Methadone addiction: symptoms, effects, withdrawal, and treatment

Methadone addiction is a state marked by the irresistible and uncontrolled consumption of methadone, an opioid drug frequently employed for the treatment of opioid dependence. Individuals with methadone addiction experience physical and psychological dependence, leading to withdrawal symptoms upon cessation of the drug. 

The symptoms and signs of methadone addiction include constipation, slow breathing, sleep disturbances, loss of interest in activities previously enjoyed, mood swings, need for higher doses, several failed efforts to cut down or stop use, and symptoms of withdrawal when dosage is reduced.

The effects of methadone addiction are categorized into short- and long-term effects. The short-term effects of methadone dependence include euphoria, pinpoint pupils, decreased heart rate, sedation, nausea and vomiting, excessive sweating, and constipation, while its long-term effects are cardiovascular issues, respiratory problems, cognitive impairments, sexual dysfunction in men and women, and physical dependence. 

The symptoms of methadone withdrawal are anxiety, restlessness, watery eyes, sweating, muscle aches and pains, cravings, severe nausea or vomiting, and tiredness.

Treatment options for methadone addiction include detoxification, medication-assisted treatment (MAT), cognitive behavioral therapy (CBT), support groups, gradual tapering, and aftercare and relapse prevention.

What is Methadone addiction?

Methadone addiction is a chronic medical condition distinguished by the compulsive and problematic utilization of the opioid-based painkiller methadone, which is also employed for the purpose of treating opioid dependence. 

Unable to control their drug use, methadone addicts develop tolerance, physical dependence, and a desire to get and take more of the drug despite its negative effects. Methadone’s addictive properties stem from its capacity to attach to the brain’s receptors that are also targeted by other opioids. 

This results in pain relief and alleviation of withdrawal symptoms, yet it additionally entails the potential for misuse and dependency. 

How common is Methadone addiction?

Methadone addiction is common. In fact, approximately 261,000 Americans aged 12 and above (0.1 percent) reported misusing methadone in 2017, according to results from the 2017 National Survey on Drug Use and Health published in September 2018 by the Substance Abuse and Mental Health Services Administration.

Furthermore, a 2023 article titled, “Drug Overdose Death Rates” from the National Institute on Drug Abuse revealed that the fatality toll from drug overdoses involving prescription opioids such as methadone increased from 3,442 in 1999 to 17,029 in 2017.

Is Methadone addictive?

Yes, methadone is addictive, according to the sixth chapter of the book titled, “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” published by the World Health Organization in 2009.

When prescribed as part of medication-assisted treatment (MAT) for opioid use disorders, it is typically administered under controlled conditions to minimize the risk of addiction. However, when used outside of prescribed guidelines or in higher doses than recommended, individuals are likely to develop a dependence on methadone, experiencing withdrawal symptoms if they attempt to stop its use.

How long does it take to get addicted to Methadone?

It only takes days to get addicted to methadone, according to a continuing education activity titled, “Opioid Addiction” last updated in July 2023 by StatPearls, which revealed that tolerance to methadone develops in a matter of days.

Furthermore, a 2019 article by Shaheed et al., published in The BMJ stated that according to recent research, the first month after beginning opioid therapy is crucial. The probability of persistent use of opioid analgesics like methadone at one year is approximately 24% after 12 days of usage, around 35% after 21 days of use, and about 43% after 31 days of use.

Is Methadone more addictive than heroin?

No, methadone is not considered more addictive than heroin. Methadone, a long-acting opioid, is primarily used in medically supervised settings for opioid substitution therapy to treat heroin or other opioid addictions. 

Its pharmacological properties contribute to its effectiveness in reducing cravings and withdrawal symptoms associated with heroin addiction. Unlike heroin, which is a short-acting opioid that produces a rapid and intense euphoric effect, methadone does not typically induce the same level of euphoria, making it less likely to be abused. 

While methadone has potential for misuse, its controlled use in a therapeutic context, along with its lower euphoric effects, generally results in a lower risk of addiction compared to heroin.

Why is using Methadone addictive?

Using methadone is addictive because of its pharmacological effects on the central nervous system. As an opioid agonist, methadone binds to the same receptors in the brain as endorphins, the body’s natural pain relievers. 

