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Methadone is a synthetic opioid used to reduce withdrawal symptoms in people addicted to heroin or other narcotic drugs. Methadone is also used as a pain medication and as part of drug addiction detoxification programs. When methadone is abused, it can be swallowed or injected. The drug is chemically unlike morphine and heroin, but it produces many of the same effects. Methadone acts on the same opioid receptors as morphine and heroin to stabilize patients and minimize withdrawal symptoms. The drug is heavily regulated; however, like any other regulated opioid, it is easily abused. The drug is commonly used in medication-assisted treatment programs for patients with opiate addiction. The dose initially starts at 10 or 20mg and is adjusted in 10-mg increments.

People who start using methadone to overcome their heroin addiction are at higher risk of abuse because they already have a history of opioid dependency. Some addicts use methadone as their drug of choice. When someone uses more methadone than they are prescribed or uses it without a prescription, they are abusing the medication. Many people do not think of methadone as being a drug that someone becomes addicted to or abuses. However, the drug is an opioid, and addicts can purchase methadone illegally; it produces euphoric effects and causes dangerous physical dependence.

Street methadone is common, and this is illegally sold methadone. Methadone affects everyone differently, and taking non-prescribed methadone could kill the person. Also, using the drug to get high causes overdose, and using methadone with other drugs also causes overdose. Some people who are prescribed methadone can take the drug home with them, and they may turn around and sell it. Methadone is especially dangerous when taken with other opioids, alcohol, sedatives, or benzodiazepines.

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How does Methadone Affect the Mind and Body?

The abuse of methadone can lead to psychological and physical dependence. When a person uses methadone, the body begins to experience physical symptoms like itchy skin and sleepiness. Someone who abuses methadone is at risk of becoming tolerant and physically dependent on the drug. Stopping the use of the drug abruptly causes dangerous and severe withdrawal symptoms. Most doctors believe the drug works like morphine, yet the effects on the body are slower. Like other opioids, the drug changes how the brain and nervous system respond to pain, providing the user a type of relief. Methadone was designed to block the opiate effects of heroin and lessen the withdrawal symptoms of opiates.

The pain relief from the drug lasts about 8 to 12 hours. The effects on the body are varied and depend on the individual. However, someone who is using methadone can experience constipation, vomiting, lightheadedness, irregular sweating, dry mouth, dependency, fluctuating weight, sleep problems, cognitive changes, and fatigue. Methadone stimulates the release of neurotransmitter chemicals in the brain and central nervous system. The effects of the opioid depress or slow down chemical interactions through the body, creating the type of high the user experiences.

Specifically, the drug occupies the receptors in the brain that are affected by heroin and other opiates. Methadone blocks the euphoric and sedating effects of opiates like heroin and relieves cravings by causing similar effects to opiates. Methadone does cause a euphoric high when it binds to the opiate receptors of the brain. However, the high is not as intense when compared to other opiates, yet the physical dependence tolerance is much more severe. Overall, the risk of experiencing significant effects on the body and increase the longer that an individual remains in methadone.

Like many other commercial drugs that are used recreationally, there are a variety of street and slang names to describe methadone. Street names are used to allow people to discuss buying, selling, or using the drug without others understanding what they are talking about. Some of the common slang terms for methadone are Chocolate Chip Cookies, Dollies, Fizzies, and Wafer. Other names include Dolls, Done, Juice, Jungle Juice, Junk, Maria, Phy, and Metho. Some of the brand names or trade names in Canada are Methadose and Metadol, and some common street names include Meth, Drink, and Done.

Most prescription opioids like methadone are classified as Schedule I drugs under the Controlled Drugs and Substances Act. The use of methadone is legal when prescribed by licensed practitioners and used by the person it was prescribed for. The illegal possession of methadone or double doctoring can result in seven years imprisonment. Trafficking, importing, exporting, or producing methadone or other opioids can result in life imprisonment.

The History of Methadone in Canada

Methadone was first discovered in 1938 by two German scientists and was patented in 1941. The individuals who developed methadone were attempting to find an analgesic that would be structurally dissimilar to morphine and non-addictive while also escaping the strict legal controls placed on opioids at that time. In 1947, methadone was discovered as being beneficial in the treatment of opiate dependence. During the 1940s, numerous studies indicated how methadone reduces withdrawal symptoms caused by heroin. The Addiction Foundation in Vancouver established the first methadone maintenance treatment program in the world.

