What is Methadone?
Methadone is a medication that doctors prescribe for pain. It’s generally prescribed for someone who needs long-term pain relief, such as a person undergoing surgery or dealing with a long-lasting injury. Although methadone is meant to relieve pain over a long period of time, however, it was not designed to be a permanent solution. When used correctly, methadone prescriptions should gradually taper off until the patient has healed enough to feel okay without pain medication.
The reason behind the tapering-off is the fact that methadone belongs to a set of medications called opioids. Opioids work for extreme pain because they bind themselves to the brain’s opioid receptors and change how the brain reacts to that pain.
Of the people in the US who receive prescriptions for opioids, 8-12% of them develop an opioid use disorder.
America’s “Opioid Crisis” began in the late 1990s. Pharmaceutical companies led doctors to believe that opioids had very little risk of dependence and addiction. Doctors, therefore, began prescribing opioids, including methadone, in larger amounts. Believing that their patients wouldn’t become addicted, doctors sought opioids as a simple way to ease their patients’ pain.
As it turns out, unfortunately, these doctors were mislead. Opioids like methadone are, in fact, extremely addictive. Now that the United States has a better understanding of opioids and their addictive properties, doctors and pharmaceutical companies have taken steps to control America’s opioid consumption. However, by the time they finally realized the dangers that come with methadone and similar medications, the damage had already been done.
As an opioid, methadone has very addictive properties. People who misuse methadone often do so because of the “high” that the medication produces. Where does this high come from? Like the high from any illicit drug, it comes from hijacking the brain’s main feel-good chemical: dopamine. In and of itself, dopamine is not a bad thing at all. It gets released when humans eat, exercise, or do a host of other things that are good for their health and survival. Drugs like methadone, however, flood the brain with large amounts of dopamine. The brain starts to crave the rush. Eventually, the brain becomes desensitized to the dopamine and will require the larger amount just to feel okay or normal. Often, people who initially took methadone for pain relief start to depend on the drug for the high feeling that it produces.
Withdrawal, of course, is the series of unpleasant symptoms that a person experiences when he or she no longer has access to his or her drug of choice. These symptoms can be uncomfortable, often to the point of being painful, but withdrawal symptoms don’t usually last. Methadone, unfortunately, is unique in this regard. Remember that methadone is designed for long-lasting pain relief in patients who have undergone major surgery or have sustained extensive injuries. Methadone is a delayed-release drug by design, which means that withdrawal symptoms (a) sometimes take a fair amount of time to begin and (b) can last for a long time. This is one part of what makes the methadone detox process so discouraging.
Why does withdrawal happen? Remember how addiction begins: with large amounts of dopamine. The addicted individual’s brain had become desensitized to dopamine, which means that normal amounts, the kind that would come from doing healthy activities, just don’t have the same impact anymore. The methadone user’s brain and body now have to get used to a normal amount of dopamine again, and unfortunately, it won’t be a comfortable process.
Withdrawal happens during the recovery phase known as detox. Recovery from any drug addiction occurs in several steps. The first is often a confrontation from loving friends and family members who want to see their loved one living a healthy and happy life again. If the individual agrees to give up his or her drug habit, detox will happen next. During detox, the substance leaves the individual’s body, and he or she can begin the first part of the healing process. Hopefully, the individual will have access to a medical detox. With medical detox, the addicted person experiences the detox process while under the care of medical staff. The added support can mean the difference between a full recovery and relapse.
“Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. However, medical detoxification is only the first stage of addiction treatment…”
National Institute of Drug Abuse
As stated by NIDA, detox is only one of many stages in the lifelong process of recovery.
Why Methadone Detox is Unique?
Aside from the previously mentioned issue of increased withdrawal time, methadone detox has another issue that sets it apart from the detox process involved with other opioids. To understand this problem, let’s first take a look at how medical professionals would ordinarily treat opioid withdrawal symptoms. Generally, when one recovers from a heroin or prescription opioid addiction, one might get withdrawal relief from one of the following types of medication:
- Agonists, which are themselves opioids and therefore “replace” the original drug in the individual’s brain.
- Partial Agonists, which are also opioids but don’t act as strongly as full agonists, or
- Antagonists, which provide withdrawal relief while blocking the brain’s opioid receptors.
Of course, one doesn’t stay on these medications forever. Instead, a medical professional will prescribe smaller and smaller dosages of the medication until the individual can function comfortably without them. Tapering off with a different, safer drug under the supervision of trained medical professionals can provide relief and help with the recovery process. However, it’s important to note that the most often-prescribed category in this case is the agonist category, and the most often-prescribed agonist is methadone. This leaves methadone users with fewer options for withdrawal relief during the detox process. In these cases, a partial agonist or an antagonist may be more helpful than a full agonist.
We’re on Your Side
Because methadone’s detox phase is so unique among opioids, care and support are especially important. If your loved one is dealing with a methadone addiction, it’s important for you to offer continued support to the best of your ability as well as to encourage him or her to seek the help that they need.