadone Is Abused
When used illegally or improperly, though, methadone is one of the most dangerous drugs on the street. According to the Drug Abuse Warning Network (DAWN), emergency room visits related to methadone overdose tripled between 1997 and 2001. Since then, methadone-related deaths and hospitalizations have continued to rise. Two factors have contributed to the spike in methadone-related emergencies. First, doctors are prescribing the drug more often as a painkiller. In that form, methadone is dispensed by pharmacies as pills and taken into homes. Sometimes it is either used improperly by the patient or sold on the street or to drug dealers.
The second possibility for methadone ER visits involves multi-drug use. Numerous drug deaths have occurred when people combine methadone with other painkillers, opiates, cocaine, tranquilizers, or alcohol. (Separate entries on these drugs are available in this encyclopedia.) The presence of other substances increases the likelihood that methadone will cause , breathing difficulties, and even death.
Since the beginning of the twenty-first century, drug enforcement agents have seized greater quantities of methadone that have been diverted or put into illegal use. Concern over this diversion has led to high-level government meetings and studies on how to keep this powerful pain reliever with many useful qualities out of the wrong hands.
Naturally occurring opiates are derived from the sticky sap of the opium poppy. Opium products have been used for many thousands of years, both for their pain-controlling properties and for the feelings of intense happiness and well-being they provide. From the ancient Egyptians to the celebrated British poets of the nineteenth century, opiate users have known of the plant's effectsnd of its drawbacks. The latter includes addiction, , and death by overdose. In his book Illegal Drugs: A Complete Guide to Their History, Chemistry, Use and Abuse, Paul M. Gahlinger noted that the famous ancient Roman general Hannibal kept a fatal dose of opium in a ring on his finger and actually used it to kill himself in 183 BCE.
Beginning in the nineteenth century, scientists worked with opium products, trying to isolate the painkilling qualities from the habit-forming qualities. They met with little success. In fact, all natural and synthetic opiate and opioidA substance created in a laboratory to mimic the effects of naturally occurring opiates such as heroin and morphine. products on the market in the twenty-first century are still known to be addictive. Methadone is no exception. Users develop a dependence, or a physical need for the drug in order to ward off withdrawal symptoms. And they suffer withdrawal symptoms if they do not follow a careful program of specific directions for use.
Usage Grows in the 1940s and 1950s
Methadone was developed in Nazi Germany in 1939 because of wartime shortages of morphine. The German scientists called it Amidon and used it as a painkiller. At the end of World War II (1939945), the American pharmaceutical company Eli Lilly began clinical trials of the substance. Lilly called it "methadone." The drug has also been marketed as Dolophine, leading to nicknames such as "dolls" and "dollies." Methadone was found to be an effective, long-lasting painkiller and cough suppressant.
According to a report issued by the Substance Abuse and Mental Health Services Administration (SAMHSA), in 1950 researchers began using methadone to treat the many symptoms of withdrawal associated with heroin dependence. Heroin addicts typically need two to three '' of the drug each day to ward off the wide range of symptoms that occur when the brain craves opiates. The desperate search to buy the illegal drug leads some addicts into criminal behavior, ranging from theft and burglary to prostitution and drug-dealing. People with opiate addictions feel trapped by their dependency. The desperation is sometimes described as a "monkey on the back."
Treating Addictions with Methadone
In 1964 a group of researchers discovered that heroin addicts could avoid the drug and live more normal lives if they received a daily dose of methadone. The methadone eased withdrawal symptoms and lessened cravings for heroin. Better yet, people taking methadone could not get high on heroin because methadone binds to the same brain receptors that heroin does.
Some problems remained. Methadone is itself an opioid, so it causes dependency too. Its side effects are identical to the natural opiates and include constipation, nausea, drowsiness, dry mouth, and the possibility of breathing problems. Researchers concluded that some people trying to wean themselves off heroin or other opiates by following a methadone treatment plan might have to take methadone for a very long time. The treatment was not foolproof, either. Many addicts returned to drug abuse, sometimes turning to cocaine to get high. Because methadone and cocaine work differently in the brain, methadone treatment does not help cocaine addicts stop using cocaine, nor does it block the effects of cocaine. (An entry on cocaine is available in this encyclopedia.)
