5 Frequently Asked Questions About Methadone
Within the pain medication family of opiates is methadone. However, even though methadone is an opioid, it is very unique and requires special attention. Because of its uniqueness, many people have questions about methadone. Sometimes a mere mention of this medication sends people into a wide-eyed trance. Let’s clear up the confusion with some answers.
Isn’t methadone used for drug addicts? Yes, methadone is used to treat drug addiction in what is called methadone maintenance clinics. In this situation, methadone is prescribed once per day. But, methadone is also used to treat pain. In this situation, methadone has to be prescribed approximately every eight hours for pain relief. So, methadone is used for two different problems in two different ways.
Will I become addicted to methadone? In order to answer that question, one must understand the difference between addiction and dependency. Addiction is a behavior problem in which someone may lie, cheat, or steal in order to obtain and use the medication despite its ongoing harmful effects. Chemical dependency is a natural physical reliance on a medication after it has been taken for a period of time. When someone is chemically dependent on a drug, then withdrawal symptoms can occur if the medication is stopped suddenly. So, to answer the question; you will become chemically dependent on methadone, but that does not necessarily lead to addiction.
Why is methadone used to treat pain? With other pain medications available, it does not seem practical to use a tricky medicine like methadone to treat pain. But, unlike the other medications, methadone is unique and special. Methadone works better for pain generated by the nervous system, like found in neuropathy, because it affects special nerve pathways like norepinephrine, serotonin, and NMDA (N-methyl-D-aspartate). All of these pathways play a central role in pain generation and, in turn, pain relief. Methadone just has a broader footprint (a broader mechanism of action) on the nerves that can block the pain more effectively than other medications.
Does methadone cause side effects? Absolutely, methadone can cause the same side effects that the other opioid pain medications can cause like nausea, itchiness, headaches, drowsiness, and confusion. Methadone also has a greater potential for causing death via respiratory and cardiac complications. The prescribing doctor needs to be very familiar with dosing and titration before prescribing methadone. The prescribing doctor also needs to be aware of potential drug interactions and be aware that patients with sleep apnea or certain cardiac conditions should not use methadone. Most importantly, anyone who has a prescription for methadone needs to take it strictly as directed. No messing around, methadone can kill you if you do not take it as prescribed.
What are some potentially dangerous drug interactions with methadone? Probably the most common combination and most dangerous combination is methadone with a benzodiazepine like Valium. This combination can be fatal by stopping breathing. Some anti-depressants like Elavil can lead to cardiac complications when used with methadone. Even the SSRI anti-depressants, like Prozac, can lead to problems with methadone. Some antibiotics (Cipro, clarithromycin) and antifungals (Fluconazole) interact with methadone. The message here is that you should go over you list of medications with your doctor and pharmacist before starting methadone. Adjustments or alternatives may be needed.
Overall, methadone is a tricky medication. But because of its unique properties, methadone can be very beneficial for difficult-to-treat pain. In some cases, the benefits of methadone outweigh the risks. Disrespect for the dangers of methadone can lead to an unnecessary death, an unintentional overdose. The amount of unintentional methadone overdoses are on the rise. The DEA has taken notice of this trend which is why the 40mg tablet is no longer available except for special circumstances. Smaller (5mg and 10mg) doses of methadone are still available and still valuable for treating pain. With a cautious approach, methadone remains a viable option for pain relief.
If you have questions or comments about methadone, please place them in the comment section below. Communication leads to solutions
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.