Methadone is one of the most popular drugs used to help people beat an opioid addiction. It is controversial, however, as it effectively means substituting one addictive and dangerous opiate for another. Indeed, there are significant pros and cons to this type of treatment, although most professionals agree that the benefits outweigh the risks if used properly. The reality is that methadone works, but when used incorrectly, it can be dangerous.
Detox Treatment of Opioid Addiction
It is now increasingly common for those addicted to opiates to be enrolled in a methadone maintenance treatment (MMT) program.
“In closed settings, MMT should be available to patients who have been receiving MMT in the community and wish to continue this treatment in the closed setting, and patients with a history of opioid dependence who wish to commence MMT. Patients should receive MMT for the entire duration of their detention in the closed setting. This ensures the maximum benefits of the treatment are obtained.”
What this means is that methadone is often not used for a short term detox, but rather as part of an ongoing maintenance program, one that can sometimes last for a very long time. This is because effectively using it for short term detox, requires a great deal of self-discipline and commitment.
How Does Methadone Work?
If used properly, methadone has the potential to remove 100% of the withdrawal symptoms associated with opiate addiction, because it is an opioid itself. It is a slow-acting opioid, however, which means that it does work as a painkiller and relaxant, but much slower than street drugs, such as heroin or opium. It also lasts much longer and, because there is no rapid onset, it does not create a euphoric high.
What few people understand, however, is how it can be beneficial to treat an addiction to opioids with another opioid. Essentially, this is due to the fact that the withdrawal symptoms associated with these addictions are very severe and often unmanageable as they trigger the fight or flight response. This is one of the reasons why so many people relapse.
What Is the Right Dosage for Methadone for Detox?
Methadone can almost instantly solve the problem of opioid withdrawal syndrome. However, it is vital that a medical professional find the correct “therapeutic dose”. If too little is given, the drug will have no effect. If too much is given, the patient can become high and can even overdose. This is why it is so important that patients seek appropriate help for methadone detox so that a trained professional can help determine the right dosage, while also understanding the relevant precautions.
“Dosing recommendations should only be considered as suggested approaches to what is actually a series of clinical decisions over time in the management of the pain of each individual patient; this drug has a narrow therapeutic index, especially when combined with other drugs.”
Usually, a patient is prescribed around 40mg or less of methadone for the first day. Over the next week or so, they will then determine whether it needs to be raised or lowered. Methadone is prescribed for three types of detox options, and the dosage will vary depending on which type you enroll in. They are:
1. The 21-day detox, which is short term detox
2. Long term detox, which usually lasts around 180 days
3. Maintenance program, which means you will continue to take methadone for a substantially longer period of time
How to Be Successful with Short Term Withdrawal
If you do not want to stay on methadone for a long period of time and your physician agrees that the 21-day detox is suitable for you, then you will likely be on methadone for no longer than a week, possibly even just three to four days. This is because the goal is simply to ensure your body contains enough opioid receptors to help you manage withdrawal. If done properly, it means you don’t just stop your body from becoming dependent on methadone, you also avoid the symptoms associated with going cold turkey. Going cold turkey is incredibly dangerous, not in the least because the chance of relapse and overdose is greatly increased at that point.
“As soon as people stop using heroin, their tolerance for the drug lowers, meaning less of the drug is needed to get high. Therefore, when people with heroin addiction relapse, they often overdose because they don’t realize their tolerance is lower than before.”
The reason why your overall detox will last 21 days is because it also ensures that you have the chance to access counseling and treatment, to determine whether there are co-occurring disorders, and to effectively give you a chance to recover properly before returning into the community.
The Downside of Methadone
For some, methadone has been a wonder drug. Many studies have shown that it is incredibly effective in the treatment of heroin addiction, leading to an increased quality of life (physically, psychologically, and socially), better family relations, and less risky and criminal behavior. However, there are some downsides to methadone as well, whether it is used short term or long term, and it is important to be aware of this.
Some of the problems with methadone relate to the side effects. They include sweating, weight gain, loss of libido, sexual dysfunction, constipation, depression, and sleepiness. All of that is caused by opioid-related endocrinopathy.
“Chronic opioid use may predispose to hypogonadism through alteration of the hypothalamic-pituitary-gonadal axis as well as the hypothalamic-pituitary-adrenal-axis.”
Another big complaint is that many people find it difficult to come off methadone. Some of that is down to fear of withdrawal, but some of is due to improper support. With short term methadone detox, in particular, treatment should ideally be offered on an inpatient basis, so that people are supported through the withdrawal of not just heroin, but also methadone. It is vital to understand that methadone is designed as a treatment, not as a full cure and that it can only be successful with proper support.
 Methadone maintenance treatment – Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings – NCBI Bookshelf. (n.d.). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK310658/
 Methadone Dosage Guide with Precautions – Drugs.com. (n.d.). Retrieved from https://www.drugs.com/dosage/methadone.html
 Is Quitting Heroin Cold Turkey a Good Idea? (n.d.). Retrieved from https://americanaddictioncenters.org/heroin-treatment/cold-turkey/
 Opioid-Related Endocrinopathy. (2015, October 13). Retrieved from https://academic.oup.com/painmedicine/article/16/suppl_1/S9/2472492