Methadone: overdoses are exploding, what is it?

Methadone is an opioid medication prescribed to relieve severe pain and help people who are dependent on opiates (heroin, oxycodone) to withdraw. Reports of overdose-related hospitalizations and deaths continue to increase.

  Methadone: overdoses are exploding, c'est quoi ?

[Updated November 10, 2022 at 5:09 p.m.] Methadone is a opioid medicine (opioid family) used for relieve severe pain (tablets or oral solution) and prescribed in case of opioid addiction as' heroin , oxycodone, fentanyl or hydromorphone. It contains a substance similar to morphine. Taken at the right dosage, methadone eliminates withdrawal effects and reduces the symptoms associated with cravings. But reports of hospitalizations and deaths related to overdose among drug users continue to increase, reports the Medicines Agency November 9, 2022. Un overdose in methadone constitutes a vital danger that requires emergency treatment. To avoid it:

  • Never give methadone to another person
  • Don't take methadone without a prescription
  • Do not take methadone with alcohol, other opioids, anxiolytics , sedatives, pregabalin, heroin or cocaine
  • Store methadone in a locked place, out of the reach and sight of children
  • Never open the bottle in advance, never take the tablets out of their blister in advance
  • Always have a ready-to-use naloxone kit. Naloxone can be obtained, with or without a prescription, from pharmacies or specialized care centers (addiction care, support and prevention centers (CSAPA), reception and risk reduction support centers for drug users (CAARUD)).

Definition: What is Methadone?

Methadone is a substitution treatment authorized since 1995 in France . Considered a amazing , it is delivered in pharmacies and centers specialized in addictology on a secure medical prescription limited to 28 days for the form capsule , and 14 days for form drinkable . Also belonging to the family of opiates , methadone acts as an agonist of mu (μ) receptors in the brain, i.e. at the same place as the opium , morphine or heroin for example. Methadone Hydrochloride APHP and Methadone AP-HP are the methadone medicinal products indicated in substitution treatment major drug dependence on opioids.

Regulations amazing amazing
Prescription support Secure prescription Secure prescription
Persons who can prescribe

Physicians practicing in CSAPAs

Hospital doctors during hospitalization, consultation or in prison



Physicians practicing in CSAPAs

Doctors practicing in hospital departments specializing in drug addiction care

Issuance splitting 7 days max unless expressly mentioned by the prescriber 7 days max unless expressly mentioned by the prescriber
Maximum duration of prescription

14 days

The prescriber can specify on the prescription the duration of each fraction, or exclude the splitting by mentioning on the prescription 'delivery in one go', or specify that the dispensation must be done daily.

28 days

The prescriber can specify on the prescription the duration of each fraction, or exclude the splitting by mentioning on the prescription 'delivery in one go', or specify that the dispensation must be done daily.

Indications: when to take methadone?

Methadone is used as substitution treatment in people addicted to heroin and opiates in general. It allows to avoid experiencing withdrawal symptoms during bondage (i.e. stopping the opiate) and to fight against long-term cravings and avoid relapses. It avoids the euphoric effects of other opioids. In drug addicts, it is used to replace short-acting opioids on which the user has become dependent, such as:

  • heroine,
  • l'oxycodone,
  • fentanyl
  • l'hydromorphone...

What are the effects of methadone?

► Psychological effect: Rather, methadone has a neutral effect, i.e. it causes neither somnolence in of euphoria . When it is well dosed and covers a heroin user's withdrawal symptoms, it allows them to feel in a normal state to reintegrate.

Effect on the brain: Methadone is an opioid receptor agonist that acts primarily on mu (μ) receptors. It therefore does not cause any euphoric effect, even if it also has analgesic and antitussive properties.

Euphoric effect: Methadone does not provide a euphoric effect, which makes it its advantage in the substitution treatment of people dependent on opiates such as heroin.

In what form is methadone available?

Methadone is available as a drinkable syrup , in single vial, or in the form of capsules .

  • In syrup form, methadone is available in doses of 5, 10, 20, 40 or 60 mg.
  • In capsule form, available doses range from 1, 5, 10, 20, to 40mg. She is therefore always taken orally , and remains extremely rarely injected .

Usually, the heroin-dependent consumer who wishes to quit starts with the syrup form for about 1 year, the time to stabilize his situation and find the dose that suits him so as not to feel withdrawal symptoms or cravings. consume (craving).

What are the side effects of methadone?

If the methadone is well dosed, it should not give any particular sedative or euphoric effect. Like any morphine, it can cause constipation, libido disorders with impotence and irregular menstrual cycles. Due to its action on the heartbeat , methadone cannot be combined with certain drugs, and an electrocardiogram is necessary to monitor the absence of QT prolongation.

