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Methadone Treatment

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Methadone is a pharmaceutical opioid that has been used for decades to help treat heroin and prescription painkiller addiction. When taken as prescribed, methadone is safe and effective.

Methadone (Dolophine and Methadose) is used to manage acute opioid withdrawal syndrome by alleviating distressing symptoms and reducing cravings. It is also used in combination with behavioral therapy to treat opioid dependence and addiction. The medication is distributed in methadone clinics, which are strictly regulated by federal and state laws. When used as part of a medication-assisted treatment (MAT) program, methadone is effective in reducing the risk of relapse and other negative outcomes of opioid abuse.1 That being said, it’s important to note that methadone is still an opioid and a federally controlled substance and some people may misuse or abuse it in attempts to get high.2

What is Methadone & How Does It Work?

Methadone in vial
Methadone is a long-lasting, full opioid agonist, which means that it interacts with the same receptors in the brain that opioids of abuse do. It is taken daily in the form of a pill, liquid, or wafer. When taken as prescribed, methadone helps reduce the painful symptoms associated with opioid withdrawal. Because of cross-tolerance, when taken regularly, methadone will block the euphoric effects of other opioids, like heroin, codeine, morphine, hydrocodone, and oxycodone. This mechanism might cut down on attempts to abuse other drugs if they aren’t going to produce any subjectively pleasurable effects.3

Methadone is often used during detox to manage opioid withdrawal syndrome. Detox using methadone can be a long process. In some cases, it can take approximately 12 weeks for methadone to be tapered off. The dose is usually decreased by 2-5 mg every 1 to 2 weeks. When methadone is gradually tapered, it often results in reduced discomfort from withdrawal, along with less intense cravings.4

Methadone binds to and activates opioid receptors on the surface of certain neurons, resulting in pain relief and mediating several other opioid effects. Methadone use will result in the development of cross-tolerance for many short-acting opioids, such as heroin.5 Cross-tolerance occurs when two substances have similar mechanisms of action, such as interacting with the same receptor or acting on the same neurotransmitters. The appropriate dose of methadone will depend on the individual’s tolerance to the opioid they’re addicted to. Due to the long half-life of methadone, one oral dose can suppress withdrawal symptoms and cravings for up to 36 hours, which is why it is such a useful opioid detoxification medicine.5

Methadone is a safe medication that produces minimal side effects when used as directed by a physician. Although it is an opioid, it doesn’t produce feelings of pleasure or sedation when taken as directed. However, there is potential for serious adverse consequences when it is misused or abused in attempts to get high. Like other opioids, methadone abuse can cause severe respiratory depression, ultimately resulting in death.2

While methadone abuse can result in death, the risk of dangerous effects should not discourage anyone with an opioid addiction from considering this medication to help them get clean and sober. Methadone has been used safely for more than 30 years to treat people with opioid dependence in what is known as methadone maintenance treatment.6

Maintenance Treatment

In addition to being used for detox, methadone is often prescribed for longer-term maintenance treatment to promote sustained abstinence.7 Methadone maintenance treatment varies in duration; some people take it for 6 months while others take it for life.8 Among the patients who stop methadone maintenance therapy after 2 years or less, relapse is common.8 However, that doesn’t necessary mean that you will relapse after discontinuing methadone. Everyone has a different recovery experience and process.

Thanks to its long half-life, methadone needs to be taken just once per day. A daily dose of methadone can suppress opioid cravings for 24 to 36 hours. This allows people that are on methadone maintenance therapy to live a happy, healthy life without the urge to return to opioid use.5

Federal law mandates that patients who are undergoing medication-assisted treatment or methadone maintenance treatment also receive comprehensive rehabilitation services, such as:9

  • Behavioral therapy, both individual and group.
  • Medical treatment.
  • Vocational training.
  • Educational classes.
  • Assessments.

