Where did methadone come
Hydrochloride is an opioid (a synthetic opiate) that was originally synthesised
by the German pharmaceutical company Axis during the second world war. It was
first marketed as 'Dolophine' (to honour Adolph Hitler) and was used as an
analgesic (a painkiller) for the treatment of severe pain. It is still
occasionally used for pain relief.
Methadone is now
primarily used today for the treatment of narcotic addiction. The effects of
methadone are longer-lasting than those of morphine-based drugs. Methadone's
effects can last up to 24 hours, thereby permitting administration only once a
day in heroin detoxification and maintenance programs.
How is methadone
taken?Methadone is usually
available as a liquid - linctus or methadone mixture - which should be
swallowed. Tablets and injectable ampoules are sometimes prescribed, and like
many other medicines some of these prescribed drugs are diverted and become
What are methadone's adverse
reactions?Deaths occur more
frequently at the beginning of treatment in methadone programs; they are
usually a cause of excessive doses (i.e. erroneously estimated tolerance) and
they are affected by concomitant diseases (hepatitis, pneumonia). Methadone
generally entails the entire spectrum of opioid side effects, including the
development of tolerance and physical and psychological dependence. Respiratory
depressions are dangerous. The released histamines can cause hypotension or
bronchospasms. Other symptoms are: constipation, nausea or vomiting, sedation,
What are the symptoms of methadone
overdose? Body as a
>>slow, shallow and labored breathing
(sometimes fatal within 2-4 hours)
Eyes, ears, nose,
fingernails and lips
>>spasms of the stomach and/or intestinal
Heart and blood vessels
>>low blood pressure
What is methadone
dependency?As an opiate, regular use
of methadone causes physical dependency - if you've been using it regularly
(prescribed or not) once you stop you will experience a withdrawal. The
physical changes due to the drug are similar to other opiates (like heroin);
suppressed cough reflex, contracted pupils, drowsiness and constipation. Some
methadone users feel sick when they first use the drug. If you are a woman
using methadone you may not have regular periods - but you are still able to
conceive. Methadone is a long-acting opioid; it has an effect for up to 36
hours (if you are using methadone you will not withdraw for this period) and
can remain in your body for several days.
Personal stories of methadone
withdrawl:>>I've been on both ends of withdrawals,
heroin and methadone, every patient of methadone will always tell you the same,
as I do; I can kick heroin anytime, but methadone that is something else. In 15
yrs of heroin addiction, I've kicked 3 times, 'cold-turkey'. In 10 years on
methadone I've never kicked methadone.
Once I landed in jail, I
had to do 72 hours of jail time before I got to see the judge. I was literally
on the floor screaming my guts out. About 12 hours before I was to see the
judge, I demanded to be taken to the hospital, I just couldn't take it. I was
cuffed, and looking like a 'chair' was glued to my back, I limped to the
ambulence, since I couldn't lift my leg to climb into the back, the police
grabbed me on both sides and shoved me in like a sack of potatoes, I fell flat
on my face. The doctor realizing my condition and that it was severe, gave me a
shot of methadone. The relief was immediate.
I was returned to the
precinct and 2 days later I was in the same condition! Never did I go through
such hell in all my days.
The intensity of
methadone withdrawl is just too much! I could never do it, by the way, about 5
years agp one inmate went into convulsions and upon falling, he hit the metal
bars and died!
>>On Sunday morning, March 30, I took my
last dose of methadone. I have been on 80 mgs of methadone for the past 6
My doctor, an anesthesiologist, writes prescriptions for 125 tablets.
This lasts 15 days. I signed a contract with him that basically says I will use
the same pharmacy, I will not get meds from other physicians, and if I run out
before the 15 days is up I just have to go without. I didn't mind signing the
contract at all, and I have abided by all the stipulations. I called him for a
refill on Friday. No response. I called again on Saturday. No response. I
called his home on Sunday. No response. On Sunday I took my last dose. I hate
anything having this much control over me. I find it very demeaning to be so
dependent on a bottle of pills.
On Monday I called his
office. They informed me that he was on vacation this week. Panic descended . .
. and so did withdrawal symptoms. At first I just got kinda nervous, jittery.
My doctor has told me that methadone is not addicting. That is contrary to
everything and anything I've ever heard or read about the drug. I never
questioned him why he thought methadone wasn't addicting. I was hoping I'd
never have to find out. What my body went through for the next 48 hours was one
severe blow after another. I kept trying to tell myself I just had the flu.
Just crawl in bed for 3 days and sweat it out. Of course I knew this wasn't
true but I was going to play whatever mind game it took to get me through this.
