Treatment controversy: Methadone or methadon't?

Risks and rewards of methadone treatment

By Mary Claire Patton - Digital Content Curator

SAN ANTONIO - Methadone is a synthetic opioid that is used as a pain reliever and also used to treat heroin addiction. It helps reduce withdrawal symptoms without the “high” associated with narcotics.

The drug is considered controversial because it can cause life-threatening physical problems like respiratory depression and heart irregularities.

Despite its benefits with pain relief and opioid addiction treatment, methadone is responsible for a third of the deaths associated with prescription drug overdoses in the U.S. Methadone deaths increased nearly sixfold in 11 years, from 784 deaths in 1999 to 4,577 deaths in 2010, according to Pewtrusts.org. 

Methadone is widely prescribed because of its low cost and its presence on Medicaid preferred drug lists.

Methadone’s affordability as a long-acting opioid analgesic is an advantage; however, public policies that designate methadone as a preferred analgesic for chronic pain may inadvertently contribute to toxicity and overdose reported the American Academy of Pain Medicine.

Addiction treatment

When heroin users stop taking the drug, methadone can help reduce withdrawal symptoms.

Withdrawal symptoms include:

• Nausea and vomiting
• Sweating
• Aches and pains
• Stomach cramps
• Hot and cold flashes
• Mood swings
• Diarrhea
• Runny nose and eyes
• Anxiety

Most methadone users are long-term, though some people choose to eventually reduce their consumption and get off methadone completely.

Methadone has been shown to reduce mortality, criminal activity and transmission of blood-born viruses. Methadone users show improvement in physical and psychological well-being and facilitate social reintegration.

Pregnancy and methadone

The opinions on methadone use during pregnancy are widely varied.

Methadone should only be used during pregnancy if the benefits outweigh the risk to the fetus, according to Drugs.com. The website also states that prolonged use of methadone can result in physical dependency in the baby. 

Another website says methadone doesn’t cause birth defects, but continues by saying a baby can experience side effects like smaller head size, low birth weight and withdrawal symptoms. 

A third website agrees that babies born to women using methadone can experience withdrawal symptoms but it advises expectant mothers to only use methadone during their second trimester. 

A small study conducted in 2010 found that out of 20 infants, 95 percent had poor eyesight and 25 percent had developmental problems when the mother used methadone during pregnancy according to BBC News. 

Buprenorphine vs. Methadone

Buprenorphine is another alternative to treat opioid addiction.

Congress passed the Drug Addiction Treatment Act in 2000, allowing qualified physicians to prescribe narcotic medications scheduled 3 and 4 to treat opioid addiction. This act allowed access to heroin treatment in a medical setting instead of limiting treatment to methadone clinics, according to Drugabuse.gov. 

Buprenorphine is similar to methadone in that it lessens the euphoria caused by opioids and there is lower potential for misuse. The drug also suppresses withdrawal symptoms and cravings for opioids.

Methadone is a full agonist and buprenorphine is a partial agonist. Effects of partial agonists reach maximum levels at a certain point, making methadone a better treatment option for people who are dependent on high levels of opioids, according to Atforum.com.

Drug Court

The Bexar County Felony Drug Court provides guidance and treatment for participants who are struggling with addiction and wanting to voluntarily break the cycle of abusing drugs.

The court works toward reducing arrest and incarceration rates in the criminal justice system.

Judge Ernie Glenn said the program not only helps participants overcome their addictions but also saves money for the county.

“There’s a side that looks at it from the humanity perspective (in) that we’re helping people and we’re helping families,” Glenn said. “And then there’s the other side of the coin that says, ‘Hey, we’re saving you guys a bunch of money,’ because every time somebody goes through criminal justice system it costs you a lot of money. So if you find a way to keep from locking people up, we’re saving everyone money (and) it's better for the taxpayers.” 

The program was established in 2004 and has an average range of 18-24 months for felony offenders and 12-18 months for misdemeanor offenders. ​

Worth the risk?

Methadone is addictive and stays in the system longer than heroin, according to the FDA.

Since methadone takes away the high associated with heroin, users might take another dose before even though they don’t need it yet. This can cause problems with toxicity levels in the body and lead to overdose.

Withdrawal from methadone is sometimes more difficult than withdrawal from heroin.

The number of methadone–related poisoning deaths were 4 percent of all poisoning related deaths in 1999, and by 2014 they measured approximately 26 percent, according to Novusdetox.com. 

The methadone controversy is diverse, complex and highly debated amongs users and physicians. There is support and opposition for methadone treatment, leading to the ultimate question:

Is treating opioid addiction with methadone swapping one addiction for another?

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