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How to Recognize & Treat a Methadone Overdose

Except for carfentanil, virtually no other substance is as lethal as fentanyl, the synthetic opioid often mixed with cocaine, heroin, or minted into counterfeit pills.

Up to 100 times stronger than morphine, a lethal dose of fentanyl is believed to be around 2 milligrams (mg), which looks like a few grains of table salt.

Indeed, fentanyl was the number one drug that caused overdose deaths in 2016, according to this CNN report. Fentanyl bested other notoriously illicit substances like heroin, cocaine, and methamphetamine.

However, there was another inclusion on that list of drugs that could be a bit of a surprise. Methadone, which is used to treat opioid addiction, was listed as the eighth-most common drug in overdose deaths in 2016, producing 3,493 fatalities (or 5.5 percent) of all overdose deaths that year.

Methadone can be deadly in overdose, causing many of the same symptoms as other notoriously dangerous opioids. Chief among those overdose effects is respiratory depression, which means that you overdose to the point that you stop breathing altogether.

Read on to learn how to recognize and treat methadone overdose. 

What is Methadone?   

Methadone was introduced to the U.S. in 1947 to treat pain. However, it was not until 1964 when the first pilot project was conducted where methadone was used to treat heroin addiction. It remains widely used in the treatment of opioid addiction and pain. Brand names for methadone include Dolophine, Methadose, Diskets Dispersible and Methadone HCL Intensol.

Like other opioids, it changes how the brain and body respond to pain and diminishes opioid withdrawal symptoms. It also blocks the euphoric sensations of opiates like heroin, morphine, and codeine, and opioids such as hydrocodone and oxycodone, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

The medication, which is available in pill, wafer, or liquid form, can only be dispensed at federally-sanctioned clinics.

When employed as an opioid dependence medication, the recommended target dose range is between 80 to 120 mg per day, according to Drugs.com. In weaning patients off methadone, dose reductions should be in increments of less than 10 percent every 10 to 14 days.

However, in large enough doses, methadone can produce mild euphoria. Like other opioids, methadone is capable of being abused.

The U.S. Drug Enforcement Administration (DEA) designates methadone as a Schedule II substance, meaning that it has “a high potential for abuse, which may lead to severe psychological or physical dependence.”

When an Opioid Use Disorder is Present

The clinical term for opioid addiction is known as opioid use disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), considered the bible of psychiatric diagnoses, has published a set of criteria used to measure whether someone has an opioid use disorder.

A diagnosis of opioid use disorder can be made if someone using opioid drugs displays at least two of the following symptoms within 12 months, states Verywell Mind:

  • Taking more opioid drugs than you intended
  • Wanting or attempting to control opioid drug use without success
  • Spending the majority of your time obtaining, taking, or recovering from the effects of opioids
  • Cravings opioids
  • Failing to perform essential roles at home, work, or school because of opioid use
  • Continuing to use opioids, even though use is causing relationship or social problems
  • Giving up or lessening other activities because of opioid use
  • Using opioids when it is physically unsafe to do so
  • Continuing to use opioids, even though use is causing physical or psychological problems
  • Displaying tolerance for opioids
  • Experiencing withdrawal symptoms when opioids are not taken

The Signs and Symptoms of Methadone Overdose

Methadone is a potent painkiller capable of producing devastating effects, because methadone remains in the body a lot longer than other opioids. It can last anywhere from 24 to 36 hours, depending on the age, weight, tolerance, and addiction level of a user.

Methadone overdose is possible when someone mistakenly or intentionally exceeds the recommended dose. Overdose can also result when someone takes methadone with prescription painkillers like hydrocodone, oxycodone, or morphine.

Whatever the case, a methadone overdose can be life-threatening, producing effects such as coma or respiratory depression.

According to MedlinePlus.gov, this treatment medication can produce the following overdose symptoms, impacting these areas of the body:

EYES, EARS, NOSE, AND THROAT

  • Pinpoint pupils

STOMACH AND INTESTINES

  • Nausea and vomiting
  • Constipation
  • Spasms of the stomach or intestines

HEART AND BLOOD

  • Low blood pressure (Hypotension)
  • Weak pulse

LUNGS

  • Slow, labored, or shallow breathing
  • No breathing

NERVOUS SYSTEM

  • Coma (diminished level of consciousness and lack of responsiveness)
  • Muscle twitches
  • Confusion
  • Disorientation
  • Fatigue
  • Weakness
  • Dizziness
  • Drowsiness

SKIN

  • Cold, clammy skin
  • Blue fingernails and lips

How to Treat a Methadone Overdose

If you suspect someone is in the throes of methadone overdose, seek medical help immediately. Before contacting 9-1-1, you should have this information ready:

  • Person’s age, weight, and condition
  • The name of the drug and the strength (if known)
  • The time it was consumed
  • The amount consumed

At the Emergency Room 

MedlinePlus.gov suggests you take the drug container with you to the hospital, if possible. The medical provider will assess and monitor your vital signs, including breathing rate, temperature, pulse, and blood pressure.