By doing so, it activates the brain’s reward system and produces feelings of pleasure and relief from pain. This mechanism, while beneficial in managing chronic pain and treating opioid dependence through medication-assisted treatment (MAT), carries the risk of abuse and addiction. 

The reinforcing nature of these pleasurable effects lead individuals to develop tolerance, requiring higher doses over time to achieve the same desired effects. Additionally, the withdrawal symptoms that occur when methadone use is abruptly discontinued contribute to the cycle of dependence, as individuals continue using the drug to avoid these unpleasant effects.

What are the symptoms and signs of Methadone addiction?

The symptoms and signs of methadone addiction include a variety of physical, behavioral, and psychological indicators that suggest a person is abusing the medicine. The symptoms and signs of methadone addiction are listed below.

• Constipation: As a result of their effects on the gastrointestinal system, opioid medications, including methadone, frequently induce constipation. Individuals with methadone addiction exhibit chronic constipation as a physical symptom, reflecting the ongoing influence of the drug on the digestive system. 
• Slow breathing: Methadone suppresses respiratory function, leading to slowed breathing rates, especially when taken in excess or inappropriately. Recognizing slow breathing is crucial as it signals a potentially dangerous physiological response to methadone use.
• Sleep disturbances: Since it changes neurotransmitter activity in the brain, methadone affects sleep patterns. In fact, a 2007 study by Dimsdale et al., published in the Journal of Clinical Sleep Medicine demonstrated that single doses of oral opioid medicines, including methadone, have been shown to have a considerable effect on sleep architecture in healthy adults, lowering deep sleep and boosting light sleep. 
• Loss of interest in activities previously enjoyed: As methadone use continues, individuals find that the substance becomes their primary focus, overshadowing the enjoyment derived from hobbies, social interactions, or other activities. This shift in priorities is characteristic of addiction, where the drug takes precedence over previously fulfilling aspects of life. 
• Mood swings: Methadone influences neurotransmitter activity in the brain which, in turn, affects mood regulation. The euphoria and sedation associated with opioid use leads to emotional instability, with individuals experiencing abrupt shifts in mood as the drug’s effects wear off or fluctuate.
• Need for higher doses: As individuals use methadone over time, their bodies adapt to its effects, requiring increased doses to achieve the same level of relief or euphoria. This trend of increasing dosage points to a physical dependence on the drug and the possible presence of methadone addiction.
• Several failed efforts to cut down on or stop use: Substance dependence makes it difficult to break free from compulsive and destructive behavior. The continued failure to diminish or cease methadone usage indicates a lack of control over one’s consumption, a fundamental characteristic of addiction.
• Symptoms of withdrawal when dosage is reduced: Methadone causes physical dependence, and a reduction in dosage can trigger withdrawal symptoms such as nausea, sweating, anxiety, and muscle aches. Experiencing withdrawal when attempting to decrease the dosage indicates that the individual’s body has become accustomed to the presence of methadone.

What are the effects of Methadone addiction?

The effects of methadone addiction include a variety of physical, psychological, and social repercussions that arise from the persistent and uncontrollable use of this opioid medicine. The effects of methadone addiction are listed below.  

The short-term effects of methadone addiction are listed below. 

