Is the methadone effect on memory loss real or is it a myth?
There are many myths about methadone. While there are real risks and problems associated with methadone, for people who are in danger of a life-threatening overdose on heroin or fentanyl, the benefits far outweigh the risks. Unfortunately, when myths are spread about untrue dangers of methadone, lives may be needlessly lost when people addicted to street opioids are convinced to stay away from the methadone clinic.
Common myths include that methadone
seeps into the bones, causing bone loss and bone pain. Another myth is that methadone damages teeth. When it comes to methadone affecting memory and brain function, there is a mix of truth and myth. It is important that we separate out the facts from the fiction.
There is an issue with methadone and memory loss and reduced brain functioning.
In addition to being used for medical treatment
of opioid addiction, methadone is also a drug of abuse. Like many drugs of abuse, particularly opioids, when a drug user takes too much, there is an effect on mental functioning.
Have you ever heard of a person “nodding out” on opiates? When a person has taken too much heroin, fentanyl, or even methadone, they become sedated and start to fall asleep and pass out. Even if they are sitting at the dinner table, engaged in conversation, you may notice that their head starts to fall and their eyes droop. “Nodding out” is a perfect description of what happens to someone who has just used opioids, and they are on the verge of becoming unconscious.
There are many potential methadone effects on the brain when methadone is misused.
Additionally, if you are talking to a person who has just snorted heroin, shot up fentanyl, or taken a swig from a bottle of liquid methadone, you will notice that they cannot keep up with the conversation. They start to forget what you are talking about, or even what they are saying, mid-sentence. As they slur their words and lose focus, you can clearly see that their mental functioning is affected by the drugs.
Of course, memory will be affected as well when a person has misused and overused an opioid. Yet, this reduced mental functioning is temporary. When the opioid leaves their system and time has passed, mental functioning returns to normal. For a person who has abused opioids for a long time, it may also take a long time for optimal mental functioning to return.
What about when a person takes methadone from a methadone maintenance clinic?
If you go to a methadone clinic to stop taking an opiate, such as heroin, are you going to get high, nod off, and start forgetting where you are and what you are doing? Generally, methadone clinics start out at a low dose and gradually increase the dosage over time. The goal is to reach a level where the patient is comfortable, without drug cravings or withdrawal sickness. Additionally, the goal is for the patient to function adequately with respect to activities of daily living.
The methadone doctor does not want their patients to get high from methadone. The goal of methadone maintenance is to treat addiction and improve functioning of the patient. A methadone maintenance patient should be able to go to work and perform nearly any job they were able to perform previously.
How does methadone work in the brain?
Methadone is a powerful opioid drug with a long half-life. Not only does methadone activate the opioid receptor as a full agonist, it also effectively blocks other opioids from having access to opioid receptors in the central nervous system. Because of the long-acting nature of the drug, patients treated with methadone maintenance function well with a single daily dose.
Some people are concerned about long-term changes in the brain after many years of methadone maintenance treatment. Is it possible to reach a point where there is no going back? Can you take methadone for years and then quit taking it? Or, does methadone change the brain, making it necessary to always have the drug to function normally?
Beware misinformation about methadone and other MAT medications from misinformed professionals.
There are people in the medical field who believe that this is true. I once spoke with a nurse who worked in a methadone maintenance clinic about the process. She told me that there are many patients who’s opioid receptors are “so burnt out” that they will require methadone maintenance for life.
The fact is that if a person’s brain is able to function at all, it will be able to eventually readjust to functioning without methadone. It may not be easy, but there is no scientific basis for condemning a person to permanent methadone treatment.
What is the best way to quit methadone?
While methadone maintenance is a highly successful form of treatment for opioid use disorder, after a few years of going to the methadone maintenance clinic every day, you may wonder about how and when you can stop the methadone. If your clinic nurse or counselor tells you that it will not be possible for you to ever stop treatment, you may want to consider going for a second opinion.
Possibly the best plan for quitting methadone will be to taper down to a reasonable dosage and then, transition to Suboxone, or a similar sublingual buprenorphine product. Experts recommend reducing your methadone dosage to 30 mg daily or less before making the switch. Then, you will have to plan for having time to make the transition.
Unfortunately, you cannot quit methadone one day and start Suboxone the next day.
If you start Suboxone
too soon, you will get precipitated withdrawal. This occurs because Suboxone is a powerful opioid receptor blocker as well as a partial activator of the opioid receptor. If you have any opioid remaining in your system, you may have this uncomfortable precipitated withdrawal reaction when you take your first Suboxone.
In most cases, the waiting period from last opioid use to the first Suboxone dosage is about 18 to 24 hours. After taking a short-acting opioid, such as heroin or oxycodone, 24 hours should be enough time to wait before taking Suboxone.
In addition to waiting long enough, you will have to assess yourself to determine if you are in mild to moderate opioid withdrawal. If you have enough withdrawal symptoms and you have waited long enough, you can start Suboxone. Your doctor will likely provide you with a scoring method to determine if you are ready to start yet.
