Methadone is a synthetic opioid. It is prescribed to dependent users of heroin and other opioids as a substitute for these drugs. Methadone is approved for different indications in different countries. Common is approval as an analgesic and approval for the treatment of opioid dependence.

Question was inspired by drug graphic posted here. The number of deaths is quite shocking and the number of reports is worrying. It's obvious that methadone programmes are favoured while risk of abuse is very high. Why? Is there really more benefit than damage?

  • Did you mean to link here instead? I don't see a graphic in the answer you linked. Mar 14 '11 at 23:22
  • Can someone give actual numbers of users of methadone and users of heroine?
    – Egle
    Mar 15 '11 at 10:24
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    Around 15,000 people in the U.S. were prescribed methadone in 2007 (extrapolated from the 2009 SAMHSA study in my answer). I could find no statistics regarding the extent of illicit methadone use. As for heroin, 213,000 people reported using it in the last month in a 2008 SAMHSA survey.
    – Patches
    Mar 16 '11 at 4:16
  • Please help the drugs proposal if you think this is interesting area51.stackexchange.com/proposals/26294/drugs-and-pharmacology
    – Nobody
    Apr 28 '11 at 15:23
  • IMO the only benefit of methadone is that it's legal and pure. Otherwise, its halflife is much longer and therefore strength of addiction, much stronger, than any recreational opiate.
    – HC_
    Oct 18 '13 at 23:33

Methadone is generally used for medical purposes because it lasts longer than traditional opiates such as morphine. It is also used as a treatment for opiate addiction, for both those reasons and the fact that it does not result in a euphoric "rush" after administration like many traditional opiates.

Previous opiate addiction treatments involved using decreasing treatments of opiates such as heroin or morphine. Many people derided such programs; characterizing them as simply providing addicts with their fix. Methadone treatment was introduced both for the aforementioned long-lasting and non-euphoric effects, and to combat this perception. But, we're still treating addiction to a substance with the very type of substance the people are addicted to in the first place! Why is that?

As you might be aware, the human body is full of various neurotransmitters, which have corresponding receptors. Opioids, such as methadone, are a form of neurotransmitter, therefore it follows that the body produces several varieties of them and has receptors to greet them as well. Another common source are derivatives of the poppy plant, properly called opiates, though many refer to all opioids as opiates, like morphine and heroin (the original brand name for diacetylmorphine, a medication sold by Bayer in the early 20th century).

Opioids are also well known for their ability to induce euphoria. Combined with the relative ease in which a tolerance to them is built, it is common for many to become addicted to them. Continued use of externally-provided opioids in increasing doses causes the human body to reduce or stop production of its aforementioned endogenous opioids, further compounding the problem. When an individual wishes to eliminate their dependency on opioids, or is compelled to by authorities, it is necessary to slowly reduce dosage over time, to give the human body ample opportunity to adjust to the changes and resume or ramp up production of its own endogenous opioids. Such treatment also reduces the pain and suffering associated with opiate withdrawal. For these reasons, for many years now doctors have used several different kinds of opioids to treat opioid addiction, most recently methadone.

Of course, as the use of methadone in treating pain and addiction rose, so did the number of deaths caused by it. In 2002, the Substance Abuse and Mental Health Services Administration (SAMHSA) of the United States Department of Health & Human Services reported on the increasing number causes of methadone deaths:

Hospital emergency department visits involving methadone rose 176 percent from 1995 to 2002. The rise from 2000 to 2002 was 50 percent, according to SAMHSA’s Drug Abuse Warning Network.

The experts surmise that current reports of methadone deaths involve one of three scenarios: illicitly obtained methadone used in excessive or repetitive doses in an attempt to achieve euphoric effects; methadone, either licitly or illicitly obtained, used in combination with other prescription medications, such as benzodiazepines (anti-anxiety medications), alcohol or other opioids; or an accumulation of methadone to harmful serum levels in the first few days of treatment for addiction or pain, before tolerance is developed.

In 2006, the Food & Drug Administration (FDA) issued an alert to medical professionals advising them of the increasing number of methadone related deaths and providing guidelines to reduce such deaths in the future. Nonetheless, methadone use and death rates continued to rise. In 2009, SAMHSA released another report regarding methadone use and related deaths (PDF). The report indicates that deaths as a result from methadone rose from 786 in 1999 to 4,462 in 2005. It also has this to say regarding the increased use of methadone which, as jwenting points out in the comments, makes the increased number of deaths less significant:

The amount of methadone distributed or delivered by the manufacturers rose dramatically from 2000 to early 2007, with increases ranging from 9 to 22 percent annually. The distribution of all formulations of methadone (liquid, tablet, or dispersible tablet) increased. However, tablets distributed with a prescription through pharmacies had the largest increase. The number of methadone prescriptions dispensed increased by nearly 700 percent between 1998 and 2006. The strongest formulation, the 40 mg strength dispersible tablet, had the largest increase of all methadone formulations.

