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Methadone is the mainstay of drug treatment in the UK. Recently some practitioners have returned to the 80s mantra that maintaining anyone on opiates/opioids rather than trying to detoxify them is merely trading one addiction for another. Consequently, these people tend to focus most of their frustrations on methadone.There are plenty of research papers from all across the world supporting methadone, and it is undeniably effective for a very large number of people who are able to rebuild their lives while on long-term maintenance ‘scripts.It can also be used as a short term community based reducing dose detox therapy (in which context it is rather less successful).
Methadone is less sedating than heroin and offers less of a ‘high’. It has a very long half-life (usually over 24 hours) and consequently can be used once daily (although some users will split their daily dose into two).Anecdotally, there is some evidence that heroin users disappointed with the effect of methadone may gravitate towards ‘potentiators’ (other substances that increase the ‘buzz’, such as alcohol, gabapentin, or a benzodiazepine like temazepam). This dynamic is hardly unique to methadone, but again, its prominence ensures that these issues are not ignored.There are a number of health considerations that often occur when methadone is discussed – tooth decay (a sugar free version is available), libido (absolutely-most opioids and opiates reduce the sex drive in the medium/long term) and somatic (bone) pain or calcium deficiency (limited evidence from a research but strong anecdotal evidence from users).Methadone is a full agonist at the mu (µ) opioid receptor (see Morphine for more details on opioid receptors) in the central and peripheral nervous systems.
This produces the typical opiate effects of analgesia, sedation, etc. and slight euphoria, although at higher doses it blocks the euphoric effects that are seen by other opiates such as morphine and heroin. It also seems to have an affinity (ability to bind) to NMDA receptors which are receptors that release the neurotransmitter glutamate. This is thought to make methadone particularly effective in the treatment of neuropathic pain (pain caused by damage to nerves) compared with other opioids.
What is it?
- Methadone is a man-made (synthetic) form of heroin. It is a strong painkiller often used in the treatment of heroin addiction.
- Sought after effects
- long-lasting and smooth action
- prevents heroin withdrawal symptoms
- Undesired effects
- none of the pleasurable effects attributed to recreational opiate use
It is an addictive drug in its own right, producing tolerance and its own withdrawal syndrome.
What does it look like?
It is available on the street, and usually comes in the form of a sticky green liquid; the liquid mixture is made in other colours however, and also in tablet form.
How is it taken?
Swallowed: both the liquid and tablet forms are made for swallowing (ingesting)
Injected: ampoules for injection are produced but are prescribed to relatively few heroin users.