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Methadone

What is the chemistry?

Methadone is a synthetic opioid, made from hydrochlorides. It works as other opioids do—by binding to the brain’s natural opiate receptors to block the transmission of pain and other unpleasant sensations—but in a fairly low-key way, without creating an emotional “rush.” When taken in place of opioids such as heroin, methadone blocks the adverse physical effects of opiate withdrawal while being less likely to cause overdose or other life-threatening reactions.

Also, if a methadone patient recovering from another opioid addiction thoughtlessly takes a “relapse” dose of the original drug, the methadone can block the brain from absorbing too much of the other drug and suffering the worst effects of relapse.

What is the history of the drug?

Methadone was first synthesized in Germany in 1937, by pharmaceutical company IG Farben—some say as part of a Nazi effort to prove Germany had no need for influence or technological help from any other country. The drug did not find widespread approval in Germany—people complained about nausea, skin inflammations, and rapidly developing tolerance—but after World War II, Allied troops confiscated the patent and brought methadone to the United States, where it was approved for medical use in 1947. It first became popular as a treatment for heroin addiction in the mid-1960s; by 1998, some 79,000 recovering heroin addicts were on methadone in the U.S.

Although it is not entirely free of its own health issues—and causes its own form of addiction—methadone is considered adequately effective and safe to be listed as an Essential Medicine by the World Health Organization. In the United States, it is classified as a Schedule II drug.

What are the side effects?

Common side effects of methadone include constipation, perspiration, vomiting, dry mouth, dizziness (especially upon rising from a prone position), drowsiness, skin rashes, and sexual dysfunction. Be sure to check with your treatment provider if you notice any unusually uncomfortable reactions. Often, the side effects are temporary and will resolve in a few weeks. However, some people suffer allergic reactions or unnatural stress on vital organs, so if your treatment providers recommend methadone, be sure to tell them if you have ever had heart, liver, or thyroid problems—or if you might be pregnant, as unborn babies can develop much more severe methadone addiction than adults.

Certain other rumored “side effects”—weight gain, tooth decay, “rotting bones”—are actually due to, respectively, the return of normal appetite (often, people “coming off” a serious addiction need to gain weight), dry mouth and/or longtime dental neglect, and mild-opiate-withdrawal aches and pains that do no real damage to the bones.

How was it intended to be used?

Methadone is best known as a treatment for heroin addiction. Although in a sense this is simply replacing one opioid addiction with another, it removes the worst physical dangers and cravings, helping people take the first steps toward getting back to normal life. If methadone is prescribed by a reputable detox center, it will come with a plan for eventually getting off the drug and living opiate-free.

Sometimes, methadone is prescribed as a pain reliever for people without existing opioid addictions.

How is it used illicitly?

Although methadone is less likely to be used recreationally or outside prescription limits than many other drugs, some people do take unauthorized “extra” doses, or turn to snorting and injecting. Often, these are people who already have other drug addictions, and are either willing to try anything that might give them a different “high,” or attempting to get off heroin without professional help (never recommended).

Perhaps the biggest danger in illicit use of methadone is that someone with non-opioid addictions will experiment with it—and overdose due to lack of opioid-specific tolerance.

What are the signs of illicit use?

In most cases, someone who starts on methadone is under medical supervision and well aware of the risks. Still, enough people have developed serious addiction problems that there are now professional detox centers specifically for people trying to get off methadone. Symptoms of addiction may include a resurgence of physical pain, chronic nausea, impaired judgment, or breathing difficulties—along with trying to obtain more than prescribed, or neglecting other responsibilities for reasons related to methadone use.

Withdrawal symptoms include runny nose, loss of appetite, watery eyes, cramps, diarrhea, chills, muscle aches, insomnia, and increased sensitivity to pain. Methadone is also considered one of the most dangerous opioids to try to quit “cold turkey”—so if you’ve been using it for some time and are starting to despair about being able to stop, ask for advice from your doctor or a detox center experienced in treating methadone withdrawal.

It is possible to overdose on methadone (especially if someone tries to “speed up” an effect), and the symptoms are similar to those of overdoses on other opioids: breathing difficulties, nausea and vomiting, disorientation or dizziness, cold and clammy skin, lips and fingernails turning blue, and possible loss of consciousness. Call 911 or take the victim to the nearest emergency room.

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