The report continues to put the blame for most deaths on illicit use, commonly combined with other drugs, along with other factors previously mentioned such as inappropriate prescription by doctors. Nevertheless, the report concludes that "Methadone is safe when used appropriately. It can be life saving for individuals dependent on opioids."

More recently, reports of increasing methadone deaths continue in several states, such as Oklahoma, Kentucky, and Georgia, with government officials and scientists continuing on blame deaths to illicit use and improper prescribing practices.

However, those reports also indicate that other opioids continue to be just as dangerous. While the number of methadone-related deaths has surpassed heroin, it remains lower than other prescription opiates such as oxycodone. Given the benefits of methadone treatment over other opiate treatments, I don't think we have enough information at this time to decide that it really helps more than it hurts. We could stand to find something better, but that's true for just about every medication in use today.

  • 2
    just stating that deaths related to methadone use are rising says nothing. If prior to the increase there were 100 users and 1 death among them per year, now there are 10.000 users and 10 deaths among them per year, that's a 10 fold increase in the number of deaths, but an actual 10 fold decline in the number of deaths per 1000 users.
    – jwenting
    Mar 15 '11 at 7:15
  • @jwenting: I mentioned this in the sixth paragraph, but looking into it some more pointed me to some more recent statistics that address both prevalence and deaths. I'll add that information to my answer. Thanks!
    – Patches
    Mar 15 '11 at 7:29
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    I want to upvote this answer. I really do. It contains alot of good, relevant information, and it's importantly written in your own words. But it's kind of meandering as it stands right now. Can you improve it to more directly answer the OP's question? For example, the first paragraph doesn't directly answer the question "...is methadone a cure or a drug that kills", so one has one trouble reading further into the meat of the post. If you hook the answer to the question first, one wants to continue.
    – Uticensis
    Mar 16 '11 at 2:45
  • @Billare: I've been meaning to edit this since I added info about the newer study this morning but I haven't quite had enough time today. Some of it is unnecessary now that I found some newer statistics. You're quite correct that it could stand some reorganization, though. However, the purpose of the beginning was to explain why methadone treatment is used, because it's kind of hard to decide whether something is more bad or good without first understanding why it would be good in the first place. Thanks for your suggestions!
    – Patches
    Mar 16 '11 at 3:31

The benefits of methadone (and similar) being handed out to heroine addicts is that those addicts may now stop buying heroine, reducing both their own need to commit crimes to feed their addiction and the potential market for heroin dealers (thus possibly removing those from the streets as well).

Even were it just as bad for the addict as is heroine medically, the public safety implications alone would be worth it, the financial benefits from reduced crime are a major bonus too (and the initial reason the methadone programs were started in Europe).

Being medically controlled however, methadone is also less likely to be taken in overdose or polluted form, thus reducing medical risk for the addict (of course some of them might still use heroine or other drugs on the side unless the methadone is given in a clinical setting with the addict as an in-patient with no possible access to other sources of drugs).

  • If the chart is correct, possibility of death from methadone is twice higher than from heroin & morphine. Basicaly someone changing heroin to methadone increases his chances of death. "the public safety implications alone would be worth it"? So it favours "cleaning streets" by killing?
    – Egle
    Mar 15 '11 at 10:20
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    what the chart doesn't map is people starting to take methadon in addition to heroin and meth. My guess is most if not all of the deaths can be attributed to that.
    – jwenting
    Mar 15 '11 at 13:12
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    This is the real value of methadone. As someone who has been through a fairly hefty opiate addiction, I can tell you that its very difficult to abuse methadone because they watch you drink it in the clinic, its not as if they hand it over and off you go. Not having to deal with shady people, fueling the criminals (trust me, most addicts hate this part but do it out of neccessity) and knowing that your dose is consistent and safe is a world away from scoring off the street.
    – Nobody
    Mar 25 '11 at 12:49
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    I also believe that getting your dose from a clinic rather than buying from criminals (which involves a lot of waiting, phone calls, being messed around) changes your mind set too. If you feel like a criminal, you are going to act like one and methadone clinics aleviate that.
    – Nobody
    Mar 25 '11 at 12:53
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    We expect users to back up any significant claim with a reliable source. Please edit your answer to include the references on which you based your answer.
    – Oddthinking
    Jul 1 '11 at 8:23

Let's not forget that Methadone is the "BEST by far" pain medicine for chronic pain, making it a necessary evil. It takes at least 200 mgs.to kill an average adult.

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