Of all drugs that are prescribed for opiate detox/withdrawal, Methadone may be the most controversial and misunderstood. Heavily administered, highly effective, and extremely addictive…Methadone is all of these things and more. It was developed in Germany in 1937, primarily because the Nazi regime needed a pain-killing compound that wasn’t reliant on the poppy. It acts on the same opioid receptors as morphine and heroin, and has many identical side effects. It was introduced to America in 1947.

Methadone has a very strong analgesic effect, and is extremely inexpensive. It’s also long lasting, having a half-life far longer than morphine or heroin. Methadone is known (and for good reason) as one of the hardest drugs to ‘kick’, or discontinue permanently.

Its use is primarily for opiate dependence, although it is also used with some success for chronic pain management. In addiction therapy, it is most successful in a moderate-to high dose (generally 40-60mg, taken orally) in order to stabilize the patient for a period of about a week, and then a taper leading to its discontinuation. Most Methadone clinics offer a 21-day detox. This is where it gets tricky. Depending on the user’s initial tolerance to opiates, there are periods during the detox where some withdrawal symptoms become more pronounced. Generally, most Methadone clinics will raise the dose upon patient request, per a staff physician. Unfortunately, this often leads the patient to switching to a maintenance program, which is, for the most part directed by the patient himself. This can be dangerous, as long-term addiction to Methadone is clearly looming at this point. One of problems with this is that detox from moderate-to-long-term use is extremely uncomfortable; generally more difficult than heroin withdrawal. A longer, slow de-escalation is called for in this case, and with that the chances of permanent dependence increases.

Another very serious danger is the increased chance of overdose. Methadone is a very dangerous drug on its own, but coupled with other opiates, alcohol and/or benzodiazepines, the chances of a lethal overdose are greatly increased. In the United States, the number of drug poisoning deaths involving Methadone in 1999 was 784. This jumped to 5,518 in 2007. While that ‘dipped’ to 4418 in 2011, these numbers are still frightening.

Over the last 20 years there has been a move away from Methadone for opiate detox to the use of buprenorphine (Subutex) and buprenorphine with Naloxone (Suboxone). These drugs were approved for opiate addiction by the FDA in October, 2002. The merits of these drugs in comparison to Methadone is not what this article is about, although if one is researching one for possible treatment, it’s a good idea to look into the other, and ask those questions to a physician or treatment specialist. When Methadone was brought to the United States in the 1940’s, initial studies concluded that in areas where Methadone clinics were opened, a dramatic decrease in strong-armed robbery was reported, making it very attractive for local law enforcement and city/county governments. I mention this only to illustrate that Methadone will probably be around for a long, long time.

If the addict in treatment can stick to a standard detox (40mg to stabilize, and approximately 1-2mg per week decrease), the withdrawal symptoms are very un-dramatic, and sometimes non-existent, due to the fact that the body has time to adjust to each change in dose. The problem herein is that many addicts, upon entering a Methadone program, will exaggerate their heroin use in the admissions stage in order to be prescribed a higher dose, which results in the drug mirroring many of the euphoric effects of heroin. One has to decide if they are using Methadone to get off drugs…or simply as an adjunct to continuing opiate abuse. It’s a tough question that no one can answer but themselves. However, if an  addict (particularly a ‘first-timer’) can get through a 21-day detox successfully, the chances of continued sobriety is good, provided their program is supported by some additional support, be it formal treatment or 12-step program participation. As with any recovery, detox is merely the first step.