Methadone is an opioid, like heroin or opium. Methadone maintenance treatment has been used to treat opioid dependence since the 1950s. The opioid dependent patient takes a daily dose of methadone as a liquid or pill. This reduces their withdrawal symptoms and cravings for opioids.
Methadone is addictive, like other opioids. However, being on methadone is not the same as being dependent on illegal opioids such as heroin:
It is safer for the patient to take methadone under medical supervision than it is to take heroin of unknown purity.
Methadone is taken orally. Heroin is often injected, which can lead to HIV transmission if needles and syringes are shared.
People are heroin dependent often spend most of their time trying to obtain and use heroin. This can involve criminal activity such as stealing. Patients in methadone do not need to do this. Instead, they can undertake productive activities such as education, employment and parenting.
Methadone has been included on the World Health Organization’s List of Essential Medicines. This highlights its importance as a treatment for heroin dependence.
There has been a great deal of research on MMT. This research has found that
MMT significantly reduces drug injecting;
because it reduces drug injecting, MMT reduces HIV transmission;
MMT significantly reduces the death rate associated with opioid dependence;
MMT reduces criminal activity by opioid users; and
Methadone doses of greater than 60mg are most effective.
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.
Methadone is a synthetic opioid agonist. This means it produces effects in the body in the same way as heroin, morphine and other opioids. It is taken orally as a tablet or syrup.
When an opioid dependent person takes methadone, it relieves withdrawal symptoms and opioid cravings; at a maintenance dose, it does not induce euphoria.
Onset of effects occurs 30 minutes after swallowing and peak effects are felt approximately three hours after swallowing. At first, the half-life (the length of time for which effects are felt) of methadone is approximately 15 hours; however, with repeated dosing, the half-life extends to approximately 24 hours. It can take between 3 and 10 days for the amount of methadone in the patient’s system to stabilise.
Most people beginning MMT experience few side effects. However, there are some side effects of methadone, including:
Nausea and vomiting
Menstrual irregularities in women
Methadone maintenance treatment is indicated for patients who are dependent on opioids or have a history of opioid dependence. In closed settings, it is important to remember that patients not currently physically dependent on opioids can benefit from the relapse prevention effects of methadone maintenance treatment.
Patients must also be able to give informed consent for methadone maintenance treatment.
Patients with severe liver disease should not be prescribed methadone maintenance treatment as methadone may precipitate hepatic encephalopathy.
Patients who are intolerant of methadone or ingredients in methadone formulations should not be prescribed methadone.