In the United States alone, around two million people abuse or are dependent on opioids, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Opioids are a class of drugs that includes both illicit street drugs like heroin and prescription narcotics like oxycodone and hydrocodone. Opioid drugs are highly addictive and act on opioid receptors in the brain, which are responsible for pain sensations, mood, and emotional regulation.
Opioid Abuse
Prescription opioid medications are largely prescribed to manage chronic or moderate to severe pain symptoms. These drugs may be abused due to the pleasant feelings or high they can produce. Detoxing from opioid abuse can be difficult, and medication-assisted treatment (MAT) is often employed to ease this process and curb drug cravings, withdrawal symptoms, and episodes of relapse. MAT can also prevent criminal drug-seeking behavior and more harmful methods of abuse, including injecting drugs and all the risks that go along with that, such as health problems and the spread of diseases from sharing dirty needles and an increased risk for overdose. The National Institute on Drug Abuse (NIDA) reports that between 26.4 million and 36 million people around the world abuse opioids.
Methadone is a partial opioid agonist dispensed in federally approved opioid treatment programs, or OTPs, and it is also sometimes prescribed to treat chronic pain. Partial opioid agonists activate opioid receptors to a lesser extent than other opioids and generally have a longer half-life as well, meaning that the drug will stay in the system longer. By only partially activating the receptors, methadone is thought to give users less of the euphoric effect, or high, while easing withdrawal symptoms and managing drug cravings.
Methadone is dispensed once daily during MAT and can stay in the system for around 60 hours, depending on the dose. It is essentially a narcotic opioid and still may be misused or abused, however.
Potential Risks of Abuse
Methadone, when taken as directed as an opioid substitute during substance abuse treatment or for the management of pain symptoms, produces very little of a high effect. It can be very effective during opioid maintenance therapy at keeping drug cravings to a minimal and blocking withdrawal symptoms. When it is abused, however, risks and potential side effects increase.
Any use of a medication beyond its prescription or intention is considered abuse. This includes taking more than the recommended dosage at a time or taking it in a way other than it was meant to be ingested, such as crushing the tablets to snort or inject it. Snorting or injecting methadone sends the drug directly and rapidly across the blood-brain barrier instead of it being digested through the stomach and digestive tract. This greatly increases the odds of hazardous consequences or overdose.
Methadone may account for as many as a third of all opioid-related overdose deaths and four out of 10 fatalities involving only one pain reliever involved methadone, as published by CBS News. Drug overdose overtook motor vehicle crashes as the number one cause of injury death in Americans between ages 25 and 64 in 2012, according to the Centers for Disease Control and Prevention (CDC).
In 2004, methadone was implicated in 13 percent of all overdose deaths in the United States, USA Today reported. An overdose occurs when methadone reaches toxic levels in the brain and body, and this may be so common because of its long half-life. Since it only relieves pain or induces some of the desired effects for a few hours, but it stays in the system much longer, users may unknowingly take too much.
Signs of a methadone overdose include trouble breathing, a blue tint to the skin or fingernails, dilated pupils, nausea, vomiting, low blood pressure and temperature, disorientation, weakness, dizziness, drowsiness, and unresponsiveness. If any of these signs are present in someone you are with, seek immediate medical attention as overdose can lead to permanent brain damage, coma or death. Mixing other substances, such as other drugs or alcohol, with methadone can increase the risks for a potential overdose as well.
In addition to the potential for a life-threatening overdose, methadone abuse can have the following side- effects:
- Slowed respiration
- Nausea and/or vomiting
- Restlessness
- Sweating
- Itching
- Constipation
- Contraction of pupils
- Menstrual cycle disruption in women
- Pregnancy complications in pregnant women
- Sexual dysfunction
Long-term abuse may also create respiration and lung issues as well as dependency or addiction.
Recognizing Addiction
Methadone, when used long-term, may lead to the brain and body building up a tolerance to it. This tolerance may turn into a physical and psychological dependence as the brain relies on methadone in order to feel normal. The brain uses neurotransmitters as its chemical messengers, and methadone can interfere with the way they work. Some messengers – including dopamine, which is responsible for feelings of pleasure and mood regulation – may be stimulated. This is part of the circuitry in the brain involved in motivation and reward.
When a user depends on a chemical instead of natural production of these feel-good messengers, the reward pathway in the brain is disrupted, creating an emotional and physical pull to continue to take methadone. Similarly, when methadone is then removed (i.e., in between doses or in an attempt to stop taking it altogether), the user may experience withdrawal symptoms. Methadone withdrawal symptoms may be similar to the withdrawal symptoms from other opioids and include flu-like symptoms as well as psychological symptoms, like feelings of agitation, irritability, anxiety, depression, and paranoia.
The most current Diagnostic and Statistical Manuel of Mental Health Disorders (DSM 5), used by clinicians and put out by the American Psychiatric Association (APA), outlines the following as symptoms of a substance abuse disorder, as published by NIDA:
- Unsuccessful attempts to stop using a substance
- Using more of a substance than intended or continuing use past intended duration
- Cravings for the substance
- Large amounts of time spent obtaining, using and recovering from the substance
- Giving up important activities to use the substance
- Financial difficulties relating to substance use
- Continuing to use the substance despite its detrimental effects on interpersonal relationships
- Using substance despite knowledge of it creating physical or psychological harm
- Repetitive substance use in potentially hazardous physical situations
- Tolerance to the substance
- Withdrawal symptoms
Tolerance and dependency do not necessarily indicate a substance abuse disorder on their own. The DSM states that two or more of these symptoms must be present in a 12-month period in order to diagnose a substance abuse disorder. The more symptoms that are present, the more severe the disorder.
How and When to Get Help
One of the first steps in methadone abuse treatment is physical stabilization, which may be performed with detox and the use of alternative medications. Medical detox can be facilitated in a detox facility that provides 24-hour medical care and supervision from consulting physicians. This may be the safest and smoothest way to purge the toxins from the body.
Other partial opioid agonists, such as Subutex or Suboxone, which are buprenorphine products, may be used during methadone detox. Buprenorphine is similar to methadone, but it has a few other safety features that limit its abuse potential, including a ceiling effect. This means that after a certain point, no matter how much you take, you cannot increase its effects. Subutex and Suboxone are also administered as sublingual strips that are dissolved under the tongue and therefore harder to alter and abuse. Suboxone contains naloxone in addition to buprenorphine, which is a partial opioid antagonist, and precipitates withdrawal symptoms if injected or abused. Opioid antagonists block opioid receptor sites in the brain, preventing other opioids from attaching and creating any effects as well. Buprenorphine helps to keep withdrawal symptoms and drug cravings to a minimum. Emotional withdrawal symptoms may also be managed with mood stabilizers, anti-anxiety, or antidepressant medications when necessary.
Medications are used as adjunct therapies, meaning that they must be used in conjunction with counseling and psychotherapy for the greatest rate of success. Behavioral therapies, including cognitive behavioral therapy, are very effective tools for helping individuals to recognize patterns of negative and self-destructive behavior and reverse them.
Substance abuse may be an attempt to self-medicate, either to relieve symptoms of a co-occurring mental health disorder or to escape stressors or a previous trauma. Behavioral therapies can help users to identify these triggers and teach new and more productive ways to handle stress. Support groups and family counseling can help addicts to repair and maintain positive relationships and networks. Substance abuse may also take a physical toll on the body, so healthy sleep, eating, and fitness schedules can help restore balance.
The Oaks at La Paloma is a state-of-the-art comprehensive treatment center. Call us today to learn more about how we can help. Our admissions coordinators can help you find the best treatment plan to meet your needs.