Methadone

Amidone, chocolate chip cookies, fizzies, maria, pastora, salvia, street methadone, wafer, dollies, dolls, mud, phyamps, red rock, tootsie roll, balloons, breaze, burdock, buzz bombwrapping a dose in a cigarette paper and swallowing it More, cartridges, jungle juice, junk, meth, green, linctus, physeptone, juice, methadone hydrochloride, amps

Narcotic analgesicpain relieving, CNSthe Central Nervous System, upon which certain drugs act depressant

Methadone is a prescription only medicine that can be taken orally and is used mainly to treat opioid addiction. Is was initially developed as a painkiller but now it is much more widely used to treat people who have got stuck on heroin or other opioid drugs (such as prescription painkillers). Methadone is a powerful opioid drug, so it has similar effects to drugs like codeine, morphine, and heroin. It lasts much longer in the body than heroin, and therefore it is used to stabilise people currently using heroin (or other opioid drugs) and then help them get off opioid drugs completely.

Methadone should not be confused with mephedrone, they are completely different drugs. Anyone taking methadone when they are looking for mephedrone risks extreme danger ¹.

Methadone is a prescription drug, and is part of a group of drugs known as opioids. Opioids are depressant drugs, which means they slow down the messages travelling between the brain and the rest of the body ².

Methadone is taken as a replacement for heroin and other opioids as part of treatment for dependence on these drugs. Replacing a drug of dependence with a prescribed drug in this way is known as pharmacotherapy. As well as improving wellbeing by preventing physical withdrawal, pharmacotherapy helps to stabilise the lives of people who are dependent on heroin and other opioids, and to reduce the harms related to drug use ³.

Methadone is also used to relieve pain following heart attacks, trauma and surgery ⁴.

Methadone is the leading drug for substitute prescribing for heroin and other opiates and can be used to maintain or detox ⁵.

Methadone is a synthetic opiate used as a strong painkiller and as a substitute for heroin in the treatment of heroin dependence.

Like heroin, it is a sedativeOne of a diverse group of drugs manufactured for medical purposes to relax the central nervous system. More drug that can produce feelings of relaxation and can reduce physical and psychological pain, but methadone doesn’t deliver the same degree of pleasurable effects as heroin.

When a heroin user first begins treatment they are given a level of methadone (or other substitute drug) that is enough to minimise the withdrawal symptoms from the heroin ⁶.

The idea is that methadone will –

• suppress symptoms of opioid withdrawal,
• decrease cravings for opioids and hence illicit opioid use,
• change risky behaviour such as injecting and sharing needles,
• stop the need to commit crimes to fund the heroin habit,
• help patients stay in treatment ⁶.

Methadone is controlled as a Class A drug under the Misuse of Drugs Act. Unauthorised possession can lead to up to seven years in jail. Supply can lead to life imprisonment and/or an unlimited fine.

Methadone, as with all the stronger opioids, can itself become addictive.

It is very important that methadone should be kept out of the reach of children. There have been fatalities from children drinking the liquid which they may find particularly attractive due to its vivid green colour ⁶.

Methadone is the mainstay of drug treatment in the UK. Recently some practitioners have returned to the 80’s mantra that maintaining anyone on opiates/opioids rather than trying to detoxify them is merely trading one addiction for another. Consequently, these people tend to focus most of their frustrations on methadone.

There are plenty of research papers from all across the world supporting methadone, and it is undeniably effective for a very large number of people who are able to rebuild their lives while on long-term maintenance ‘scripts’.

It can also be used as a short term community based reducing dose detox therapy (in which context it is rather less successful). Methadone is less sedating than heroin and offers less of a ‘high’. It has a very long half-lifethe amount of time required for the amount of something to fall to half its initial value (usually over 24 hours) and consequently can be used once daily (although some users will split their daily dose into two).

Anecdotally, there is some evidence that heroin users disappointed with the effect of methadone may gravitate towards ‘potentiators’ (other substances that increase the ‘buzz’, such as alcohol, gabapentin, or a benzodiazepine like temazepam). This dynamic is hardly unique to methadone, but again, its prominence ensures that these issues are not ignored.

There are a number of health considerations that often occur when methadone is discussed – tooth decay (a sugar free version is available), libido (absolutely – most opioids and opiates reduce the sex drive in the medium/long term) and somatic (bone) pain or calcium deficiency (limited evidence from a research but strong anecdotal evidence from users) ⁷.