Methadone has been in use for the treatment of opioid addiction since the early 1960s. Opioid Agonist Therapy has been around in Canada for many decades. The first drug to receive approval for this form of treatment was methadone and approved by Health Canada in 1959. Historically, methadone maintenance had its beginnings in British Columbia. The first methadone maintenance program began in 1959 in Vancouver. During that time, the administration and regulation of methadone prescriptions were held at the federal level. The program began to example, and policies shifted at the federal and provincial levels.

During the 1980s and early 1990s, the federal government transferred administrative jurisdiction over methadone treatment regulation to the provinces. In 1996, the methadone maintenance programs experienced rapid growth in British Columbia and began to expand across the country. Methadone maintenance therapy remains the most common form of substitution therapy for opioid addiction in Canada. According to a National Post article published in 2016, the number of methadone patients soared in Ontario from 3,000 in 1996 to over 50,000. British Columbia saw its numbers double to over 18,000 over seven years. Unfortunately, statistical data is scarce showing how many Canadians are using methadone, but evidence suggests it is growing.

What are the Long-Term and Short-Term Effects of Methadone?

Methadone is used both medically and illicitly, and it is a narcotic drug with a high chance of addiction and dangerous side effects. When someone takes methadone, they run the risk of experiencing a host of dangerous effects. The short-term use of methadone causes drowsiness, dry mouth, lightheadedness, urinary retention, gastrointestinal distress, and sexual impotence. Serious side effects include irregular heartbeat, depressed respiratory function, tremors, unstable gait, fainting, seizures, and death due to overdose.

Methadone also causes psychological short-term and long-term effects. These effects include hallucinations, insomnia, anxiety, depression, paranoia, delusions, suicidal ideations, and impaired concentration. The long-term effect of methadone is an addiction, and this is a real problem for many Canadians. Methadone leads to physical dependence, and the risk of addiction is high, especially for opiate addicts. Methadone is a depressant and affects opioid receptors in the brain and causes impairment of the brain's reward system.

Long-term methadone use can cause changes in the brain, such as sharp decreases in key signalling molecules, which are important in learning and memory. Methadone also has an effect on cell generation and the formation of nerve cells in the hippocampus. Some of the potential impacts of methadone use on the brain involve brain abnormalities, changes in brain chemistry, damage to brain cells, decreased oxygen for brain tissue, and memory impairment.

Finally, long-term methadone use causes addiction and dependence. Tolerance and dependence on methadone take hold quickly, resulting in dangerous withdrawal symptoms. Methadone is as addictive as morphine and heroin, and methadone. In addition, it is one of the most difficult drugs to detox from since its effects are long-lasting, and it is readily stored in the body's tissue.

Methadone Overdose, does it Happen, and How Does it Occur?

Methadone overdose often occurs because the drugs remain in the body for an incredibly long period of time. Even after several hours of use, methadone is not clear from the body. Overdose symptoms could occur within different areas of the body. The stomach and surrounding muscle structures are susceptible to a number of complications like spasms, vomiting, and constipation. The vascular and respiratory system is also impacted, and the lungs are the primary attack point for methadone overdose. The person overdosing experiences laboured breathing and a tight chest. The central nervous system is also impacted the person becomes unnaturally confused or disoriented.

The signs of a methadone overdose are similar to that of an opioid overdose. Initially, the individual experiences low blood pressure and a weak pulse, constricted pinpoint pupils, body spasms, dizziness, cold and clammy skin, blue lips and fingernails, and respiratory depression. Anyone experiencing a methadone overdose requires immediate medical attention. The short-term and long-term use of methadone causes an increased tolerance, yet anywhere between 150 to 200 mg of methadone can prove lethal. However, this is not always the case, as some opioid users have a higher tolerance than others.

Additionally, the number of milligrams needed for an overdose can be as low as 25mg if there is no tolerance to methadone. Most fatal methadone overdoses occur within the first few weeks of being prescribed the drug. Using other drugs and or alcohol with methadone increases the risk of overdose. Alcohol is known to produce a lethal overdose while someone is taking methadone. Treating a methadone overdose requires getting the person to the nearest hospital immediately. Typically, overdosing on methadone means there is a large amount of the drug in the system needing to be removed.

In a study published in the Journal of Clinical Pathology, toxicological analyses of deaths involving methadone were conducted to determine the fatal concentration of methadone in these deaths. The study concludes there is an overlap between therapeutic methadone concentrations and methadone concentrations seen in fatalities. Someone who died from methadone poisoning may not be the same as someone in a methadone program. According to the Centers for Disease Control and Prevention, methadone accounted for approximately 1% of all opioids prescribed for pain and 23% of all prescription opioid-related deaths in 2014.