• Euphoria: When methadone binds to the opioid receptors in the brain, neurotransmitters associated with pleasure and reward are released, including dopamine. The stimulation of the brain’s reward system produces euphoria or a strong sense of well-being. Individuals with methadone addiction seek and misuse the drug to experience this euphoric effect, contributing to the development and perpetuation of the addictive cycle. 
• Pinpoint pupils: Pinpoint pupils, or constricted pupils, are a physiological response which is a characteristic sign of opioid use, including methadone. Affected individuals exhibit pinpoint pupils as a visible indicator of the drug’s presence in their system, and the persistence of this symptom is a sign of ongoing opioid use.
• Decreased heart rate: Opioids like methadone slow down nerve signals throughout the body, including those that regulate the heart rate. The continued use of the drug leads to prolonged and persistent bradycardia (decreased heart rate), which contributes to cardiovascular complications over time.
• Sedation: One of the most frequent adverse effects of opioids is sedation, which adds to the calm, drowsy sensations individuals get from methadone. The medication’s effect on neurotransmitter activity in the brain causes this sedative effect.
• Nausea and vomiting: Over 60% of patients experience nausea and vomiting as adverse effects following opioid medication, with nausea being much more prevalent than vomiting, according to a 2012 review article titled, “An overview of nausea/vomiting in palliative medicine” from the Annals of Palliative Medicine. 
• Excessive sweating: Opioids, including methadone, cause dysregulation of the body’s temperature control mechanisms, leading to profuse sweating. In fact, methadone-induced hyperhidrosis or excessive sweating is a side effect that happens to as many as 45% of patients who are prescribed the drug, according to a 2017 case report by Hong et al., published in the Journal of Addiction Medicine.
• Constipation: Methadone acts on receptors in the gastrointestinal tract, slowing down the movement of the digestive muscles. As individuals continue to use methadone regularly, this slowing of digestive processes becomes persistent, leading to constipation.

The long-term effects of methadone addiction are listed below. 

• Cardiovascular issues: A study by Taheri et al., published in the 2023 winter issue of the Caspian Journal of Internal Medicine revealed that methadone usage has been linked to cardiac adverse effects such as bradycardia, prolonged QT interval (irregular heart rhythm), Brugada-like syndrome (dangerous irregular heartbeat), and Torsades de Pointes arrhythmia (a rare type of ventricular tachycardia or fast heartbeat). 
• Respiratory problems: Methadone, like other opioids, acts on the respiratory centers in the brain, slowing down the respiratory rate. In cases of addiction, individuals engage in chronic and escalating use, and over time, the respiratory system becomes increasingly compromised. Respiratory depression, characterized by shallow and slowed breathing, is a significant danger linked to opioid use disorders, such as addiction to methadone.
• Cognitive impairments: In 2015, the journal Addiction & Health published a study by Mazhari et al., which compared the neuropsychological functioning of methadone maintenance patients (MMP) to that of healthy controls. The paper found that methadone usage is linked to cognitive deficits, especially in the areas of verbal fluency, verbal memory, and executive functioning.
• Sexual dysfunction in men and women: According to a 2021 study by Ramli et al., published in the International Journal of Medical Sciences, among the population receiving opioid substitution therapy (OST), the prevalence of sexual dysfunction varies; among men receiving methadone maintenance treatment (MMT), it ranges from 14% to 93%. In contrast, there is a scarcity of data regarding MMT in women; yet, what is known about the prevalence suggests that it is 56.6%.
• Physical dependence: With continued use, the body adjusts to the presence of methadone, and tolerance develops, requiring higher doses to achieve the same effects. Simultaneously, the body becomes reliant on the presence of methadone to function normally, leading to physical dependence.

What are the causes of Methadone addiction?

The causes of methadone addiction involve a complex blend of different elements that contribute to someone developing an addiction to methadone. The causes of methadone addiction are listed below. 

• Genetic predisposition: As per the 2021 study by Brian Reed and Mary Jeanne Kreek published in the Cold Spring Harbor Perspectives in Medicine, genetics plays a major role in opioid addiction. The paper further stated that studies involving twins and relatives have shown a strong hereditary component in the predisposition to develop opiate addiction. 
• Pre-existing mental health conditions: Pre-existing mental health issues contribute to methadone addiction development by acting as a catalyst for persons seeking emotional relief. Psychological disorders create vulnerability, and certain people turn to medications like methadone for self-medication to treat conditions like depression or anxiety. 
• Childhood maltreatment: Findings of a 2011 study by Naqavi et al., published in Addiction & Health revealed that in comparison to the control group, the prevalence of all forms of childhood maltreatment was significantly higher in the opiate-dependent group. The detrimental impacts of physical neglect, emotional abuse, and sexual abuse on opiate dependence were substantial.
• Environmental influences: Factors such as access to methadone, social circles, and peer pressure influence one’s addiction risk. When individuals have ready access to methadone, whether through legal prescriptions or illicit means, the likelihood of misuse and dependency increases. Social circles and peer pressure contribute to the initiation and maintenance of methadone use, influencing addiction development.

What are the risk factors for Methadone addiction?