A synthetic opioid that is used as the hydrochloride. It is an opioid analgesicpain relieving that is primarily a mu-opioid agonist. It has actions and uses similar to those of morphine. It also has a depressant action on the cough centre and may be given to control intractable cough associated with terminal lung cancer. Methadone is also used as part of the treatment of dependence on opioid drugs, although prolonged use of methadone itself may result in dependence ⁸.

Methadone mixture is used in the management of opiate – mainly heroin – dependence. Methadone linctus is used as a cough suppressant and occasionally as a pain killer ⁹. Its mostly used as a substitute medication for people addicted to opioids such as heroin. It is occasionally prescribed as a pain-killer ¹.

• Maintenance (long-term programmes) – may last for months or years, and aim to reduce the harms associated with drug use and improve quality of lifethe overall enjoyment of life, a sense of well-being, and the ability to carry out routine activities. More.
• Withdrawal (short-term detoxification programmes) – run for approximately 5 – 14 days and aim to ease the discomfort of stopping the use of heroin ¹⁰.

For the treatment of dry cough, drug withdrawal syndrome, opioid type drug dependence, and pain ⁸.

It is available on the street, and usually comes in the form of a sticky green liquid; the liquid mixture is made in other colours however, and also in tablet form ⁷. It is usually a green liquid although there is a blue liquid that is much more concentrated. Methadone also comes as tablets but this preparation is rarely used ¹. Liquid mixture, most frequently green, but also blue, orange, yellow or clear; tablets; ampules for injection ¹¹.

Methadone hydrochloride is a white crystalline powder or colourless crystals. Available primarily in tablet or liquid form ¹². On prescription from a GPGeneral Practitioner, a community-based doctor in the UK or doctor in a drug dependency clinic, or diverted from either ⁹. Prescribed drug, also sold illicitly ¹¹.

When sold on the streets, ampules typically sell for £20 or more, and are not relatively scarce as a street drug; tablets are increasingly scarce and could cost a few pounds each. Methadone Mixture is hugely variable in price at a street level – from £10 for a small volume up to £30 or £40 for a larger dose ¹¹. The current price for a methadone 10mg tablet is £3 ¹³.

Methadone usually comes in liquid form that can be swallowed. It is usually a green liquid although there is a blue liquid that is much more concentrated. Methadone also comes as tablets but this preparation is rarely used.

Methadone is used illicitly, there is a street value for methadone that has been diverted from medicinal use. Most people use it illicitly in the same way as prescribed. As methadone is a powerful opioid drug it is very dangerous for people who are not tolerant to opioid drugs ¹.

Methadone is an opioid drug. It mimics the body’s natural pain-killing chemicals, endorphins'feel-good' chemicals produced by the body itself More. Therefore it can relieve pain, cause drowsiness, can cause mild euphoriafeelings of joy and happiness, slow breathing, slow the bowels causing constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More, and cause other side-effects of opioids ¹.

Methadone is a full agonist at the mu (µ) opioid receptor (see Morphine for more details on opioid receptorsnerve endings that sense changes in the body More) in the central and peripheral nervous systems. This produces the typical opiate effects of analgesiadecreased pain awareness. More, sedationthe state of being relaxed or sleepy because of a drug More, etc. and slight euphoriafeelings of joy and happiness, although at higher doses it blocks the euphoric effects that are seen by other opiates such as morphine and heroin. It also seems to have an affinity (ability to bind) to NMDA receptorsnerve endings that sense changes in the body More which are receptorsnerve endings that sense changes in the body More that release the neurotransmitter glutamate. This is thought to make methadone particularly effective in the treatment of neuropathic painpain caused by damage to the nerves. More compared with other opioids ⁷.

Opioids exert their effects by binding to and activating the μ-opioid receptor. This occurs because opioids structurally mimic endogenousproduced within or caused by factors within the body. More endorphins'feel-good' chemicals produced by the body itself More which are naturally found within the body and also work upon the μ-opioid receptor set. The way in which opioids structurally mimic these natural endorphins'feel-good' chemicals produced by the body itself More results in their euphoriafeelings of joy and happiness, pain relief and anxiolyticDrugs that relieve medically-diagnosed anxiety. More effects. This is because endorphins'feel-good' chemicals produced by the body itself More are responsible for reducing pain, causing sleepiness, and feelings of pleasure. They can be released in response to pain, strenuous exercise, orgasm, or general excitement. The bioavailability of orally administered methadone can vary from 40% to around 99%. Methadone is metabolised by the cytochrome P450 system.