Going from methadone to Suboxone is a little more difficult because of the long half-life of methadone.
While you may only feel the effects of the drug for a day or less, it stays in your system for many hours, and even days after your last dose. Officially, the earliest you can take Suboxone after methadone is about 34 hours after the last methadone dose. Realistically, it is often much longer than this. Most likely, you may have to wait for several days, at least.
During the wait to start Suboxone, you will likely experience some uncomfortable withdrawal symptoms. Fortunately, your doctor will be able to prescribe medications that help with the withdrawal effects to make the symptoms more tolerable.
When you are finally on Suboxone and feeling better, you will see that it is possible to get off of methadone and stop going every day to the methadone clinic. With Suboxone, you can see your doctor on a monthly basis. This allows for much more freedom in how you choose to live your life.
If you can go from methadone to Suboxone, can you then go from Suboxone to not taking medication for opioid addiction?
While I disagree with that methadone nurse who thought that many methadone patients would never be able to get off of methadone, I do see some truth in what she said. There are patients who will do best by sticking with medication-assisted treatment indefinitely. Even if a patient is able to stop taking methadone or Suboxone altogether, they may have an increased risk of relapse in the future.
That being said, if a patient is willing to do the work necessary to stay relapse-free long-term without the help of medications, such as Suboxone, methadone, or naltrexone, they should have support from their doctor to make that decision. It is certainly possible for just about anyone who is determined to commit to their recovery to stay drug-free beyond medication-assisted treatment.
For example, I have known patients on medication-assisted treatment who were also very involved in peer-support recovery programs, such as Alcoholics Anonymous, Narcotics Anonymous, Celebrate Recovery, or Smart Recovery. In some cases, patients involved in a support program made the decision to stop taking Suboxone therapy after an adequate period of treatment. The decision was based on their confidence that they could rely on their program of recovery without the need for ongoing MAT.
While not all patients in this particular situation were able to remain relapse-free, many have been successful in getting past the need for MAT with the support of their recovery network and program. In all cases where a patient decides to discontinue MAT, I strongly recommend a program of relapse prevention which can include ongoing therapy and involvement in a peer-support group program.
Besides memory, are there other effects on the brain from methadone or Suboxone that go away after stopping treatment?
For the most part, patients who take methadone or sublingual buprenorphine are able to function normally and experience life just like anyone else who does not take medication-assisted treatment for opioid addiction
. The same goes for naltrexone, an opioid blocker which is used similarly to treat opioid use disorder.
However, one issue with all three of these medications, methadone, buprenorphine
, and naltrexone
, is that they interfere with the normal functioning of the endorphin-based reward system of the human central nervous system. The purpose of having opioid receptors in the brain is for the brain to produce endorphins to stimulate the receptors, providing a mild reward for positive activities in life.
Exercising, eating healthy foods, completing a difficult task, and many other activities will lead to endorphins being released in the brain. This reward system gives us a good feeling and reinforces positive behaviors and helps to develop good habits.
Unfortunately, drug use and other harmful habits can hijack the brain’s reward system, reinforcing dangerous behaviors. When this process gets out of control, when potent, highly addictive drugs are involved, the result can be active addiction.
Are there any long-term issues related to methadone addiction treatment or other forms of MAT?
Some patients who take any of the three MAT medications complain that they do not feel good when they exercise they way they used to. Their medications block natural endorphins, so they do not get a “runner’s high” when running or performing other, similar physical activities.
One benefit of completing MAT may be the restoration of this endorphin reward system after the patient stops taking methadone, Suboxone, or naltrexone. While this may sound like a big issue of long-term MAT, it is not for most patients.
Patients who are on MAT are able to still feel happy, relaxed, and fulfilled, enjoying life and spending time with friends and family. They are able to excel in their work and feel rewarded by their accomplishments.
It almost seems as if the endorphin system of the human brain is a vestigial structure that may no longer be needed by human beings in modern society.
We know what foods are healthy to eat, and we know that exercise is good for us. Learning that running can be a healthy activity by getting a runner’s high is not necessarily the best way to learn about proper exercise and healthy activities.
Many patients live stable, fulfilling lives, without any feeling of missing out on anything while taking medication to treat opiate addiction. Patients rarely complain about effects of methadone, buprenorphine, or naltrexone on their ability to function mentally or on their emotional state.
Methadone Addiction Treatment is not always the best option for medication-assisted treatment of opioid addiction.
If you are experiencing negative side effects from methadone or if you do have concerns about potential long-term effects, buprenorphine is a good alternative to consider. In addition to being a safer medication with less side effects, buprenorphine, the main ingredient in Suboxone, can be prescribed by almost any doctor.
In addition to being safer, with less side effects, Suboxone can be prescribed for up to one month at a time. There is even a six month implant available. While methadone is safer and more effective than many people believe and most of the myths about methadone are untrue, there are still many risks associated with taking methadone. If you are currently going to a methadone clinic, there is nothing wrong with continuing treatment, but you may want to consider transitioning to an alternate form of treatment in the future.