The patient may be subject to tests, including:

  • CT scan
  • Blood and urine tests
  • Chest x-ray
  • ECG (electrocardiogram, or heart tracing)

The patient may also receive treatment, which could include:

  • Intravenous administration of fluids through a vein
  • Medications to reverse the effects of methadone (like naloxone) and to address other symptoms
  • Breathing support (such as a tube through the mouth or being connected to a ventilator)
  • Laxative
  • Activated charcoal

Outlook and Recovery

Recovery will depend on the amount of methadone used and how quickly the patient got treatment. The faster medical help is delivered, the better someone has a shot at recovery.

If an overdose antidote can be given, recovery from that event can begin right away. The person may receive multiple doses of the remedy and stay overnight at the hospital since methadone’s effects can last about a day, states MedlinePlus.gov

People who ingest large amounts of methadone may stop breathing altogether. They may also have seizures if the antidote is not quickly administered.

Health complications can result such as pneumonia, brain damage from the lack of oxygen, and muscle damage from being on a hard surface for an extended period, which can all cause permanent disability.

Severe overdose cases can result in death. 

Professional Treatment

Like other opioids, methadone can cause painful and uncomfortable withdrawal symptoms when use stops abruptly. Those symptoms can lead one to suffer a relapse and life-threatening overdose.  Early withdrawal symptoms can include anxiety, restlessness, tiredness, sweating, trouble sleeping, watery eyes, runny nose, and yawning.

Peak symptoms of any opioid withdrawal will feel like the flu. Such symptoms include:

  • Severe nausea
  • Depression
  • Drug cravings
  • Vomiting
  • Cramps
  • Diarrhea
  • Muscle aches and pains
  • Goosebumps

The psychological symptoms of methadone can last far longer. Methadone withdrawal and its harmful effects make professional treatment vital. A reputable professional treatment program will provide a medically-supervised detox and treatment that addresses the psychological and emotional aspects of opioid addiction. Depending on the severity of the addiction, clients can be treated through a residential or outpatient treatment program.

Essentially, professional treatment will provide you a number of proven treatment approaches designed to help you achieve lasting recovery. Those treatment approaches include:

  • Detoxification treatment
  • Cognitive-Behavioral Therapy (CBT)
  • Dialectical Behavior Therapy (DBT)
  • Medication-assisted treatment
  • Motivational Interviewing
  • Dual diagnosis treatment
  • Individual therapy
  • Group therapy
  • Family therapy
  • Stress management
  • Educational workshops
  • Relapse prevention planning

Sources

Center for Substance Abuse Research. (n.d.). Methadone. Retrieved from http://www.cesar.umd.edu/cesar/drugs/methadone.asp

U.S. Drug Enforcement Agency (DEA). (n.d.). Retrieved from https://www.deadiversion.usdoj.gov/schedules/

Drugs.com. (n.d.). Methadone Dosage Guide with Precautions. Retrieved from https://www.drugs.com/dosage/methadone.html

Hartney, E. (2019, July 12). Opioid Use Disorder Diagnostic Criteria in the DSM-5. Retrieved from https://www.verywellmind.com/opioid-use-disorder-22046

Healthline. (n.d.). Methadone Withdrawal Symptoms and Treatments. Retrieved from https://www.healthline.com/health/going-through-methadone-withdrawal#symptoms

Keating, D., & Granados, S. (n.d.). Analysis | See how deadly street opioids like 'elephant tranquilizer' have become. Retrieved from https://www.washingtonpost.com/graphics/2017/health/opioids-scale/?utm_term=.1ff03143aa10

Kounang, N. (2018, December 28). Fentanyl is the deadliest drug in America, CDC confirms. Retrieved from https://www.cnn.com/2018/12/12/health/drugs-overdose-fentanyl-study/index.html

MedlinePlus.gov. (n.d.). Methadone overdose: MedlinePlus Medical Encyclopedia. Retrieved from https://medlineplus.gov/ency/article/002679.htm

Substance Abuse and Mental Health Services Administration. (2015, June 16). Methadone. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone

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