Unlike most opioids, methadone is a weak serotonin reuptake inhibitor as well as a week NMDA antagonist. Similarly to dextropropoxyphene, methadone is a nicotinic acetylcholine receptor antagonist ¹⁷, ¹⁴.

The inside of your stomach is a churning, acidic place. Anything that hits this caustic environment is broken down almost immediately. In order to help methadone reach the stomach, rather than being broken down in the mouth or in the throat, manufacturers create a bubble around the active ingredient in these oral medications ²¹. Those additives can include –

• glycerin,
• food colouring,
• flavouring,
• sorbitol ²¹.

Some of these ingredients simply won’t break down inside the veins, and no matter how much you might try to filter out all of the particulates, some tiny bits might remain and they might work like little missiles, zooming to your heart or to your lungs and causing very serious damage. Injecting this material can also damage your veins, causing them to block up and bleed ²¹.

• swallowed – both the liquid and tablet forms are made for swallowing (ingesting),
• injected – ampules for injection are produced but are prescribed to relatively few heroin users ⁷.

Methadone is dispensed primarily in oral forms, including tablets, powder, and liquid for the treatment of narcotics addiction. Single doses, which should not exceed 80 – 100 milligrams daily, can last anywhere from 24 – 36 hours depending on user characteristics (e.g. age, weight, level of addiction, and tolerancethis is the process by which the receptors in your brain become habituated to the action of a drug. When tolerance is reached, more of the drug is required to achieve the same effect. With benzodiazepines, and probably with many other classes of drugs as well, tolerance is virtually always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependence. More); the long-acting nature of the drug is a distinct advantage since it requires less frequent administration, limiting potential harmful effects (0472). Tablet forms of the drug, sometimes called diskettes, contain approximately 40 milligrams of methadone and are often dissolved in water and ingested orally. There is also a white crystalline powder form available that is dissolved in water and swallowed. Illicit methadone is sometimes administered through injection (injection is not a valid route of administration in treatment) directly into the bloodstream. This form subjects users to increased risks of a variety of diseases, including HIV/AIDS ²².

Methadone mixture and methadone linctus are taken orally, physeptone ampules are injected. The tablets are taken orally but are sometimes injected ⁹.

Methadone mixture is designed to be taken orally; it contains additives which cause irritation and discomfort when injected. This irritation combined with the large volumes and associated vein damage make methadone an unpopular choice for injectors.

Tablets are also designed to be taken orally. However some users grind up tablets and inject them.

Injectable ampules are intended for intramuscular use; concentrated 50mg/ml were not originally intended for intravenous use, and can cause irritation and significant vein damage when injected in to a vein. Some users will dilute the ampules to reduce the discomfort of injecting this highly acidic compound ¹¹.

As an opiod, it mimics the body’s natural pain-killing chemicals, endorphins'feel-good' chemicals produced by the body itself More. Therefore it can relieve pain, cause drowsiness, can cause mild euphoriafeelings of joy and happiness, slow breathing, slow the bowels causing constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More, and other side-effects of opioids. As it takes longer to build up in the body and takes longer to come out of the body it causes much less euphoriafeelings of joy and happiness than heroin. However, most people report being drowsy, mentally slowed, and often a bit sweaty taking methadone every day ¹.

Medications that are meant to be swallowed often contain time-release properties, meaning that a tiny amount of the drug becomes active at a time. This allows people to take the drug and feel the effects of the drug over a long period of time. If you inject time-release methadone, you’ll get the entire impact of the drug all at once. Even a dose you might take orally with no issues could cause an overdose if you inject it, simply because you’ll have the full impact hitting your body at the exact same time. Death can quickly follow a methadone overdose ²¹.

If the dose is too high, the following symptoms may be experienced. If any of the following effects are experienced an ambulance should be called, ambulance officers don’t need to involve the police.

• pinpointthe pupils are very small. More pupils,
• slow pulse,
• shallow breathing,
• low body temperature,
• low blood pressure,
• poor circulation,
• dizziness,
• cold clammy skin and bluish tinge,
• mental numbness,
• occasional seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More ⁴,
• slow shallow breathing,
• cyanosisbluish tinge to fingers and lips, caused by inadequate blood supply,
• stomach spasms,
• clammy skin,
• convulsionswhen your body shakes violently without you meaning it to,
• weak pulse,
• coma,
• death ²⁷.

If someone takes an overdose of an opioid drug they can die quickly. This is usually by respiratory depressionslowing the drive and effectiveness of breathing More. Anyone not used to opioid drugs would be much more at risk of this. Methadone is often reported as a contributory cause of death in opioid drug-related overdoses. It is particularly dangerous if mixed with other drugs such as heroin, alcohol, and benzodiazepines.

