Methadone and Mental Health

Methadone and Mental Health

We live in a society where a solution is often some kind of drug. Let that be for weight loss, muscle gain, cognitive performance, and even drug addiction. People want a quick and easy fix so that is what is provided to them, unfortunately, this does not solve the root cause of certain ongoing issues. The “take a pill for this” method does not work in every situation but that is what the consumer wants, so that is what they received.  

What is Methadone?

Methadone was developed in Germany around 1937 and 1939 by Gustav Ehrhart and Max Bockmühl. 

Heroin and fentanyl are opiates that affect our brain’s reward center by releasing dopamine. When these receptors are activated, they stimulate the release of neurotransmitters that regulate pain, hormone production, and feelings of well-being throughout the body. With this in mind, heroin binds to mu-opioid receptor (MORs) which stimulates a reinforcing behavior cycle on drugs; meaning users will continually use more for their desired effects–until withdrawal symptoms start taking over where we may feel physical or mental distress until we can get another hit

  • Mu receptors play an effect on analgesia, smooth muscle tone, sedation, mood alteration, and n/v.

Methadone acts by binding to the µ-opioid receptor, but also has some affinity for the NMDA receptor.

  • mu-opioid receptors are a key molecular switch triggering brain reward systems and potentially initiating addictive behaviors.
  • This receptor, therefore, mediates therapeutic (analgesia) and addictive activities of morphine, suggesting that further development of morphine-like compounds may necessarily lead to addictive analgesics.

Methadone is a synthetic opiate that is used to treat drug addiction. Methadone binds to the same brain receptors as heroin and morphine, but methadone blocks the euphoric high caused by heroin or morphine. It has a long half-life, lasting 24 – 36 hours, making it an ideal detox agent for ongoing treatment. Methadone also decreases cravings for drugs and helps addicts stop using illegal drugs. However, in higher doses methadone can exhibit opiate-like effects, creating a state of euphoria, sedation, respiratory depression, and relaxation for users.

Methadone is the most common drug for treating heroin addicts worldwide. It has been used as a treatment since it was first discovered in Germany during WWII, and now doctors are starting to use methadone more than ever before due to its effectiveness and safety. Methadone allows people with addictions time to recover from their addiction while they assimilate back into society by working or going through school instead of being high all day every day like when using other drugs such as heroin- which can have harmful effects on one’s body if abused over long periods of time (such as liver damage). For optimal results, patients should also participate in counseling sessions where they will talk about how life affects them so that together these professionals can help the addict find ways out.

https://psychiatry.uams.edu/clinical-care/cast/what-is-methadone/

https://www.drugabuse.gov/publications/research-reports/heroin/effects-of-heroin-on-body 

The lowest GoodRx price for the most common version of methadone is around $10.26, 75% off the average retail price of $41.30.

Methadone administration

A relatively low dose of methadone (eg, <30 mg per day) can lessen acute withdrawal but is often not effective in suppressing craving and blocking the effects of other opioids. Though a few patients respond to a maintenance dose of 30–60 mg per day, most patients fare better if their initial 30–40 mg per day dose is gradually raised to a maintenance level of 60–120 mg per day, which typically creates sufficient tolerance to minimize a euphoric response if patients self-administer additional opioids. 

https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf 

Is Methadone a good solution for opioid addiction?

Methadone is a highly addictive synthetic opiate, more addictive than Heroin and harder to withdraw from. The National Treatment Agency for Substance Misuse (NTA) recognizes that addicts have been parked on methadone for too long, and now promotes abstinence as the treatment goal, with time limits on the duration of methadone maintenance.

https://www.theguardian.com/society/2012/jan/10/why-methadone-drugs-dont-work 

While methadone may help reduce cravings for heroin and other dangerous narcotics, it still leaves the individual dependent on an opiate drug. Despite this, methadone use can keep addicted people safer and out of the justice system as they begin recovery.

  • Deaths from opioids (including semisynthetic opioids, natural opioids, and methadone) have increased more than 300% in the last 20 years.
  • Methadone is responsible for nearly one in four opioid-related deaths.

Study

Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States, 2007–2014

  • Methadone accounted for approximately 1% of all opioids prescribed for pain but accounted for approximately 23% of all prescription opioid deaths in 2014. State drug management practices and reimbursement policies can affect methadone prescribing practices and, in turn, might reduce methadone overdose rates within a state.
  • https://www.cdc.gov/mmwr/volumes/66/wr/mm6612a2.htm 

More than 70,000 Americans died from a drug-involved overdose in 2019, including illicit drugs and prescription opioids. 

In response to the escalating number of deaths related to the improper use of the prescription drug, methadone, the Illinois Department of Human Services’ (IDHS) Division of Alcoholism and Substance Abuse is urging Illinois consumers, health care professionals and the opiate treatment clinics to be well informed on the safe use of methadone.

https://www.dhs.state.il.us/page.aspx?item=46054 

Mental health

For some people, the feelings of anxiety and depression that emerged during this pandemic will resolve as routines resume. But others who face new or worse mental health issues may not be so lucky–a number which could very well become quite large given the magnitude of despair and disruption caused by a virus, unlike anything we have ever seen before in our lifetime. This burden would undoubtedly put an even greater strain on already strained systems for treating these conditions if they were to come into contact with one another down the road.

  • Young adults have experienced a number of pandemic-related consequences, such as closures of universities and loss of income, that may contribute to poor mental health. During the pandemic, a larger than average share of young adults (ages 18-24) report symptoms of anxiety and/or depressive disorder (56%). Compared to all adults, young adults are more likely to report substance use (25% vs. 13%) and suicidal thoughts (26% vs. 11%). Prior to the pandemic, young adults were already at high risk of poor mental health and substance use disorder, though many did not receive treatment.
  • Research from prior economic downturns shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide. During the pandemic, adults in households with job loss or lower incomes report higher rates of symptoms of mental illness than those with a job or income loss (53% vs. 32%).
  • Research during the pandemic points to concerns around poor mental health and well-being for children and their parents, particularly mothers, as many are experiencing challenges with school closures and lack of childcare. Women with children are more likely to report symptoms of anxiety and/or depressive disorder than men with children (49% vs. 40%). In general, both prior to, and during, the pandemic, women have reported higher rates of anxiety and depression compared to men.
  • https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/ 

Drug overdose deaths spiked dramatically during the COVID-19 pandemic. According to the Centers for Disease Control and Prevention (CDC), nationwide a record 93,000 people died from a drug overdose in 2020, a 29% increase over the previous year. The state of Illinois saw more than a 27% increase in deaths, while Michigan recorded a 16% increase.

While the numbers may be shocking, for some they weren’t surprising.

https://newsroom.osfhealthcare.org/covid-19-fallout-a-spike-in-drug-deaths/ 

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