Despite these drawbacks, methadone has remained the drug of choice for treatment of opiate dependency since the 1960s. It is not a "perfect cure," but it does provide a way for motivated people to straighten out their lives, hold jobs, and otherwise live more normally. The SAMHSA report stated: "Methadone is a medication valued for its effectiveness in reducing the mortality associated with opioid addiction as well as the various medical and behavioral morbidities associated with addictive disorders." In other words, even the U.S. government believes that methadone, when used properly, saves lives and cuts down on crime.
Methadone Clinics Open
In the late 1960s, the U.S. government began sponsoring methadone clinics in many parts of the country, especially the nation's largest cities. At methadone clinics, people line up to take their daily dose of the drug under the watchful eye of a nurse or other health care worker, and then leave. After a period of months, a patient who has followed the treatment program carefully might be allowed to carry one or two doses home. These doses are called "." Most patients use their "carries" as carefully as the doses given to them at the clinics, but some turn the "carries" over to illegal use. In addition, the drug is being prescribed more by doctors. Some patients sell their medications to others. In these ways, some of the drug makes its way on to the street illegally.
What Is It Made Of?
Methadone is not derived from the opium poppy plant. It is synthetic, or made from chemicals in a laboratory. Pure methadone is an odorless white powder that dissolves easily in water, juice, or alcohol. Hospitals also have solutions of methadone that can be delivered by injection.
Methadone takes effect slowly and stays in the brain for a period of twenty-four to thirty-six hours. During that time the userssuming he or she uses no other drugsill function normally, perhaps feeling a bit sluggish or groggy. Sleep cycles will be normal, but appetite may be lessened. Constipation is a troublesome side effect.
How Is It Taken?
In most clinics, methadone is dispensed in sugary liquids and swallowed by the patient. The drug can also be taken as a biscuit ("diskette") or in pill form. Very rarely, in a hospital or clinical setting, the drug is injected into a muscle. Methadone is not commonly used in post-surgical settings because other drugs such as morphine and fentanyl work faster to relieve pain. (Separate entries on morphine and fentanyl are available in this encyclopedia.) Rather, methadone is used for long-lasting pain, such as that resulting from cancer, back injuries, or severe arthritis.
In 2000 the federal government relaxed rules on prescribing methadone in pill form. Doctors who complete an eight-hour training seminar become certified to dispense methadone pills that vary in strength from 20 to 120 milligrams.
The first week of methadone use for chronic pain can be difficult and dangerous. Doctors need to monitor patients carefully because the drug acts slowly on the pain and accumulates in the body. Patients must be watched for tolerance levels so that they are not given deadly doses. They must also be cautioned that methadone is not a "quick fix" for pain, and that taking an extra dose will not make the drug work any faster. Typically, patients will see little or no pain relief from methadone for the first twenty-four to forty-eight hours. After that, methadone works well for chronic pain, provided the user follows the directions and does not mix the medication with other drugs, except on the advice of a doctor.
People also use methadone illegally as a recreational drug, which is a drug used solely to get high, not to treat a medical condition. People have been known to grind up methadone tablets and snort the powder or inject the drug. This can be extremely dangerous, even in the absence of other drugs or alcohol. Because methadone works so slowly, it does not provide the of euphoria that the user craves. This may entice the user to take more methadone, eventually leading to a deadly build-up of the drug in the body. It is often hours and sometimes even days before the poisonous effects of methadone become apparent, as the user first slips into a deep sleep, then into a coma, and then stops breathing.
Are There Any Medical Reasons for Taking This Substance?
