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Methadone Overdose

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Methadone is a long-acting opioid agonist that works by reducing the effects of other opioids.1 It is FDA-approved for the treatment of opioid use disorder (OUD), and can be used on a short-term or long-term basis to help reduce opioid-related cravings and withdrawal symptoms and improve health outcomes.1, 2 When taken as prescribed, methadone is a safe and effective component in OUD treatment.1 It can reduce shorter-acting opioid use, symptoms of an opioid use disorder, infectious disease transmission, and drug-related criminal behavior.3

While highly useful in the treatment of opioid use disorder, methadone can, however, be misused when someone takes it in a way other than prescribed or by taking more than prescribed. Since methadone is a long-acting opioid agonist and does act on opioid receptors, there is some potential for misuse, although not nearly as high as stronger- or shorter-acting opioids. Methadone is considered more of a treatment modality for opioid use disorder than as a medication for misuse.

It is very important that patients who are prescribed methadone for the treatment of opioid use disorder take it under the supervision of a medical professional. If someone takes more than prescribed (intentionally or unintentionally), there is an increased risk of overdose due to potential respiratory depression.4

The remainder of this article will cover topics such as signs of methadone overdose, how to respond to the effects of a methadone overdose, preventing methadone overdose, and addiction treatment options. Continue reading to learn more about methadone and how to use it safely for the treatment of opioid addiction.

Methadone Overdose Signs and Symptoms

There are many reasons someone might take methadone, such as for the management of moderate to severe pain, to treat opioid use disorder, or for recreational use to experience its euphoric effects (not very common).5 Taking methadone for any of these reasons can potentially lead to overdose, whether it is an intentional overdose (purposefully misusing a drug) or unintentional (accidentally taking a drug or taking too much).6

There are several signs and symptoms to look out for in a suspected opioid-related overdose, including:7, 8

  • Unconsciousness or difficult to wake up.
  • Difficulty breathing, such as making choking or gurgling sounds.
  • Slowed or shallow breathing.
  • Limp body.
  • Vomiting.
  • Blue or purple lips and/or fingernails.
  • Decreased or stopped heart rate.
  • Inability to speak.

In addition, some signs of overmedication that could potentially proceed to an overdose include:7

  • Extreme sleepiness or drowsiness.
  • Mental confusion.
  • Slurred speech.
  • Drunken behavior.
  • Decreased breathing rate.
  • Extremely small/pinpoint pupils.
  • Low blood pressure.
  • Slow heart rate.
  • Difficulty awakening.

Risk Factors for Methadone Overdose

There are various factors that may increase methadone overdose risk and the risk of opioid-related deaths. It is important to note that methadone overdose is not nearly as common or serious compared to other opioids such as heroin or fentanyl. These risk factors may include:7, 9

  • Intentionally misusing methadone.
  • Using an illicit opioid, such as heroin.
  • Taking an opioid that has been contaminated with another substance, such as the more potent opioid fentanyl.
  • Being prescribed multiple medications.
  • Combining methadone with other substances, such as alcohol or benzodiazepines.
  • Tolerance (needing a larger dose or increased frequency of taking a substance to experience its effects).
  • History of substance use disorder.
  • Medical conditions, such as heart conditions, asthma, sleep apnea, or chronic obstructive pulmonary disease.
  • Older adults.
  • Mental health conditions.
  • History of head injury or brain tumors.

What to Do if You Overdose on Methadone

If you suspect someone is suffering from a methadone overdose, this is a medical emergency, and it is critical to immediately contact 911 for medical assistance.

Naloxone (name brands include Narcan, Zimhi, and Kloxxado) is an opioid antagonist that is FDA-approved to rapidly reverse the effects of an opioid overdose.10 Naloxone works by attaching to opioid receptors and blocks or reverses the effects of other opioid drugs.10 It is a critical tool for people, families, first responders, and communities to help reduce fatal overdoses.

If someone is showing signs of an opioid overdose, naloxone can be administered, even if it is not clear that the signs displayed are from opioids.10 Naloxone is not approved for the treatment of opioid use disorder.10

Naloxone comes in 3 FDA-approved forms. The injectable form can be injected into a person’s muscle, under their skin, or into the veins. Typically, this method requires filling a syringe with naloxone from a vial. The FDA recently approved an auto-injector form of naloxone that comes in a prefilled syringe and can be easily injected into someone’s muscle or under the skin. The third form comes in a prepackaged nasal spray. This comes prepackaged and does not include needles; it is administered by spraying the substance into 1 nostril while the person receiving the dose is on their back.10

Preventing Methadone Overdose

You may be wondering what can be done to prevent a methadone overdose. Some helpful strategies to prevent overdose and overdose deaths include:7

  • Learning to recognize the signs and symptoms of an overdose.
  • Understanding how to administer naloxone and carrying it with you.
  • Talking with your family members and friends about how to respond to an overdose.
  • Talking with medical providers.
  • Avoiding combining methadone with other substances.
  • Taking the medication as prescribed by your provider.
  • Properly disposing of unused medication.

Addiction treatment is a critical step in reducing opioid use disorder symptoms and related consequences. Different addiction treatment options exist, including:11

  • Detoxification. This process is often an initial step in addiction treatment. During detoxification, people may be medically supervised while drugs are eliminated from their body. Medications may be used to help manage and lessen the discomfort associated with withdrawal.
  • Inpatient treatment. Inpatient care provides a place for people to stay while they are attending treatment. Inpatient care may include individual and group-based therapy and learning to reduce behaviors related to substance use.
  • Outpatient treatment. Outpatient care exists in different types of programs. Typically, patients meet individually with a counselor or attend group sessions on a regular basis.
  • Therapy. Cognitive and behavioral therapies may occur in inpatient and outpatient settings and can help patients change their thoughts and behaviors around substance use, increase healthy coping skills, and adhere to other components of treatment, such as taking medications.
  • Medications. Medications, such as methadone for the treatment of opioid use disorder, can be used to manage withdrawal symptoms, reduce cravings, and prevent relapse.

Treatment and Rehab Centers Near Me

Many treatment and rehab centers exist if you are seeking treatment for addiction. If you are interested in addiction treatment and want to learn more about the options available to you, American Addiction Centers is here to help. Visit our online directory today. If you have health insurance coverage, you can instantly check your coverage by verifying your insurance. Call to learn about your treatment options.

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Kristen Fuller, MD, enjoys writing about evidence-based topics in the cutting-edge world of mental health and addiction medicine and contributes to medicine board education. Her passion lies in educating the public on the stigma associated with mental health. Dr. Fuller is also an outdoor activist, an avid photographer, and is the founder of an outdoor women's blog titled, GoldenStateofMinds. In her free time, she enjoys hiking, backpacking, skiing, camping, and paddle boarding with her dogs in Mammoth Lakes, California, where she calls home.
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