Risk factors for methadone addiction include a range of characteristics that raise the possibility that people will become dependent on this opioid drug in an unhealthy way. The risk factors for methadone addiction are listed below. 

• Young age: A study by Hudgins et al., published in the November 2019 issue of PLoS Medicine reported that 7.8% of 28,213 young adults (18–25 years) and 3.8% of 27,857 adolescents (12–17 years) misused opioids. The majority of young adults and teenagers reported getting their opioids for free from friends or family.
• Personal or family history of substance misuse: Methadone addiction is significantly increased by a personal or family history of substance abuse. Individual vulnerability to substance use disorders, including methadone dependency, is influenced by genetic predispositions and learned behaviors within a familial setting.
• Living with stress: Emotional distress is induced by stressful circumstances and chronic stress, which motivates people to look for methods of relieving their discomfort. Individuals often seek comfort from medications such as methadone, whose sedative effects allow a momentary respite from stress-related emotions.
• Risk-taking or thrill-seeking behavior: According to a study by Mahu et al., published in the June 2023 issue of Frontiers in Psychiatry, one of the personality traits linked to substance use behaviors, motivations for substance use, and co-occurring mental health disorders is sensation-seeking (SS). The research further stated that the majority of thrill-seeking and risk-taking behaviors were exhibited by SS patients. 
• Poor social support: Inadequate social support is a risk factor for methadone addiction, particularly among people who are unable to build social ties. In the absence of positive support networks, people turn to methadone as a coping mechanism for feelings of isolation, exacerbating the risk of addiction.

What are the symptoms of Methadone withdrawal?

Symptoms of methadone withdrawal refer to the physical and psychological manifestations that occur when an individual dependent on methadone abruptly reduces or discontinues its use. The symptoms of methadone withdrawal are listed below. 

• Anxiety: Anxiety is a common symptom of methadone withdrawal, characterized by a heightened sense of unease and nervousness. As the body adjusts to the absence of methadone, individuals initially experience an overwhelming sense of apprehension, contributing to the overall discomfort during the withdrawal process. 
• Restlessness: Restlessness is a manifestation of the nervous system’s response to methadone withdrawal. Individuals find it challenging to sit still or relax, experiencing a persistent need to move or engage in activities as a result of the neurochemical adjustments occurring in the absence of the drug.
• Watery eyes: Watery eyes are a physical symptom of methadone withdrawal, often accompanied by other flu-like symptoms. The opioid receptors in the brain, previously influenced by methadone, become dysregulated during withdrawal, leading to tear production and watery eyes as the body readjusts to its natural state.
• Sweating: During methadone withdrawal, the body is no longer receiving the opioid, and the nervous system goes into overdrive. Sweating is a common response as the body attempts to regulate its temperature, and this is particularly pronounced during the acute phase of withdrawal. In a letter to the editor written by Caflisch et al., published in 2003 in The American Journal of Psychiatry, one patient reported that he had never experienced sweating issues before beginning methadone maintenance therapy (MMT) three years prior. Yet, regardless of the dosage (20–90 mg/day, and later 40 mg/day), he experienced adverse responses at work and had to change his wet clothing multiple times a day starting on the first day of methadone therapy.
• Muscle aches and pains: Muscle aches and pains are prevalent during methadone withdrawal, reflecting the body’s heightened sensitivity to pain as a result of the opioid receptors recalibrating. Individuals experience generalized discomfort in their muscles, joints, and limbs, contributing to the overall physical distress of withdrawal.
• Cravings: Intense drug cravings are a psychological symptom of methadone withdrawal, as the brain, accustomed to the presence of the drug, signals a desire for its reinstatement. Cravings are often strong and difficult to control, emphasizing the psychological components of addiction and the requirement of comprehensive assistance during the detox process.
• Severe nausea or vomiting: Severe nausea or vomiting is a common physical manifestation of methadone withdrawal. The gastrointestinal system, accustomed to the presence of the opioid, reacts to its absence with pronounced nausea, potentially leading to vomiting. This symptom contributes to the overall discomfort experienced during withdrawal.
• Tiredness: Tiredness, or fatigue, reflects the body’s effort to readjust its physiological functions in the absence of the drug. Individuals experience profound lethargy, weakness, and a general lack of energy, making it challenging to engage in daily activities during this phase of withdrawal.