Methadone is an effective means of taking control of an opiate habit. It lessens the withdrawal symptoms of opiate abuse and helps controlut does not eliminateravings for opiates. People driven to desperation in their search for illegal heroin or painkillers can resume a normal lifestyle if they follow a methadone treatment plan. Studies have shown that long-term use of methadone in the absence of other drugs and alcohol has no adverse effects on the heart or other internal organs.
Someone who stops using methadone suddenly will suffer the withdrawal symptoms typical of all opiates, including diarrhea, nausea, chills, muscle pains, anxiety, insomnia, sweating, and frequent yawning or sneezing. In order to quit using the drug without these symptoms, it is necessary to lower the dose slowly over a period of months. This allows the body to adjust its brain chemistry gradually. Again, patients must be highly motivated to stay with the program, as even small reductions in dosage can bring a mild onset of withdrawal symptoms.
An epidemic of illegal OxyContin abuse since 2000 has led more doctors to prescribe methadone for chronic pain. Methadone is very effective in this role, but patients must be aware that the full effects of the pain relief may take as much as a week to achieve. During that time, they must be careful to monitor sleep patterns and to be aware of how the drowsiness might affect them while driving or operating machinery. If the painful condition improves, patients must taper their use of methadone gradually to avoid withdrawal symptoms.
Drugs like methadone are not prescribed on an "as needed" basis. The kind of pain for which methadone is used is a crippling, ongoing, day-and-night pain that may never improve. For extremely sick cancer patients, methadone allows a quality of life that might be impossible otherwise. The drug does not cure the cancer or even slow its progress, but it can help patients manage the pain. The same holds true for other conditions such as chronic back pain and osteoarthritis.
The amount of methadone dispensed in clinics for the treatment of opiate addiction has remained stable for decades. However, between 1999 and 2002, the number of doctor-generated prescriptions for methadone increased by 331 percent, according to a report by SAMHSA. Pills and biscuits account for almost all of this increase.
Researchers at SAMHSA acknowledged several reasons for the jump in prescriptions for methadonend a related jump in methadone deaths. First, doctors began prescribing more methadone for pain, believing that its potential for abuse is less than that of oxycodone (OxyContin) and hydrocodone (Vicodin). Second, some doctors began prescribing methadone to patients who are trying to recover from oxycodone or hydrocodone habits. The SAMHSA researchers also suggested that some opiate addicts do not want to be seen visiting a methadone clinic and may be turning to their personal doctors for help in kicking their habits. Getting a prescription from a doctor, and having it filled at the local pharmacy, is far more anonymous than arriving at a clinic every morning. Some communities even fight expensive legal battles to keep methadone clinics out of their neighborhoods.
Methadone on the Streets
The increase in methadone prescriptions has led to an increase of the drug being sold on the street. Seizures of illegal methadone by drug enforcement agents increased 133 percent between 2001 and 2002. Deaths associated with methadone have grown sharply since the early 1990s. SAMHSA used data to show that between 1993 and 2002, methadone-related fatalities jumped 200 percent in the state of Washington. The report declared: "While overdose mortality was declining among [clinic] patients, such fatalities were rising in the overall population." DAWN statistics are quite similar. Between 1994 and 2001, DAWN reported a 230-percent increase in the number of emergency room patients being seen for methadone related problems or multi-drug problems with methadone in their systems.
According to the "Pulse Check" report in 2004, methadone addicts tend to be "white, middle-socioeconomic males older than 35." Florida, Pennsylvania, Ohio, Indiana, and Texas are among the states with the largest methadone problems. The availability of the drug in these states stems from patients in treatment centers who are saving their doses and selling them on the streets. "Pulse Check" authors noted that the cities of Tampa and St. Petersburg, Florida, in particular, have seen a "dramatic increase in emergency department episodes and deaths involving methadone."
Increased Abuse of Painkillers
The Join Together Web site published a survey by Kentucky's Louisville Courier-Journal that found 345 fatalities in that state from methadone overdoses between January of 2003 and May of 2004. In Kentucky during that same period, methadone surpassed OxyContin as "the most misused prescription drug in the region," according to the article.