How soon do the effects occur after taking?

The effects of methadone are quite quick after taking, in general a few minutes, in particular for the syrup form which quickly relieves withdrawal symptoms as soon as they appear.

How long do the effects last?

Methadone has a particularly long half-life, allowing the treated person to experience no signs of opioid withdrawal for at least 24 hours.

What are the signs of a methadone overdose?

Methadone overdose is a vital danger that requires emergency treatment. The signs do not appear immediately after ingesting methadone and may appear up to four hours later. The absence of signs of intoxication should therefore not be taken as reassuring. These signs can be:

  • slower breathing and shallower breathing ( depression breathing) which can lead to respiratory arrest and death.
  • consciousness disorders,
  • nausea and vomiting,
  • transpiration,
  • hypoglycemia,
  • narrowing of the pupil,
  • severe drowsiness,
  • even a coma.

What to do in case of methadone overdose?

If a person (child or adult) has ingested methadone that was not intended for them, and if an overdose is suspected:

  • Contact an emergency service immediately: fifteen (FIND), 18 (firefighters) or 112 (all emergencies: medical, fire, security);
  • Administer to him from naloxone and keep her awake until help arrives:

From 14 years , you can use naloxone nasal spray.

In adults , naloxone solution for intramuscular injection is also permitted.

What are the symptoms of a lack of methadone?

As with all opioids, withdrawal from methadone, when done prematurely and without medical supervision, leads to significant withdrawal symptoms, such as abdominal pain, nausea , of the vomiting , diarrhea, insomnia, rapid heart rate, as well as goosebumps feeling. The person feels strong anxiety, agitation and depression. Symptoms can last 5 days to a week and are most severe 24 to 48 hours after stopping the drug. To avoid this, it is preferable to continue treatment under the supervision of a doctor, and to gradually reduce the dose of methadone.

How to successfully quit methadone?

Initially, methadone makes it possible to successfully wean off heroin by allowing the user to reintegrate and avoid the complications of his consumption. It is always advisable to continue the same dose of methadone in syrup form for the first year and then to switch to the capsule form. When the user feels sufficiently stabilized in his life, a progressive decrease in the dose can be proposed over several months, even several years. In this way, he puts all the chances on his side to avoid a withdrawal syndrome, and a relapse of heroin consumption.

Is methadone dangerous during pregnancy?

According to the CRAT (Reference Center on Teratogenic Agents), methadone can be prescribed during pregnancy and breastfeeding . It is therefore not justified to interrupt methadone with a view to pregnancy or during pregnancy because it does not cause malformations. On the contrary, it stabilizes the patient and avoids withdrawal effects, allowing her to continue her pregnancy in a more serene way. During childbirth, the medical team must be informed of methadone treatment to receive the newborn in the best conditions because he may suffer from a withdrawal syndrome for which morphine may be taken for a few days. During lactation, the amount of methadone ingested in the milk is low, since the child receives about 3% of the maternal dose, which does not cause any problems.

What are the contraindications for methadone?

This medicine should not be used in the following cases:

  • severe respiratory failure,
  • child under 15,
  • in combination with analgesics containing buprenorphine, nalbuphine or pentazocine.

Precautions are necessary in case of renal, hepatic or adrenal insufficiency, hypothyroidism, epilepsy, prostate adenoma or asthma.

What precautions should be taken with methadone?

► Always have with you a naloxone kit ready to use. Administered rapidly, this antidote can temporarily block the effects of an overdose of an opioid such as methadone, pending emergency treatment by a medical structure. Naloxone can be obtained, with or without a prescription, from pharmacies or specialized care centers (addiction care, support and prevention centers (CSAPA), reception and risk reduction support centers for drug users (CAARUD)).

► Never give methadone to another person

► Do not take methadone without a prescription

► Never open the bottle in advance, never take the tablets out of their blister in advance

► Methadone must be started only after the first signs of withdrawal appear .

► In the event of concomitant consumption with alcohol, other opioids, anxiolytics , sedatives, pregabalin, heroin or cocaine, there is a very high risk of overdose . These substances should therefore not be mixed.

► Do not compare your methadone dosage with someone else's, as everyone will need their own dosage to find balance and relieve withdrawal symptoms.

There is no maximum dosage , which is why you should not hesitate to ask your doctor to increase the dose of methadone if you experience withdrawal symptoms and a desire to consume. Once you have found the right dosage, do not hesitate to maintain it as long as possible to put the odds on your side.

Avoid driving and hazardous activities at the start of treatment: noticeable drowsiness may occur. This risk is increased by the joint intake of alcohol or sedatives.

Source journaldesfemmes.fr