When partnered with these services, methadone maintenance treatment is highly effective. This type of comprehensive or “whole-person” approach is the best way to prevent relapse. Methadone maintenance treatment coupled with a range of supportive services can help people addicted to opioids achieve long-term sobriety and maintain regular work and personal lives.9

Methadone maintenance treatment has been shown to:1,9

  • Increase retention in treatment.
  • Reduce illegal opioid use and other crimes.
  • Reduce the rates of injection-related hepatitis C and HIV transmission.
  • Decrease the number of deaths from opioid use.
  • Improve birth outcomes among pregnant, substance-abusing women.
  • Improve employment outcomes for people with a drug addiction.

Where is it Dispensed?

Opiate withdrawal on contract
Methadone is a highly regulated, Schedule II Controlled Substance. When used to treat opioid addiction, methadone must be dispensed through an opioid treatment program (OTP) that is certified by the Substance Abuse and Mental Health Services Administration (SAMHSA).3 Opioid treatment programs provide medication-assisted treatment for people who have been diagnosed with an addiction to opioids.10

Before SAMHSA approves an OTP, it must complete the accreditation and certification process and meet several other federal requirements. The purpose of accreditation is to ensure that the OTP meets the nationally-accepted standards for medication-assisted treatment. Further, an OTP must register with the Drug Enforcement Administration (DEA), as well as become licensed by the state in which it provides treatment.10

This extensive certification process aims to improve the quality of treatment that individuals receive in OTPs. Accreditation increases confidence in the program, improves recruitment of medical professionals, meets certain Medicare requirements, and more.10

Patient Rights

Because of a general lack of knowledge about the effectiveness and safety of medication-assisted treatment, people in MAT programs often face discrimination from employers, landlords, police officers, and others. However, people in MAT programs have federal rights and protections related to discrimination.11

Several laws protect people in MAT from discrimination. These include the following:11

  • Rehabilitation Act of 1973
  • Fair Housing Act (FHA)
  • Workforce Investment Act (WIA)
  • Americans with Disabilities Act (ADA)

Additionally, many states also have anti-discrimination laws that protect people in MAT programs. These laws protect people with disabilities. Someone who has a disability is someone who has severe impairments because of physical or mental conditions. An opioid addiction, which limits a person’s ability to function in one or more areas of their life, falls under the category of “disability.” Therefore, people enrolled in MAT programs are protected under the above anti-discrimination laws. Consequently, it is illegal for people to discriminate against anyone enrolled in a MAT program.11

Therefore, if someone refuses you a job, housing, or fair treatment because you are enrolled in a medication-assisted treatment program, then they can be held liable. You can file a complaint with one the federal agencies authorized to investigate discrimination violations. The agencies are listed below. A lawyer is not needed to file a complaint.11


People enrolled in MAT programs also have the right to confidentiality under federal privacy laws (HIPAA). These laws protect your personal medical information.  Medical personnel cannot share information about your medical condition or your treatment to third parties without your explicit written consent. There are strict penalties for healthcare organizations that fail to abide by HIPAA laws.12

Sources

  1. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva.
  2. Drug Enforcement Administration. (2014). Methadone.
  3. Substance Abuse and Mental Health Services Administration. (2015). Methadone.
  4. Diaper AM, Law FD, Melichar JK. (2014). Pharmacological strategies for detoxificationBritish Journal of Clinical Pharmacology. 77(2):302-314.
  5. Substance Abuse and Mental Health Services Administration. (2017). Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs: A Treatment Improvement Protocol TIP 43.
  6. National Institute on Drug Abuse. (2008). Methadone – Appropriate Use Provides Valuable Treatment for Pain and Addiction.
  7. CrimeSolutions.gov. (2011). Program Profile: Methadone Maintenance Treatment.
  8. Kosten TR, George TP. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science & Practice Perspectives. 1(1):13-20.
  9. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
  10. Substance Abuse and Mental Health Services Administration. (2015). Certification of Opioid Treatment Programs.
  11. Substance Abuse and Mental Health Services Administration. (2009). Are You In Recovery From Drugs Or Alcohol Problems? Know Your Rights. Rights For People On Medication Assisted Treatment.
  12. HHS.gov. (2013). Summary of the HIPAA Privacy Rule.

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