The "2003 National Survey on Drug Use and Health" also determined that illegal use of methadone was on the rise among teenagers. The survey found that methadone use had increased 25 percent in just one year, part of a general increase in the abuse of prescription painkillers. Overall, methadone is becoming less associated with heroin addicts trying to go straight and more associated with the quiet epidemic of prescription painkiller use and abuse. The epidemic includes men and women of all races, ages, and economic levels.
Effects on the Body
Taken by mouth in pill, biscuit, or liquid form, methadone passes into the digestive system and from there is broken down in the liver. The liver releases the drug into the bloodstream, and it is carried to the brain and spinal cord, where it attaches to opiate receptors.
When no drugs are in the brain, opiate receptors take in and enkephalinsPronounced en-KEFF-uh-linz; naturally occurring brain chemicals that produce drowsiness and dull pain., two brain chemicals that regulate feelings of well-being, overall motor coordination, breathing and coughing, and moods. Opiates replace these natural chemicals quickly and in such quantity that the user experiences a rush of pleasurable sensations and a calm drowsiness for hours afterward. This is the "high" that opiate users seek.
No "Rush" with Methadone
When methadone is introduced to the opiate receptors, it does not cause the rush of pleasure that other opiates and painkillers do. Its onset is slower, and it stays in the brain and body longer. Users may feel drowsy and relaxed. Any kind of pain will gradually cease, and it will not return as long as the user takes regular, carefully prescribed doses of the drug. As the dose of methadone leaves the brain and bodyenerally in about twenty-four to thirty-six hourshe user will begin to feel the discomfort of withdrawal unless a new dose is taken.
In other parts of the body, methadone causes the same symptoms as other opiates and opioids. It inhibits the muscles in the bowels, leading to constipation, and works as a cough suppressant. If taken improperly, it can also affect breathing and lead to asphyxiationhe inability to breathe, which results in death.
Users may also experience nausea and loss of appetite, dry mouth that can lead to tooth decay and gum disease, and pinpoint pupils leading to sensitivity to light. Methadone may also lessen sexual function and desire.
At the end of methadone treatment, users must taper doses slowly to allow all the bodily systems to return to normal. A sudden end to methadone use brings on diarrhea, anxiety, insomnia, and flu-like symptoms.
Reactions with Other Drugs or Substances
Methadone becomes far more dangerous when combined with other drugs or alcohol. All types of tranquilizers, sedatives, antidepressants, and anti-anxiety drugs will increase the likelihood of breathing problems if taken along with methadone. The drug should not be combined with other painkillers, even over-the-counter medications like acetaminophen (Tylenol) and ibuprofen (Advil), unless supervised by a doctor.
In a 2004 report, the National Drug Intelligence Center revealed that in 65 percent of all emergency room visits related to methadone use, another drug was also present. Frequently the second drug was alcohol. When used together, methadone and alcohol magnify each others' effects. Drinking while taking methadone can lead to very poor motor control, vomiting and breathing problems, coma, and asphyxiation.
Illegal users of methadone sometimes combine it with cocaine as well. Cocaine causes a different sort of high in the brain, one that is unaffected by methadone. Users of cocaine and methadone find themselves in the difficult position of being addicted to two different substances at the same time, with a host of side effects unique to each substance.
Methadone should not be combined with medications that increase metabolism time in the liver. These include medicines for tuberculosis, such as Rifampin, and medicines for seizures and , including Dilantin. Some antibiotics, and even over-the counter vitamins, can increase the level of methadone retained in the bloodstream. Methadone decreases the power of medicines prescribed for the human immunodeficiency virus (HIV), the virus that can lead to acquired immunodeficiency syndrome (AIDS). Methadone can worsen nausea, vomiting, and fatigue in patients with AIDS. Since people can be infected with HIV by sharing needles to inject heroin, some ill addicts might not be able to tolerate a methadone plan of treatment.
