Methadone

• Methadone belongs to the group of drugs known as opioids. Opioids are classed as depressant drugs because they work by slowing down the central nervous system.
• Methadone is synthetically manufactured and used as a substitute for the treatment of people dependent on heroin and other opioids. Its effects are much longer lasting than heroin, a single dose being effective for approximately 24 hours; the effects of heroin may only last for a couple of hours.
• In a treatment program, methadone is usually given out in syrup form and drunk with cordial or fruit juice.

Methadone programs

There are two types of methadone programs:

• A maintenance or long-term program, which may last for months or years, that aims to reduce the harms associated with drug use and improve quality of life; and
• A withdrawal (short-term) detoxification program, which lasts approximately 5–14 days, that aims to ease the discomfort of coming off heroin.

A person can only become a client on methadone treatment after being assessed by a doctor who is an approved methadone prescriber. Generally the client should be 18 years of age or over and be physically dependent on opiates. The doctor's assessment takes into account other characteristics such as alcohol or other drug use and psychological health.

The advantages of methadone treatment

Many people believe that it is preferable for heroin users to stop taking drugs altogether. This is achievable for some heroin users but others have a high risk of relapse. Methadone maintenance has helped many people reduce the recurrence of compulsive heroin use.

Methadone can improve the health of people dependent on heroin in a number of ways:

• people are less likely to use heroin that may be contaminated with other substances;
• methadone is taken orally, which makes it cleaner and safer than injecting heroin;
• the routine involved in methadone treatment encourages people to lead a balanced and stable lifestyle - including improved diet and sleep;
• people are less stressed, as they do not have to worry about where their next "hit" of heroin is coming from;
• methadone lasts longer in the body than heroin, so it only has to be taken once a day;
• it allows people to handle the withdrawal process with less discomfort;
• criminal activities conducted to obtain illegal drugs are reduced;
• it helps people cut their connections with the drug scene;
• it's cheaper - although there is usually a dispensing fee with methadone, this is relatively cheap compared to the cost of illicit drug use; and
• under certain conditions, take-away doses of methadone are also available, which help clients return to a more stable lifestyle.

To be eligible, clients must meet the criteria as outlined by the state/territory health department as well as those of the methadone prescriber. Some of these criteria include family commitments, illness and travelling long distances.

Other considerations with a methadone program

• it is recommended that clients on a methadone program also receive professional counselling;
• methadone, like heroin, is a potent drug and can be dangerous if used incorrectly;
• while people are on methadone, they are still physically dependent on opioids;
• there is no “high” experienced from a methadone dose;
• clients must commit to attending daily for their dose, therefore, holidays etc may be difficult to organise;
• and there are side effects.

Effects

Some people on methadone programs will experience unwanted symptoms during their treatment. These may be caused by the dosage they are receiving being too low or too high, which can occur particularly at the beginning of treatment. Some symptoms may also occur due to the side effects of the drug itself.

Symptoms of the methadone dose being too low may resemble having a bout of the flu. They include:

• runny nose, sneezing;
• abdominal cramps;
• feeling physically weak;
• loss of appetite;
• tremors;
• muscle spasm and jerking;
• goose bumps;
• tears;
• nausea/vomiting;
• yawning;
• diarrhoea;
• back and joint aches;
• high temperature but feeling cold;
• sweating;
• irritability/aggression/feelings of uneasiness;
• difficulty sleeping; and
• cravings for the drug.

A person who suddenly stops taking methadone may experience many of the symptoms listed above. The withdrawal symptoms usually begin one to three days after the last dose, and peak around the sixth day, but can last longer.

Symptoms of too high a dose include:

• drowsiness/nodding off;
• nausea/vomiting;
• shallow breathing;
• pinpoint pupils;
• below normal drop in body temperature;
• slow blood pulse, lowered blood pressure;
• heart palpitations; 
• dizziness;
• problems with sexual functioning; and
• poor blood circulation.

Some people may also experience certain side effects that are unrelated to the dosage including:

• sweating (clients should drink at least two litres of water per day to avoid dehydration);
• constipation;
• aching muscles and joints;
• lowered sex drive;
• skin rashes and itching;
• sedation;
• fluid retention;
• loss of appetite, nausea/vomiting;
• abdominal cramps;
• irregular periods.

 Side effects should diminish soon after the methadone program is completed.

Signs of overdose

Methadone deaths are rare. Methadone related deaths have almost always been due to combining methadone with other drugs, particularly benzodiazepines such as Valium and Rohypnol, and/or alcohol.

It is generally accepted among health professionals that methadone treatment is effective in reducing deaths among heroin-dependent people. Deaths involving those in methadone treatment have occurred in Australia mainly due to the following reasons:

• accidental overdose – research indicates that the abuse of alcohol and benzodiazepines is common among methadone clients. Any combination of sedative drugs, including opiates, such as heroin and methadone, alcohol, and benzodiazepines, results in an increased risk of respiratory depression, coma and death;
• suicide – emotional disorders are common among methadone clients; and
• accidents – including those involving a motor vehicle.

Pregnancy and breastfeeding

Pregnant women who are dependent on opiates are encouraged to enter a methadone program as early as possible into their pregnancy, as it is likely to result in fewer complications than the use of other opiates. This is because:

• the unexpected periods of drug withdrawal experienced by pregnant women using other opiates (that can be harmful to the baby) do not occur when on a daily dose of methadone;
• the lifestyle of women is often enhanced when on methadone treatment, resulting in improved nutrition and less stress, which all contribute to a healthier baby; and
• methadone supplied by a pharmacy or treatment centre hasn't been cut/mixed with any other potentially harmful substance that may be passed on to the baby.

Like all opiates, methadone crosses the placenta to the unborn child. Many of the babies born to methadone-dependent mothers go through withdrawal at birth. Their symptoms can be successfully treated while the baby is still in hospital. Overall, women using methadone have fewer problems during their pregnancy than those who continue to use heroin.

As small amounts of methadone may be passed on through breast milk, mothers that are on a methadone program are often encouraged to breastfeed in order to help ease the baby's withdrawal from methadone. Methadone has been found to reach its maximum level in breast milk between two and four hours after a dose, therefore feeding the baby just before a dose or taking the methadone just before the baby has a long sleep will reduce the amount available to the baby.

Methadone and the law

Injecting methadone, taking more than one dose at a time, or giving methadone to somebody else is illegal. In Australia, as in most other western countries, methadone is legal providing it is prescribed by a doctor who has been registered as a methadone prescriber.

Where to get help

If a person is interested in entering a methadone treatment program, they should contact their local Aboriginal Health Service, their doctor or a drug and alcohol service.

• Direct Line. Phone; 1800 888 236
• Family Drug Help; Phone: 1300 660 068
• Youth Substance Abuse Service (YSAS); Phone: 1800 014 446; Website: www.ysas.org.au
  Drug and alcohol services for people aged between 12 and 21 who are experiencing significant problems related to their drug use.
• Alcoholism and Drug Treatment Centre Moreland Hall; Phone: 9386 2876.

This fact sheet has been adapted from more detailed information provided by the Druginfo Clearinghouse.