Is Methadone Still Used to Detox from Heroin?

Is methadone still used to detox from heroin? Yes, in some cases. However, Suboxone has become the gold standard for both heroin withdrawal and heroin maintenance treatment. There are several reasons for this. Suboxone’s synthetic opioid ingredient, buprenorphine, is only a partial agonist of the brain’s opioid receptors, especially the MOR or mu receptor. Because of this, buprenorphine’s ability to cause a high is quite limited, especially in a chronic user of opioids who almost always has a very high tolerance for all opioids in general. Buprenorphine is typically strong enough to suppress heroin withdrawal symptoms and curb drug cravings. It does this by binding to the same opioid receptors that heroin does, especially the mu, but it can’t bind the same way heroin, a full opioid agonist, can. This is why Suboxone keeps heroin withdrawal at bay without causing euphoria itself.

However, not everyone will respond well to Suboxone. It may not help someone with a very high tolerance to opioids, especially ultra-powerful ones like fentanyl. Heroin is at least 30 times weaker than fentanyl, but today’s street supply of heroin is often cut with fentanyl, resulting in an addiction to both heroin and fentanyl. Dealers like to cut their heroin with fentanyl because it’s cheap, easy for them to get and it boosts the high of the heroin, sometimes even fatally. Fentanyl is incredibly powerful. In fact, the lethal dose for a nonuser of opioids is only about two milligrams or roughly an amount represented by a couple grains of table salt. Even a regular heroin user with a high opioid tolerance may still die from doses as low as five or six milligrams. Street dealers are not skilled chemists with the knowledge of how to safely cut their heroin with fentanyl. They just want to increase their profits. When Suboxone fails to help someone with heroin withdrawal symptoms and other non-opioid adjunct medications aren’t enough, either, there is little choice but to give the patient methadone.

What is Methadone?

Methadone is a synthetic opioid developed early in World War II by the Germans. They had to be sure their soldiers and citizens would have access to a reliable painkiller even if opium supplies were cut off by the Allies. So, they created methadone. It was no problem; the Germans were and still are master chemists who have made many amazing contributions to this field. In fact, it was a German who first isolated morphine from opium in the early 1800s.

Methadone is a powerful analgesic, even better than morphine. It’s slow-acting and tends to produce little euphoria when compared to other opioids. For the treatment of heroin withdrawal and maintenance, it can be given orally and just once a day. Methadone has another major advantage over Suboxone: it can be given anytime during the withdrawal process and will provide complete relief to virtually anyone, as long as the dose is sufficient. In contrast, Suboxone has a waiting period before it can be taken for heroin withdrawal relief. If taken too soon, it can actually make the withdrawal symptoms far, far worse. This is called precipitated withdrawal or PW. Once begun, PW cannot be stopped. The only treatment is time. Eventually, after somewhere between 24 and 72 hours, the buprenorphine molecules will drop off the brain’s receptors and the syndrome will stop.

Methadone has no waiting requirement. Because it’s a full agonist, it will not cause precipitated withdrawal and can be given anytime. On average, a person in heroin withdrawal will have to wait at least 24 to 48 hours before it’s safe for them to begin Suboxone treatment. By that point, the person will be in full heroin withdrawal, in pain and extreme distress and discomfort. Not everyone is willing to do that. Methadone can be given right away, will provide reliable relief and then can be gradually tapered downwards over time.

Methadone can also be taken indefinitely to help users stay clean from heroin use. Here is where Suboxone has a major advantage: It can be prescribed by specially licensed doctors, filled at any pharmacy and taken at home. Methadone, when used for opioid maintenance, can only be dispensed at specially licensed methadone clinics, usually only one dose at a time on a daily basis. This is often a major intrusion into someone’s daily life. Worse, there may be no methadone clinics nearby.

If you Need Help

Methadone has helped millions reclaim their lives. It’s controversial, but if you think it may be right for you, no one has the right to judge you for it. Just call us at 844-639-8371 anytime for information about methadone detox and clinics near you. We look forward to helping you.

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