Treatment for Habitual Users
Habitual use of methadone is encouraged in people trying to kick an opiate habit. This is because proper use of methadone allows addicts to resume a normal life again. Studies from many countries show that heroin addicts who have lost jobs and contact with their families, and have fallen into criminal behavior, can turn their lives around as long as they adhere to a strictly supervised methadone plan. Sometimes recovering addicts take methadone for years. In other cases, the methadone doses are gradually decreased over a period of months until a full recovery is achieved.
However, many addicts who start a methadone treatment program will have difficulties following the plan. Some quit and go back to hard drugs. Others falter here and there, or become dependent on
another drug such as cocaine. Some combine methadone with other brain-altering drugs or alcohol. This greatly complicates the treatment process.
One researcher in a nationally published report by SAMHSA likened opiate addition to illnesses such as diabetes and extreme obesity. People with diabetes know that they have to manage their weight and watch what they eat. Some do, others do not. The ones who follow doctors' orders live longer than the ones who ignore the advice and carry on with their habits. The same holds true for obesity. People must be highly motivated to lose weight. Some are, some are not. The ones who make a commitment to change often live longer than the ones who do not change their lifestyles. Drug addicts are also suffering from a disease, and their willingness to fight the disease influences their ability to overcome it.
Most doctors realize that simply dispensing methadone tablets to people with a drug addiction will not end the cycle of abuse. Opiate addicts must also undergo talk therapy with counselors who are trained to offer strategies for combating drug use. Self-help groups such as Narcotics Anonymous can be helpful but might not be enough for those requiring methadone therapy. Most methadone clinics combine drug treatment with personal counseling.
Self-Healing on the Street
Studies are being conducted of methadone abuse on the streets to see how the drug is used recreationally. Some researchers suggest that methadone is used less for the high it produces and more as a self-treatment for withdrawal symptoms when other opiates are not available. Methadone is not a safe recreational drug. It is habit-forming. Anyone using it for any reason should be under the close supervision of a doctor.
When used properly, methadone can literally save lives. Heroin users expose themselves to many deadly diseases, including HIV and hepatitis (a liver disease), when they share dirty needles. Heroin users are also prone to commit crimes or indulge in risky behavior. By stopping heroin use, the cycle of the desperate pursuit of the next "fix" ends. A thirty-one-year-old recovering heroin addict, quoted in the York Daily Record, said he rode a bus two hours each way from his home every day for his methadone treatments. Admitting he had been jailed "at least ten times," the man said that methadone "gives me the ability to get on with my day." While methadone treatment for drug abuse is not easy, quick, or always successful, it does offer hope to people who are harming themselves and others.
As a prescription painkiller, methadone use must be monitored very carefully for the potential of poisonous build-up in the body. Doctors prescribing it for pain need to be quite knowledgeable about how to adjust the doses and how to monitor patients for overdose. Patients must be aware that they need to take the medicine exactly as prescribed or face possibly fatal consequences. Doctors must be particularly careful when patients are taking any other medications, either prescription or over-the-counter drugs. When used as a prescription painkiller, methadone is typically a drug of last resort.
Any use of methadone with other drugs and alcohol in a recreational setting can be fatal. Failure to store the medicine properly can lead to poisoning in children. Crushing methadone pills and snorting or injecting them for recreational use can cause death, sometimes many hours or even a day or two after use. Methadone overdose generally causes the user to fall asleep, and the sleep then deepens into a coma that ends when the user's breathing stops.
Methadone is a habit-forming drug. Community leaders often fight against having methadone clinics in their neighborhoods because the clinics attract drug abusers who may have committed criminal acts. Anyone considering experimentation with methadone should keep in mind that those who really need the drug have very difficult lives with extremely challenging mental or physical illnesses.
Methadone is a Schedule II controlled substance, meaning that the U.S. government finds it to have some medical uses but also a high potential for abuse and addiction. Penalties for possession and sale of illegal methadone vary from state to state and can be quite harsh, since the drug carries so many potential dangers. Even a first conviction for possession or sale of illicit methadone can carry jail time. Second and third offenses can result in a lifetime in prison.
