Methadone

Where did methadone come from?

Methadone hydrochloride is an opioid (a synthetic opiate) that was originally synthesized by German pharmaceutical companies during the second world war. It was first marketed as 'Dolophine' 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 last longer 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.

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.

What are the dangers of methadone?

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 conclusion about 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 (3).
• 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 area'.
• '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 illicit methadone.
• 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'.

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