Methadone Abuse on the Rise in the United States

 

By Hugh C. McBride

Most conversations that involve the terms “methadone” and “drug abuse” are focused on methadone’s ability to help heroin addicts overcome their addictions and reclaim their lives.

But in recent years, these two terms have become linked in a more disturbing manner, as increasing numbers of drug users are turning to methadone not as a means to end addiction, but rather as another way to get high.

This increase in the prevalence of methadone abuse has been accompanied by what one medical expert has termed “a tidal wave” of emergency room visits, as well as the deaths of many young people who apparently had no idea of the power and dangers of unsupervised methadone use.

“They might mix [methadone] in with a beer or with some other drug,” drug addiction expert Dr. Ernest C. Rose said in a Feb. 9, 2003 New York Times article. “They take it thinking it’s just like any other drug and will give them a buzz, and they end up either dead or deeply unconscious.”  

Safe When Supervised, Dangerous When Abused

As part of medically supervised addiction recovery programs, methadone maintenance has proven to be both safe and effective. Primarily used to treat addictions to heroin and other opioids, methadone has been closely evaluated during decades of use in drug treatment programs.

The U.S. Office of National Drug Control Policy (ONDCP) characterizes methadone as a “rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence.”

The ONDCP website also describes the ability of methadone maintenance programs to allow opioid addicts to lead healthier, more productive lives:

Heroin releases an excess of dopamine in the body and causes users to need an opiate continuously occupying the opioid receptor in the brain. Methadone occupies this receptor and is the stabilizing factor that permits addicts on methadone to change their behavior and to discontinue heroin use.

Taken orally once a day, methadone suppresses narcotic withdrawal for between 24 and 36 hours. …

Methadone reduces the cravings associated with heroin use and blocks the high from heroin, but it does not provide the euphoric rush. Consequently, methadone patients do not experience the extreme highs and lows that result from the waxing and waning of heroin in blood levels.

Ultimately, the patient remains physically dependent on the opioid, but is freed from the uncontrolled, compulsive, and disruptive behavior seen in heroin addicts.

The ONDCP isn’t the only organization to note the benefits of methadone maintenance for the medically supervised treatment of opioid addictions.

“Methadone is an important and beneficial drug when prescribed and used properly,” Douglas Throckmorton, M.D., Deputy Director of the FDA’s Center for Drug Evaluation and Research, said in an April 28 press release that announced a government-sponsored initiative to increase awareness about methadone safety.

The Prevalence of the Problem

The rise of methadone abuse appears to have occurred primarily within the last nine years.

In her Feb. 9, 2003 New York Times article, writer Pam Belluck described evidence related to the spike in methadone abuse cases on the state and national levels:

  • In North Carolina, deaths caused by methadone increased eightfold, to 58 in 2001 from 7 in 1997 – an “absolutely amazing” jump, said Catherine Sanford, a state epidemiologist.
  • In Maine, methadone was the drug found most frequently in people who died of overdoses from 1997 to 2002. It was found in almost a quarter of the deaths.
  • In the first six months of 2002, methadone killed 18 people in Maine, up from 4 in all of 1997.
  • The federal Drug Abuse Warning Network reported that in 2001, 10,725 people turned up in emergency rooms after having abused methadone. That is nearly double the number of such visits in 1999.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the number of people who received medical treatment for problems related to the abuse of “other opiates” (a category that includes methadone) increased dramatically at the beginning of the century, rising from 28,235 in 2000 to 36,265 in 2001.

Methadone is not known for providing a particularly powerful high, and most experts believe that increases in methadone abuse have as much to do with access as with efficacy. Though most widely used in medical maintenance programs for opioid addiction, the drug also has analgesic (painkilling) effects, and doctors have recently begun using methadone more often for this purpose.

“Some doctors also prefer methadone because it is far cheaper than OxyContin, it does not generate as much of a high as other drugs, and its effects are slower, seemingly making it less likely to be abused,” Belluck reported.

Effects of Methadone Abuse
According to information provided by SAMHSA, methadone users should contact their healthcare provider immediately if they experience any of the following side effects:

• Difficult or shallow breathing
• Accelerated heartbeat
• Chest pains
• Lightheadedness
• Hives or rash
• Swelling of the face, lips, tongue or throat
• Chest pain
• Hallucinations or confusion

Of course, individuals who have illicitly acquired methadone, or who are abusing the drug in order to get high, are unlikely to have either an awareness of potential side effects or the wherewithal to access immediate medical care.

As methadone abuse becomes more common, so, too, are cases of methadone poisoning. According to an April 28 SAMHSA release, the percentage of all poisoning deaths linked to methadone has tripled in recent years, rising from 4 percent in 1999 to 14 percent in 2004. The death rate from methadone poisoning, SAMHSA reports, is rising faster than the rate of poisoning deaths from any other narcotic.

Because many drug abusers take multiple drugs (including alcohol), the effects of methadone abuse may be exacerbated by the presence of other substances. The SAMHSA website features the following cautions related to methadone use by individuals who are also taking other drugs or medications:

  • Methadone may be more hazardous when used with alcohol, other opioids (opium-like substances) or illicit drugs that depress the central nervous system.
  • Be especially careful about other medicines that may make you sleepy, such as other pain medicines, antidepressant medicines, sleeping pills, anxiety medicines, antihistamines or tranquilizers.
  • Other medicines to watch out for include diuretics, antibiotics, heart or blood pressure medication, HIV medicines and MAO inhibitors.
  • If you are taking medicine that may cause disruptions in your heartbeat (known as arrhythmias), you should be especially cautious taking methadone.

Getting Help
Because methadone can be a dangerous drug when used without the supervision of a qualified healthcare provider, anyone who is abusing this medication is in danger and needs immediate assistance. Depending upon the nature and severity of a person’s methadone abuse, and the presence of any underlying or co-occurring conditions, treatment may take several forms.

Pain patients who have begun illicitly abusing methadone after initially being prescribed the drug by their physician will most likely benefit from participating in a program that can address both the drug abuse and the chronic pain. One example of this type of program is Twelve Oaks Recovery Center, a residential recovery program that is designed to help clients who are struggling with both addiction and chronic pain.

For adolescents, effective treatment options include outpatient therapy, wilderness recovery programs and therapeutic boarding schools for teens in recovery.


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