How to overcome Methadone withdrawal?

To overcome methadone withdrawal successfully, it is crucial to tackle the procedure with a deliberate and positive approach. First and foremost, consult with a healthcare professional or addiction specialist to assess your individual situation. 

If discontinuing methadone is deemed appropriate, work collaboratively with your healthcare provider to develop a gradual tapering plan. Undergo the withdrawal process under medical supervision to monitor progress, manage symptoms, and make necessary adjustments. 

Utilize support services, such as counseling, therapy, or support groups, to address the emotional aspects of withdrawal. Stay hydrated, eat a balanced diet, and get enough rest to manage physical discomfort. Mindfulness or meditation are two stress-reduction methods that you can use to ease your anxiety.

Gather a solid network of friends and family who understand your journey and can help you. Set reasonable expectations and appreciate small triumphs along the way, remembering that overcoming methadone withdrawal is a process that takes time. 

Finally, seek aftercare or help to sustain success and avoid relapse. Communicate with your doctor during the withdrawal process for a safe and successful experience tailored to your needs.

What are the available treatments for Methadone addiction?

Available treatments for methadone addiction include a variety of therapeutic procedures aimed at addressing the complexities of substance dependence and assisting individuals on their road to recovery. The available treatments for methadone addiction are listed below. 

• Detoxification: Detoxification is an initial step in treating methadone addiction, involving the systematic removal of the drug from the body. In order to manage withdrawal symptoms and provide a safe and controlled transition to the following stages of therapy, this process is usually carried out under medical supervision. 
• Medication-assisted treatment (MAT): MAT for methadone addiction entails the use of medications in conjunction with counseling and support services, such as buprenorphine or clonidine. As part of MAT, these medications help with withdrawal management, which in turn helps people get their lives back on track and make better use of therapeutic interventions. For detoxification, buprenorphine, a partial μ-agonist and ê-antagonist, has been utilized extensively, according to a 2012 study titled, “Newer approaches to opioid detoxification” published in the Industrial Psychiatry Journal. Clonidine, an antihypertensive medication, is used to help lessen withdrawal symptoms such as agitation, anxiety, sweating, muscle pains, runny nose, and cramps during opioid detoxification, according to an article titled, “Opiate and opioid withdrawal” last reviewed in April 2022 by MedlinePlus. It has no effect on reducing cravings. A 2006 publication titled, “Detoxification and Substance Abuse Treatment” from the Substance Abuse and Mental Health Services Administration further stated that as needed, acetaminophen, aspirin, or ibuprofen can be used to treat withdrawal symptoms such as headache, muscle aches, and bone pain.
• Cognitive behavioral therapy (CBT): The trifecta of cognition, emotion, and action is the focus of this method of organized therapy. When someone is addicted to methadone, CBT helps them recognize and change the unhealthy ways they think and act that are linked to drug use. Individuals undergoing CBT for addiction are given the skills to deal with addiction’s triggers, prevent relapse, and cultivate positive behavioral changes that will last a lifetime. 
• Support groups: Individuals recovering from methadone addiction will benefit from peer support groups such as Narcotics Anonymous (NA) or SMART Recovery. These groups give people a place to talk about their problems, get support, and feel like they belong, all of which are capable of helping them stay motivated and avoid relapse.
• Gradual tapering: Gradual tapering involves a systematic reduction in methadone dosage under medical supervision. Through helping people acclimate gradually to lowering drug levels, this strategy reduces withdrawal symptoms and promotes a more comfortable and regulated transition to total abstinence.
• Aftercare and relapse prevention: These are integral elements of sustained rehabilitation. To address post-treatment challenges, these entail ongoing counseling, therapy sessions, or participation in support groups. Individuals who continue to receive support and guidance reinforce the coping skills they learned during treatment, lowering the risk of relapse.

When is Methadone addiction counseling necessary?

Methadone addiction counseling becomes necessary when people need all-encompassing help to address the psychological, emotional, and behavioral aspects of their addiction. Counseling is important at different points during the course of treatment. 

