- Is Methadone Replacement Therapy just swapping one drug for another?
Many people mistakenly believe that Methadone and other Opioid Replacement Therapy medications are only replacing one drug for another. This is a lack of understanding of how opioids work in the brain. This isn’t a lack of character or willpower that makes people into addicts. Opioids take control of the brain’s reward system, the neurotransmitter dopamine. Dopamine is normally used to reward the person doing things necessary for survival like eating, sleeping, and procreation.
Opioids, and most other addictive drugs, hijack this reward mechanism and use it to force them to use more of the drug. Anyone thinking opioid abuse is an issue of willpower would quickly realize their mistake, if they ever used an opioid for an extended period of time.
Let’s try to answer a few common questions about Methadone and Methadone Replacement Therapy before making the decision to go to rehab or ask your doctor about it.
- How long does Methadone withdrawal last when stopped abruptly?
A major downside to opioids with long half-life’s like Methadone is the long period of time it takes to get out of your system and for the withdrawal symptoms to stop. If Methadone is not slowly tapered down, withdrawal symptoms will start about 30 hours after the last dose, last about 3 to 6 weeks, and gradually start improving after day 10. The higher the dose the longer the tapering period needed to prevent withdrawal symptoms. Some people need years to properly taper themselves off of Methadone.
- How often do I need to visit the clinic for medication?
Methadone treatment usually requires visiting a local clinic once a day to receive the medication. Over time some patients are allowed to take home small doses of medicine. Being in Methadone treatment can chain someone to the local area of their treatment, because they can’t go to just any clinic. This makes it difficult to travel to visit friends or family, travel for work, or travel for vacation. The need to return daily to the clinic can also cause stress from the process of getting there, or from the thought of not being able to make it there.
- Do Methadone Replacement Programs kick you out if you relapse?
Many Methadone programs have a zero tolerance policy to participants who relapse and use heroin or other opioids again. I think this is a terrible policy that doesn’t help anyone. Someone relapsing needs more help, not less. There are also cases of people being denied medication because of an issue with their insurance, or because they didn’t have the money to pay for the current weeks’ treatment. Make sure you check into the Methadone clinic before accepting treatment there. Find out about the rules, and how they would treat you in these situations. A good clinic will work with you on payments, and not just cut you off.
- Can you get “High” taking Methadone?
There seems to be a lot of debate about whether or not Methadone can get someone “high”. Methadone is less euphoric than other opioids, but if the dose is raised too quickly it can cause euphoria like heroin, morphine, and other opioids. The key to Methadone treatment is a consistent dose, that is sized just right for the individual. In the beginning of Methadone treatment, while the correct dose is being determined, you may feel some euphoria, but it will quickly go away. It needs to be a large enough dose to prevent cravings and withdrawal symptoms, but small enough to prevent euphoria. If you take the exact same dose consistently over a relatively short period of time, the feelings of euphoria will diminish to nothing.
- Is Methadone Safe?
Methadone is generally safe when taken are directed by a doctor, but can be much more dangerous than other opioids when abused. With other opioids the negative effects, such as respiratory depression, last the same time as the effects they are seeking like the “high”. Immediately after taking an opioid like heroin is when the user is at the highest risk of overdose. The “high” and the danger are tied together. This is dangerously not the case with Methadone. The pain killing effect and the “high” will typically only last for 4 to 6 hours after taking Methadone, but the other effects like respiratory depression will last for several days. If someone is dosing based on how they feel, they could easily take too much and die from respiratory depression. This increase in negative effects is called stacking. This makes it vitally important to take the same dose consistently.
In addition to using Methadone for opioid substitution, there is another newer medication called Suboxone. I think Suboxone is a much safer medication that should always be used instead of Methadone unless there is a specific medical reason.