According to Health Canada, more than 10,300 people lost their lives between January 2016 and September 2018 related to opioids. Approximately 93% of the 3,286 opioid-related deaths in Canada between January 2018 and September 2018 were accidental. Between January 2016 and June 2020, 17,602 apparent opioid toxicity deaths occurred in Canada. Overall, methadone is accounted for a percentage of these deaths. The CDC points out that between 1999 and 2014, the overall prescription opioid overdose death rate involving semi-synthetic, synthetic, and natural opioids increased 300%. The rate of methadone overdose deaths increased 600% from 1999 to 2006 and then declined after 2007.

Methadone Addiction and Recreational Drug use in Canada

Methadone addiction and dependence occur with long-term use of the drug. Methadone is a commonly abused opioid in Canada and is prescribed to help heroin addicts and opiate addicts in general. According to the Canadian Center On Substance Use and Addiction, opiate pain medication is used by 13% of the Canadian population. Approximately 2% reported using them for non-medical purposes. Methadone has a long-lasting effect and causes dangerous dependency when the drug is abuse or taken longer than needed.

The symptoms of methadone addiction are similar to opioid addiction. Some of the symptoms are restlessness, vomiting, nausea, itching, pupil contraction, shallow breathing, severe sweating, constipation, and sexual dysfunction. Most individuals start taking methadone to treat withdrawal symptoms and heroin addiction. However, it is easy to become addicted to methadone even while using a regulated dose. Common addiction signs include social isolation, lying and secretive behaviour, financial losses, a decline in performance at work or school, legal problems, and devoting more time to accessing methadone. Some addicts skip scheduled doses to stockpile or attempt to acquire illegal methadone.

Methadone is a long-lasting opioid and can remain in the system for 8 to 60 hours, depending on how much is taken and which type. People abuse methadone recreationally because it alters sensory perception, is an analgesia, causes dizziness, euphoria, light-headed feelings, and sedation. When someone is abusing methadone, it is not always easy to tell because it takes longer and can be harder to see the signs compared to other opioids. The symptoms of methadone abuse are similar to that of opioid abuse and drug-seeking behaviour.

However, there are some other clear indicators to look for when someone is abusing methadone. Like any other opioid, they develop a tolerance and show outward signs of this tolerance. When they start to adjust to the drug, they may begin to chase down the original effects the drug had on them. The drug user will begin to experience withdrawal symptoms after they become physically dependent on the drug. Like any other addiction, there is a loss of control, and they tend to start using the drug more. There is a focus on the drug, and they begin to start buying the drug illegally. Finally, stockpiling methadone, whether through a methadone maintenance program or buying the drug illegally.

Methadone Addiction Treatment and Drug Detox in Canada

The first step in treating methadone addiction is detox. Methadone is extremely physically addictive, especially when taken in high doses. Once the body becomes reliant on methadone to function normally, a dependence has developed. Like any other opioid dependence, the drug user experiences withdrawal symptoms. Withdrawal occurs because the body has to relearn how to function without methadone. Methadone withdrawal causes adverse symptoms, and the recommended treatment approach is medical drug detox and withdrawal management.

Withdrawal symptoms are similar to other opioids, but some users have described them as being more difficult to overcome. Methadone remains in the body much longer than most opioids, and the severity of withdrawal depends on the amount and other drugs being abuse. Common withdrawal symptoms include chills, fever, anxiety, muscle aches, nausea, sweating, rapid heartbeat, stomach cramps, irritability, paranoia, cravings, insomnia, hallucinations, and depression. Quitting methadone cold turkey is not advisable and potentially dangerous. Withdrawal symptoms are more severe and serious, and the withdrawal process could be longer. Withdrawal symptoms typically begin within 24 hours after the person's last dose. However, it can take anywhere between 15 and 60 hours for methadone to be out of the person's system.

Someone withdrawing from methadone could be at a medical drug detox facility for two weeks or more. Within the first couple of days, the withdrawal symptoms begin to occur like chills, fever, rapid heartbeat, and muscle aches. After about one week, the cravings for methadone become stronger, and the person experiences anxiety, body aches, insomnia, and nausea. It often takes three to eight days for methadone withdrawal symptoms to peak because of how long methadone remains in the body. Withdrawal symptoms have usually peaked within two weeks, but this is different for each person. Users may still experience strong cravings, low energy, anxiety, trouble sleeping, and this could persist for two to three weeks.

Addiction treatment for methadone addiction involves physical and psychological rehabilitation. Because of the physical tool methadone has taken on the body, it is important that a drug rehab center incorporates some holistic or nutritional therapy. Drug rehabilitation should involve some form of behavioural therapy like cognitive behavioural therapy, motivational enhancement, 12-step facilitation, or individual counselling. Most people who have stopped using methadone were likely struggling with an addiction to another opiate requiring proper drug rehabilitation.

