Methadone Addiction: Signs and Side Effects of Methadone Abuse

Methadone is a prescription opioid used for pain management situations and opioid addiction treatment in centers approved by the Substance Abuse and Mental Health Services Administration. When you take it as prescribed, you aren’t engaging in what some might call methadone abuse. However, even using the drug as directed can result in physical dependence and methadone addiction, and the drug can be used in problematic ways.

Prescription methadone comes in forms such as Dolophine and Methadose. However, street supplies are often mixed with other substances and may not contain any methadone at all, making them especially risky. Street slang varies by region, but methadone might be referred to as done, wafers or fizzies, and using street variants of

This article explores topics related to methadone addiction, including whether you can become dependent on this drug and what methadone withdrawal and side effects look like.

Methadone is a synthetic opioid agonist, which means it engages the brain in the same way organic opioids such as heroin do. The result is pain relief and, in many cases, a feeling of calm. In treatment environments, those results are purposeful. However, outside of prescribed use, the desirable side effects of methadone can lead to repeated use of the drug.

Even when methadone is used as prescribed, long-term use in lasting pain management cases can create tolerance and dependence. Someone using methadone as prescribed may begin to feel like their prescription is required for life to be normal. Prolonged use can also mean it takes more methadone to feel the desired pain relief or calming effects, which can drive people to take more than prescribed.

Opioid withdrawal cycles, which create uncomfortable effects when someone stops using methadone or uses less than they’re used to, can make it hard to quit. In many cases, methadone addiction is mental and physical.

The terms “misuse,” “abuse,” and “addiction” are sometimes used interchangeably when people talk about Methadone use, but they don’t describe the same things. Methadone misuse is a clinical term for what many people call Methadone abuse; it means using the drug in a way other than what your doctor prescribed.

Methadone addiction goes beyond problematic use and involves compulsive use. Someone with methadone addiction may feel like they have no control over continued use, even if they can see the harm use is causing to their physical health or relationships.

Signs of methadone misuse include:

• Taking more of the drug than prescribed or taking it more often than directed
• Using someone else’s prescription
• Mixing methadone with alcohol, stimulants, benzos or other substances, especially when you’re doing it to purposefully impact the drug’s effects
• Self-treating opioid withdrawals with methadone outside of medical supervision in an inpatient rehab center or outpatient treatment program

Misuse doesn’t always lead to addiction, but it increases the chances of developing a dependence. What may start as an extra dose to deal with higher-than-normal levels of pain or manage withdrawal symptoms on your own can gradually develop into compulsive use.

Warning signs that misuse may have shifted into opioid use disorder include:

• Running out of prescribed medication early, especially if it happens often
• Seeking methadone from multiple sources, such as borrowing from a friend or trying to get multiple prescriptions
• Hiding methadone use from others
• Continuing to use methadone even though you’ve had an overdose scare or worsening physical health symptoms

Methadone can cause physical and psychological dependence. Physical dependence means your body adapts to having a certain amount of methadone in your system. When you stop using methadone or use less of it, your brain thinks there’s something wrong in your body, which triggers withdrawal symptoms.

Psychological dependence refers to being unable to cope, sleep or function normally without methadone. You may not experience physical symptoms with this type of dependence, although you could have cognitive and emotional signs, such as brain fog or mood swings.

Dependence isn’t the same thing as addiction, but it can be a warning sign of coming compulsive use. Methadone dependence can also develop even if you use the drug as prescribed, especially over long periods, making open communication with your doctor important.

Methadone addiction can develop gradually, and early warning signs are easy to miss or rationalize. Taking just one extra pill on a super bad day may sound reasonable, but over time, that one extra dose can become several every day that you believe you can’t live without.

Signs of methadone-related opioid use disorder can be behavioral, physical or cognitive and include:

• Taking more than you intend or running out of a prescription early
• Repeatedly trying to cut back on use without success
• Seeking methadone from multiple sources, especially outside of legitimate channels, such as pharmacies
• Not meeting personal obligations at work or school or with your family and social network
• Pinpoint pupils, nausea and heavy drowsiness
• Changes to mood or cognitive function, such as anxiety between doses
• Mixing methadone in risky ways with other substances, including alcohol

Opioid withdrawal is often compared to how you might feel with a severe case of the flu, although intense restlessness and cravings are also present. Methadone withdrawal symptoms typically don’t start until 24 to 36 hours after your last dose. The acute phase of methadone withdrawal, which is when you’re likely to feel the most severe symptoms, can last 2 to 3 weeks on average.