In 2000 the FDA relaxed some of the restrictions on the legal prescription of methadone. Still, doctors who prescribe the drug must attend training sessions to learn about methadone's profile, how to prescribe the drug safely, and how to monitor patients for life-threatening side effects. Doctors who finish the training are issued a special license to prescribe methadone. Needless to say, any doctor or pharmacist who issues methadone without the proper documentation can face prosecution as a criminal.
Methadone's dangerous side effects, its history as a substance used to help addicts, and its long-lasting effects on the body have all combined to bring its usesoth legal and illegalnder greater scrutiny.
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See also: Cocaine; Codeine; Fentanyl; Hydromorphone; Morphine; Opium; Oxycodone; Ritalin and Other Methylphenidates
Methadone (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
Methadone (Dolophine) is a synthesized molecule with pharmacological actions very similar to those of the OPIOD drug, MORPHINE. Methadone serves an important place in the history of opioid ANALGESICS, since it is one of the first synthesized agents (1939). The ability to synthesize opioid analgesics from simple chemicals diminishes our reliance on natural products (such as morphine, CODEINE, and thebaine) to provide the base for many of the currently used opioid analgesics. Structurally, the drug does not look like morphine. Unlike the rigid fused ring structures of morphine, the structure of methadone is extremely flexible. It bends so that the key portions of the molecule can assume positions similar to those of morphine. The structure of methadone is very similar to that of propoxyphene (Darvon), a weaker opiate widely used to treat mild to moderate pain. It has two stereoisomers, but the (-) isomer is far more active than the (+) isomer.Methadone can be administered orally, intramuscularly, or intravenously. It is well absorbed from the gastrointestinal track making it very useful orally. Its oral/parenteral ratio of potency is approximately two. Methadone is threefold more potent than morphine orally, but about equipotent when given by injection. It is metabolized by the
Pharmacologically, methadone is used in the form of its hydrochloride salt. It has actions quite similar to morphine and works predominantly through mu opiate RECEPTORS. As an analgesic, methadone is similar in actions and in potency to morphine. It produces analgesia, as well as many of the side effects associated with morphine use, including respiratory depression and constipation. A major difference between methadone and morphine is methadone's long duration of action. Typically, the drug is given to patients every six to eight hours. This long duration of action can be very advantageous, particularly in patients who require the drug for long periods of time, such as cancer patients. However, there are some disadvantages. With a half-life ranging from twenty to thirty hours, it may take many days of continued dosing to reach constant (or steady-state) levels of the drug in the body. Thus, the full effect of a change in drug dose may not be seen for three or four days. This may make it difficult to adjust the dose for an individual patient. Increasing the dose too rapidly may even lead to delayed increases in its concentration in the body, far beyond those anticipated and, in some situations, may actually lead to an overdose. Continued administration of methadone will produce TOLERANCE AND PHYSICAL DEPENDENCE. The actions of methadone, like those of morphine, are readily reversed by ANTAGONISTS such as NALOXONE or NALTREXONE; however, these antagonists will also produce an immediate WITHDRAWAL syndrome in physically dependent people.
Despite its clear utility in the control of PAIN, the major use of methadone in the United States is in the treatment of HEROIN addicts. Although methadone must be administered approximately every six to eight hours to maintain analgesia, its slow rate of elimination prevents the appearance of withdrawal symptoms for over twenty-four hours. This slow appearance of withdrawal signs has made this agent very useful in maintenance programs, since it permits once-a-day dosing. With chronic administration of high doses of methadone, addicts become very tolerant, markedly limiting the euphoria an addict might obtain from illicit use of other opiates such as heroin. Thus, methadone minimizes occasional opiate use, is readily tolerated by the addicts, and can be administered once a day, which makes it easily dispensed. Methadone has been used clinically in maintenance programs and is one of the most effective treatment modalities available for opiate addicts.
(SEE ALSO: Addiction: Concepts and Definitions; Methadone Maintenance Programs; ; )
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GAVRIL W. PASTERNAK