Opioid addiction in Canada continues to be a problem resulting in thousands of overdose deaths, hospitalization, and treatment admissions every year. Methadone has contributed to many overdose deaths is still a common drug used to treat opiate addiction. According to a study looking at the treatment of prescription opioid use disorders in Canada—opioid maintenance therapy, mostly by means of methadone, has become the front-line treatment for opioid addiction. Within the province of Ontario, approximately 50,000 people are enrolled in a methadone maintenance program by 2014. Young adults are enrolled in these programs at rates three to four times higher than the United States.

According to a report looking at methadone maintenance therapy in British Columbia between 1996 and 2008, the number of methadone clients rose from 2,827 in 1996 to under 10,000 in 2006. During that same time, the number of dispensing pharmacies increased from 131 to 482. As of 2021, methadone is still widely used across Canada, along with Suboxone. Opioids continue to cause significant harm, and between January 2016 and June 2020, there were 17,602 apparent opioid toxicity deaths in the country, according to the Opioid and Stimulant Related Harms report.

Western Canada continues to be the most impacted region of the country. Since 2016, rates have increased in other Canadian regions like Ontario. However, between January and June 2020, 86% of all opioid toxicity deaths occurred in British Columbia, Alberta, and Ontario. According to the Canadian Center on Substance Use and Addiction, Prescription Opioids, pain is the most common reason for seeking health care in North America. In 2012, between 15 and 29% of the Canadian population experienced chronic pain. Methadone is prescribed to treat pain but not as common as other pain medications.

Additionally, in 2015, the rate of past-year opioid use among the general population was 13.1%, and this was a decrease from 2013. Teens and young adults aged 15 to 24 had a rate of 10.3%, while 13.6% of adults aged 25 and over had used pain medication. Hospitalizations due to opioid poisoning is a significant problem. From 2007 to 2008 and from 2014 to 2015, the rate of hospitalization due to opioid poisoning increased by over 30%. Between 2014 and 2015, there was an average of more than 13 hospitalizations per day. Unfortunately, adults aged 65 and older have consistently had the highest rates of hospitalization due to opioid poisoning.

During that same time, Ontario and Alberta had the highest rates of emergency department visits due to opioid poisoning. Within Alberta, there were 27.3 visits from every 100,000 population, and in Ontario, it was 17.4 per 100,000 population. Fentanyl continues to be connected to most of the opioid-related deaths in Canada. Overall, methadone maintenance and buprenorphine-naloxone continue to be available treatment options for opiate addiction, yet methadone continues to cause dangerous addictions and drug dependency.

Common Terminology for Methadone Use in Canada

Terms Definition
Methadone Clinic These are places for people receiving treatment for opiate addiction, and clients are given a daily dose of methadone. Methadone clinics also offer a variety of treatment options for people struggling with addiction.
Opioid These are a class of drugs that treat pain, and this includes methadone. Opioids are chemically related and interact with opioid receptors on nerve cells in the body and brain.
Synthetic Opioid These are substances that are synthesized in a laboratory and that act on the same targets in the brain as natural opioids.
Opioid Analgesic Also known as narcotic analgesics, these are pain relievers that act on the central nervous system.
Medication-Assisted Treatment MAT is the use of medication in combination with counselling and behavioural therapies and is commonly used to treat opioid addiction.

CONTRIBUTORS TO THIS ARTICLE

Marcel Gemme, DATS

Marcel Gemme, DATS

Author

on March 7, 2022

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Michael Leach, CCMA

Michael Leach, CCMA

Medically Reviewed

on March 7, 2022

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Michael Leach is a Certified Clinical Medical Assistant, who has over 5 years of experience working in the field of addiction. He spent his career working under the board-certified Addictionologist Dr. Rohit Adi. His experience includes working with families during their loved one’s stay in treatment, helping those with substance abuse issues find treatment, and teaching life skills to patients in a recovery atmosphere. Though he has worked in many different areas of rehabilitation, the majority of his time was spent working one on one with patients who were actively withdrawing from drugs. Withdrawal and the fear of going through it is one biggest reason why an addict continues to use and can be the most difficult part of the rehabilitation process. His experience in the withdrawal atmosphere has taught him that regardless of what approach a person takes to get off drugs, there are always mental and emotional obstacles that need to be overcome. He believes having someone there to help a person through these obstacles can make all the difference during the withdrawal process.