After the jitters, the muscle contractures started. It felt like the muscles in
my legs and then in my arms were like rubber bands, being stretched and pulled
to their max and then constricting to a shape that wasn't natural. Then came
the sweats, diarrhea, hallucinations.
I remember trying to
dial the phone. It was a number I've called a thousand times before, only now I
couldn't remember it. For that matter, I couldn't even hold the phone . . . I
kept dropping it. My muscles were out of control. The pain that led me to
methadone returned with a vengeance. In a strange way it was like an old
friend. I knew it well and understood it completely. The combination of
withdrawal and pain was too much. The all too familiar thoughts of suicide were
It was now Tuesday morning. I called the pharmacist and explained the
situation. By 1:10 PM I had 8 methadone tablets. I took the entire dose at once
all 8 tablets. Within 2 hours my muscles had stopped screaming, my head was
beginning to clear, and the pain was lessening.
It's now Thursday
morning. I'm still not back to myself . . . but much better. The assault on my
body was indeed very traumatic . . . I lost 7 pounds and am still very shaky.
Addiction is indeed a dangerous thing and should be avoided. I must admit when
I was in the throes of withdrawal there's not much I wouldn't have done to
relieve the symptoms.
What are the dangers of
methadone?Following is an article
by two doctors addressing this question.
Is methadone more likely
to kill you than heroin?
By Drs Marcel Buster & Giel van Brussel, MD
Based on literature and
analysis of mortality figures Dr Russell Newcombe concluded that methadone
programmes as a form of harm-reduction possibly cause more victims than they
prevent. We have doubts whether the conclusionabout methadone is fully
justified. Looking at the mentioned literature gives a one-sided view at the
problem. Moreover, the conclusions drawn are beyond those justified by the
results of the analyses. Several points of debate come to mind:
Methadone is not an
innocent substance; 'one's methadone maintenance dose is another's poison' (2).
A regular user of opiates develops a certain tolerance. Therefore, it is
possible that a tolerant person can function normally with dosages which can be
fatal to a non-tolerant person. Also, methadone dosage in the case of first
entry to the programme has to be evaluated carefully. It is wise to begin with
a low dosage that has to be increased slowly in the course of weeks or even
months. At entry to the programme it has to be carefully evaluated whether a
patient has a clear and unambiguous heroin dependence. In methadone maintenance
programmes, methadone is dispensed to tolerant persons, moreover, this
tolerance remains high because of daily use of methadone. Therefore, it is not
surprising that deaths at the King's College Hospital caused by methadone were
not those of participants of a methadone maintenance programme but were those
of 'recreational' users of illicit methadone.
In cases where more than
one drug is used, the drug responsible for death due to overdose is difficult
to establish. Moreover, the same drug prescribed by physicians can also be
bought on the street. In seventy percent of the deaths due to overdose studied
in Glasgow and Edinburgh a combination of different drugs was found
Prescribed drugs such as temazepam were often encountered in deaths
in Glasgow. However, among only 14 of the 34 persons who died in 1992 and where
temazepam was found, this was prescribed by their physician. Because of the
presence of other drugs it is not clear whether temazepam really caused the
death of these people. Probably the combination of these different drugs was
fatal to them. This was also the case with the methadone deaths in Edinburgh.
However, in Edinburgh, the authors could not determine whether methadone was
prescribed or not. Both Hammersley and Obafunwa report that heroin/morphine
deaths seldom occur in Edinburgh (4). 'The fall of the deaths due to overdose
in the Lothian and Borders Region of Scotland (LBRS) after 1984 reflects in
part the strict policing that took place, in particular in the Edinburgh
'The increase of methadone deaths is probably due to the
introduction of a street trend to use this agent as a substitute to heroin'.
The author suggests that methadone deaths are mainly caused by the use of
Therefore, these figures
suggest that participants of methadone programmes are at lower risk of death
due to overdose. However, this does not mean that methadone is an innocent
substance. The high and increasing number of methadone deaths in Britain is
alarming and certainly needs more attention. The first priority should be to
establish whether the methadone causing death has been prescribed within a
methadone programme or bought on the street. It also should be evaluated at
what point during the course of the methadone programme death takes place.
Further instruction doctors prescribing methadone could be necessary. The use
of non-prescribed methadone without medical supervision can lead to high risks,
especially when it is used as a substitute for heroin in order to get a 'high'
instead of to prevent withdrawal symptoms. Physicians have to be aware of this
danger and they should make sure that the prescribed methadone (as well as
other psycho-active drugs) does not end up in the 'grey market'.