Is Methadone a Viable Option for Opiate Addiction?

Is Methadone a Viable Option for Opiate Addiction?


The idea behind using methadone for opiate addiction is that of harm reduction.

In other words, we know that methadone is a powerful opiate drug, just like heroin or other certain prescription pain pills.

The difference with methadone, however, is that it is a controlled and regulated substance that can be given out as part of a specific program, one that is intended to reduce the overall harm that an addict may be experiencing.

Some opiate addicts have tried over and over again to get clean and sober using abstinence based models of recovery, such as the 12 step program of Narcotics Anonymous, and by going through inpatient treatment programs to detoxify their body. But after several failed attempts at these traditional approaches, some opiate addicts get exhausted with the cycle of failure and they decide to try a different approach–that of harm reduction.

To some extent, the opiate addict is giving up, they are surrendering to the fact that they seem to need something to self medicate with. They have proven over and over to themselves that they cannot seem to maintain a life of abstinence from all mood and mind altering substances. Therefore they have decided that they will give harm reduction a try, and go on a drug such as methadone semi-permanently.

I say “semi-permanently” because once you are taking methadone as a maintenance drug for recovery, you really only have two options if you want something to change: Relapse back to your drug of choice, or quit the methadone entirely and be completely clean and sober.

In my experience, people who are trying to quit methadone completely have a very difficult struggle. One problem with methadone is that it has a very long half life, and therefore it stays in your system a great deal longer than other opiates, making it very difficult to detoxify from your body. Methadone is sticky, and the longer you have been taking it and the higher the dosage, the more difficult it is going to be to get off of it. The half life of something like, say, heroin is much shorter, and the withdrawal can be very intense. That said, heroin withdrawal is typically over in about 3 to 5 days. Methadone has a much longer half life, and the withdrawal may only be starting on day five or so, and is probably not even up to peak intensity yet.

Because of these factors, getting off of methadone can be even more challenging than getting off of other opiates. Therefore, we might argue that methadone is not so much a way to overcome opiate addiction, but rather it is a way to maintain your opiate addiction. To some extent, you have to ask yourself what you want your life to look like in long term recovery. And it may be the case that you have very little hope for long term sobriety, and therefore you do not have a clear vision of what a happy and successful life would look like in recovery.

Can someone still be happy and free while taking methadone? Probably. But I know for a fact that some people who are taking methadone are also trapped by it, and they are stuck in an addiction mentality, and they really are not much better off than if they were addicted to other opiates. So your results may vary, your mileage may vary, and you can have very different outcomes depending on how you personally react to being on methadone long term.

There are a few alternatives that you might consider. The main alternative is Suboxone therapy, which is a similar idea but a vastly different medication. Let’s break it down a bit further: Methadone is what we consider to be a “full opiate.” If you keep taking more and more of the substance you will eventually coma and die from it, just like with other full opiates (including heroin, vicodin, etc.).

Suboxone is slightly different because it is only a partial opiate, meaning that once the suboxone molecules fill up those opiate receptors in your brain, they stop flooding the brain. Therefore you cannot take more and more suboxone until you coma and die from it. In a sense, you don’t really get “high” from suboxone, not in the same way that you get high from methadone or other full opiates. Suboxone simply “caps off” your opiate receptors in the brain and stops after that.

This is a newer treatment than methadone and would probably be a much better choice for anyone who is considering an opiate maintenance drug. Of course, some people have tried Suboxone and they have various excuses as to why it will not work for them–it doesn’t help them, it makes them feel sick, it makes them go into opiate withdrawal, and so on. I have watched a number of struggling opiate addicts who made a variety of excuses as to why they needed methadone instead of suboxone. From an outside perspective, it sure looks as if the person just wants to get high, and like they are seeking the euphoria that comes from a full opiate rather than the more passive opiate effect from a partial opiate like suboxone.

At the very least you should discuss these options with your doctor, but also with your substance abuse therapist. If you do not yet have a substance abuse therapist then I would strongly recommend that you get one before you make the decision to get on methadone.

If you are going to rebuild a life that is successful and healthy and find some peace and serenity in it then you are going to need the help of professionals. Simply taking a medication such as methadone or suboxone is not going to magically fix all of your problems in life. Many addicts assume that if a medication could just take away all of their cravings that they would be able to overcome addiction on their own, without any outside help, but this has been proven false over and over again through countless examples.

My hope for you is that you can find freedom and happiness and peace in recovery. If you need to use MAT in order to accomplish that, so be it. But I would also hope that you could find more freedom than what is offered by someone on a semi-permanent dose of daily methadone. Perhaps for some people, this is the only way. But I am hoping you can do a bit better, and find more freedom, and thus be happier in life.