Common methadone withdrawal symptoms include:

• Anxiety, restlessness and irritability
• Sweating, chills and fever
• Runny nose and watery eyes
• Excessive yawning
• Muscle aches and joint pain
• Insomnia
• Nausea, vomiting and other digestive distress
• Strong cravings

Symptoms typically peak during the acute phase between the third and eighth day. Some people experience post-acute withdrawal symptoms (PAWS), which are symptoms that linger. PAWS can include low mood, difficulty sleeping and poor concentration that lasts for months.

Methadone misuse carries real health risks that range from uncomfortable short-term effects to serious, potentially life-threatening consequences with longer-term use. Risks of harm increase when you mix methadone with alcohol or sedatives.

Short-Term Side Effects

Short-term effects of methadone misuse can include:

• Feelings of sedation or drowsiness
• Dizziness and poor coordination
• Nausea, vomiting and constipation
• Slowed or shallow breathing
• Pinpoint pupils
• Impaired driving
• Increase fall risk

Respiratory depression, which is dangerously slowed breathing that can lead to unconsciousness, is typically the most dangerous short-term side effect. Super slow breathing can lead to brain damage or be fatal, and risks increase when methadone is mixed with other depressants, such as alcohol.

Long-Term Side Effects

With prolonged misuse, methadone can affect the heart. Research published by the National Library of Medicine included information about FDA safety alerts linking methadone to QT prolongation, which is a change in heart rhythm that can contribute to a serious and even fatal condition. The risks of QT prolongation are dependent on dose and increase when methadone is mixed with certain medications or used by someone who has an underlying heart condition.

Other long-term side-effects can include:

• Chronic constipation
• Hormone disruption
• Sexual dysfunction
• Sleep problems

No single factor determines whether someone might develop opioid use disorder related to methadone use. Risk is related to a combination of personal history, mental health and individual circumstances.

Risk factors for methadone addiction include:

• A history of opioid misuse or other substance use disorders
• Untreated or co-occurring anxiety, depression, post-traumatic stress disorder (PTSD) or other mental health conditions
• Long-term chronic pain that involves management with opioids that may increase risks for tolerance and escalating use
• A family history of substance use disorders
• Regularly combining methadone with other substances
• Using methadone outside of a licensed opioid treatment program or under the care of a doctor as part of a pain treatment plan

A clinician diagnoses opioid use disorder using criteria from something called the DSM-5. This diagnostic manual for mental health disorders includes information on patterns of use that indicate addiction.

According to the Centers for Disease Control and Prevention (CDC), diagnoses require at least two of 11 stated criteria to be present within a 12-month period. The criteria include:

• Taking more methadone than intended or taking it longer than intended
• Having persistent cravings and being unable to control use alone
• Spending a lot of time getting or recovering from use
• Using despite negative relationship outcomes or impaired work or school performance
• Not being interested in or involved with previously normal activities
• Using methadone in a way that is dangerous or risky

Assessment also usually involves mental health screening and evaluation of overdose risks and other substance use. Drug testing alone isn’t enough for a diagnosis. While it can confirm the presence of methadone in someone’s system, it doesn’t determine the severity of use or provide insight into misuse patterns helpful in identifying treatment options.

Opioid addiction can happen to anyone. In fact, it impacts around 2.1 million people in the United States, and many of them started with prescription opioid misuse. Being unable to stop methadone use isn’t a personal failure; it’s a potential symptom of a substance use disorder that may require addiction treatment.

If you’ve experienced an overdose scare, find yourself engaging in risky behavior just to use methadone or feel like opioid use is negatively impacting your life, it may be time to get help. You can find inpatient rehabs and detox centers, outpatient treatment programs and support groups for recovery from methadone use disorder.

Help.org acts as a free and confidential treatment finder for methadone recovery resources. Browse rehabs in your area or research other opioid addiction help options now.