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Just Because Methadone is Legal Does Not Mean it’s a Safe Alternative

Methadone

Even though the problem has recently gotten more media attention, methadone has been a dangerous painkiller for more than 50 years. Because of the increased dependency on heroin and opioid prescription medication throughout the nation, the number of individuals who receive a prescription for methadone has also increased dramatically. What is the overall result of this increase from 1999 to 2009? An increase in methadone overdose related fatalities of more than 600%. We look at some of the lesser-known facts and try to determine why this drug only accounts for 2% of the prescriptions for opiate pain relievers, but leads to more than 30% of opiate related overdose deaths.

It Has Been Around a Long Time

As a painkiller, it has been around for decades. German scientists first synthesized the drug during World War II. The allied forces had cut off the supply of opium to Germany, so the Germans needed to find an alternative painkiller. It was not the only synthetic medication of the time either, both Darvon and Demerol were developed during this time. Researchers found that the produced results were similar to heroin and morphine, even though the chemical composition is different. After World War II ended, methadone made its way to the United States in 1947. Here it quickly became a treatment for narcotic addiction, heroin in particular. Because its effects lasted much longer than morphine drugs (upwards of 24 hours), it became an easy ‘once-a-day’ alternative for most rehabilitation facilities. However, it did not take too long to find out that this painkiller also comes with a range of nasty side effects of its own. Just as the drug it was meant to replace, dependency develops rather quickly and if the user does not receive frequent doses of the drug, withdrawal symptoms will begin to occur. Even though researchers found that dependence did not develop as fast, the withdrawal effects were much more prolonged than morphine or heroin.

Even though it is DEA schedule II, we still use it as a treatment for heroin addicts. For those who are unaware, a schedule II substance has:
  • Accepted medical use with severe restrictions or accepted medical use in treatment.
  • Found to have a high potential for abuse.
  • Abuse may lead to severe physical and psychological dependence

Why are We Seeing Increased Overdoses?

Even though the actual relief and numbing effects of methadone will only last between four and six hours, it does have a significantly longer half-life. The half-life of a substance indicates when half of the substance has left the body. Unlike many of the substances it is meant to replace (hydrocodone, Vicodin, oxycodone and OxyContin) it stays in the body much longer. This means that many patients will be using their next dose when their system has not cleared the previous dose yet. This buildup may lead to problems.

The Dangerous Side Effects

Because the effects are comparable to the effects of heroin, it should come as no surprise that the use of methadone does not come without some dangerous side effects either. It effectively raises the pain threshold and suppresses the central nervous system. We look at three different types of problems associated with the use of this prescription pain reliever:
  • Cardiovascular problems – Treatment with the substance may lead to a delay between the Q wave and the T wave or prolongation of the QT interval. This indicates an arrhythmic heart electrical cycle or a slowed or weakened heartbeat. That may lead to an elevated heartbeat of more than 100 BPM (ventricular tachyarrhythmia). Once this occurs, it leaves the patient at greater risk of sudden death, cardiac arrest, or cardiac damage.
  • Respiratory problems – Similar to morphine, it may lead to respiratory depression. Especially because of overuse or when taken in combination with other drugs it can lead to respiratory acidosis. Respiratory acidosis describes elevated alkalinity and serum carbon dioxide; this may lead to potentially fatal problems with the respiratory system.
  • Sexual problems – One of the side effects of the drug includes sexual complications in men. Taking the substance may lead to significantly lower testosterone levels. Decreased sexual drive, decreased prostatic and vesicular secretions and ejaculation dysfunction are just a handful of problems associated with the use of methadone.

Potential Withdrawal Symptoms

Even though it is often used to relieve withdrawal symptoms from opioid drugs, it comes with its own set of problematic withdrawal symptoms.

These include the following:

    Physical Symptoms:

  • Elevated blood pressure
  • Elevated pain sensitivity
  • Aches and pains, often in the joints and/or legs
  • Tachycardia (rapid heartbeat)
  • Tremors
  • Chills
  • Fever
  • Diarrhea
  • Vomiting
  • Nausea
  • Sneezing
  • Runny nose
  • Tearing
  • Lightheadedness

  • Mental Symptoms:

  • Delusions
  • Paranoia
  • Panic
  • Anxiety
  • Agitation
  • Marked decrease in sex drive
  • Increased perception of odors, real or imagined
  • Visual hallucinations
  • Auditory hallucinations
  • Delirium
  • Prolonged insomnia
  • Adrenal fatigue
  • Adrenal exhaustion
  • Depression
  • Thoughts of suicide

Actually Fixing the Problem

The problem is that many treatment programs often ignore the underlying problems. If a person is struggling with an addiction to OxyContin or heroin, simply replacing the drug of choice with methadone is not going to be a ‘healthy alternative’. The patient will eventually become used to the prescribed dosage and attempt to find ways to increase the ‘high’ in order to satisfy previous cravings. Anyone who claims that using a substitute will keep the long-term users sedated simply does not understand how the problem of dependency actually works.

It is problematic that we would require long-term users who struggle with addiction to come to a methadone clinic every day to pick up their prescription. Even if the patient can take his or her prescription home, the actual underlying problem still exists because nothing has been done to address it. It is merely a matter of medicating a user rather than making long-term changes. Imagine sending a person struggling with addiction home with a week’s supply of methadone, a person who has an established tolerance for the drug and telling them “Now be sure you only use enough to avoid withdrawal symptoms, not experience the desired high!” That should make it clear why this type of ‘treatment’ is nothing more than swapping addictions so that the pharmaceutical companies receive their money rather than it going to drug dealers.