At the outset, it assists people in recognizing and accepting their addiction, thereby establishing a fundamental basis for transformation. During active addiction, counseling helps individuals identify triggers, understand the root causes of substance use, and develop coping mechanisms to manage stressors without resorting to methadone misuse. 

Methadone addiction counseling additionally proves very important for preventing relapse because it helps people become more resilient, build stronger support networks, and deal with problems that come up on their way to recovery. 

In order to address the complex nature of methadone addiction and help individuals achieve long-term recovery, it is essential to incorporate counseling into a comprehensive treatment plan.

What is Methadone used for?

Methadone is a medicine that has been licensed by the United States Food and Drug Administration (FDA) to treat opioid use disorder (OUD) and to control pain, according to an article titled, “Methadone” last updated in September 2023 by the Substance Abuse and Mental Health Services Administration (SAMHSA). 

Methadone for OUD lessens cravings and withdrawal symptoms but does not produce the “high” that comes with drug addiction. Additionally, an article titled, “Methadone” last revised in May 2023 from MedlinePlus indicated that methadone is used to alleviate intense pain in individuals who are anticipated to require continuous pain relief for an extended duration and are unresponsive to alternative treatments.

Methadone is a schedule II drug that is a long-acting full opioid agonist. The article added that only a SAMHSA-certified Opioid Treatment Program (OTP) is permitted by law to provide methadone for the treatment of OUD. A 2016 report from the United States Government Accountability Office (GAO) titled, “Opioid Addiction: Laws, Regulations, and Other Factors Can Affect Medication-Assisted Treatment Access” stated that substances are put on Schedule II if they have a high chance of being abused, are currently acceptable for medical use in treatment in the United States, or are currently used in treatment with strict rules. Moreover, a schedule II classifications means that abusing the substance in question may result in severe mental or physical dependence.

Why is Methadone used to treat heroin addiction?

Methadone is used to treat heroin addiction due to its unique pharmacological features which help it effectively manage the physiological components of opioid dependence. Methadone, is a full mu-opioid receptor agonist; it reduces cravings and eases withdrawal by binding to the same brain receptors. 

As per a 2009 study by Stotts et al., published in the Expert Opinion on Pharmacotherapy, methadone is suitable for both maintenance therapy and detoxification due to its extended elimination half-life (24–36 hours) and slow onset of action when administered orally. 

The paper added that methadone has been utilized as an alternative to heroin and other opiates, effectively averting opioid intoxication and withdrawal via the mechanisms of tolerance and cross-tolerance.

Detoxification and maintenance therapy are the two main methods used to stop using heroin. An article titled, “Methadone Brand Name: Physeptone” last reviewed in March 2021 by the National Health Service (NHS) stated that in maintenance therapy, one transitions from heroin to a heroin replacement drug, such as methadone, and maintains a steady dosage of the replacement. This is usually a long-term course.

On the other hand, detoxification involves switching from heroin to a replacement drug like methadone and then gradually weaning off of it until the patient is free of both.

According to the sixth chapter of the book titled, “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings” published by the World Health Organization in 2009, throughout the course of treatment, a patient’s opioid dependence will persist. Compared to heroin, methadone is far safer. With the help of methadone, one can take a rest from their drug-using lifestyle and address any family, social, or financial issues that have emerged from their drug use.

What is Medication-assisted treatment (MAT)?

Medication-assisted treatment (MAT) is a comprehensive method used to treat substance use disorders, specifically opioid use disorders. With MAT, the psychological and physiological elements of addiction are addressed by the use of pharmaceuticals in addition to counseling and behavioral therapy.

According to an article titled, “Information about Medication-Assisted Treatment (MAT)” last updated in May 2023 by the United States Food & Drug Administration, the FDA has approved three medications to treat opioid dependence: naltrexone, methadone, and buprenorphine.

Medication-assisted treatment aims to ease withdrawal symptoms, curb cravings, and counter the effects of opioids, enabling individuals to find stability and actively participate in the healing aspects of addiction treatment. 

It’s acknowledged as a proven approach, grounded in evidence, that assists individuals in navigating their addiction journey. Through the integration of medication into a personalized and comprehensive treatment plan, MAT supports individuals in managing their addiction and striving for long-lasting recovery.