The risks of death by overdose increase when many substances are taken together for example alcohol and benzodiazepines which also have effects on breathing. Methadone decreases control and impairs judgment, making the risk of accidents much higher. This means activities like driving under the influence of methadone are potentially very dangerous. If you are prescribed methadone by your doctor you must inform the DVLADriver Vehicle Licensing Authority - the UK authority that manage driving licences. More and they have to make a decision whether you are still safe to drive ¹.

The risks of depressed breathing caused by methadone may be increased in people with conditions such as muscle weakness (e.g. myasthenia gravis), sleep apnoeaSuspension of breathing. During apnoea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. More, or lung disease/breathing disorders ¹.

Addiction to methadone can be defined as the condition of being habitually or compulsively occupied with, or involved in the use and abuse of methadone ²⁸. There are two main components of the definition of methadone addiction –

1. The first symptom of addiction is that individuals who are addicted to methadone use this medication regularly and habitually despite the harms it causes.
2. The second main symptom of addiction is the occurrence of compulsive methadone use which is generally beyond the individual’s conscious control ²⁸.

Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption ¹⁴.

• Depressants (1,4-Butanediol, 2m2b, alcohol, barbiturates, benzodiazepines, GBL / GHB, methaqualone) – This combination can result in dangerous or even fatal levels of respiratory depressionslowing the drive and effectiveness of breathing More. These substances potentiate the muscle relaxation, sedationthe state of being relaxed or sleepy because of a drug More and amnesiainability to remember caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
• Dissociatives – This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.
• Stimulants – It is dangerous to combine methadone, a depressant, with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedativeOne of a diverse group of drugs manufactured for medical purposes to relax the central nervous system. More effect of methadone, which is the main factor most people consider when determining their level of intoxication. Once the stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate wears off, the effects of methadone will be significantly increased, leading to intensified disinhibition as well as other effects. If combined, one should strictly limit themselves to only taking a certain amount of methadone.
• Psychedelics – Methadone is well known to lower seizure threshold and psychedelics also cause occasional seizuresthe outward effect can vary from uncontrolled jerking movement (tonic-clonic seizure) to as subtle as a momentary loss of awareness More ¹⁴.
• 5-Hydroxytryptophan,
• MAOI,
• Serotonin,
• Serotonin-norepinephrine reuptake inhibitors ¹⁴.

Methadone is dangerous if mixed with alcohol, benzodiazepines or heroin. Taking methadone with depressant drugs increases the risk of depressing breathing. Additionally, the effects of methadone may be masked if taken with a stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate, which can lead to an overdose if a lot of the drug is taken and then the stimulanta drug that acts on the Central Nervous System, increasing some rates of function such as heart-rate wears off. Certain medications (e.g. some antidepressants) may also interact with methadone to increase sedativeOne of a diverse group of drugs manufactured for medical purposes to relax the central nervous system. More effects ¹.

A period of sustained dependence on any drug can be debilitating and prevent people from working and leading an active life. It may also cause mental and physical harm and opioid withdrawal can be very unpleasant.

Acute withdrawal effects from methadone can be intense, although for many they will be milder than those from heroin. Acute withdrawal effects include shivering, yawning, feeling cold and clammy, goose-bumps on the skin, diarrhoeaWhere you frequently pass watery or loose faeces and vomiting, flu-like symptoms, agitation, anxiety, insomniadifficulty in going to sleep or in getting enough sleep and sensitivity to sound/light. Opioid withdrawal symptoms are unpleasant but do not endanger life.

Potential effects of long term methadone use include constipationmeans that you're not passing stools regularly or you're unable to completely empty your bowels. More, tiredness, sedationthe state of being relaxed or sleepy because of a drug More. People often have problems with their teeth as methadone reduces your natural saliva which protects the teeth against dental caries ¹.

Long-term risks of methadone are low if it is used as prescribed ¹

Methadone withdrawal develops more slowly and is less intense than withdrawal from heroin. Withdrawal symptoms are similar to those listed under ‘Dose-related effects’ under ‘too low’ dose. Most of these effects will begin within 1 – 3 days after the last dose and will peak around the 6th day, but can last longer ², ⁷.

Withdrawal symptoms can begin within 12 hours of missing a dose and can last for several days. They include –

• anxiety,
• muscle pain,
• sweating,
• dilated pupils,
• nausea,
• agitation,
• paranoiasuspicion, distrust or fear of other people ²⁹,
• cravings,
• depression,
• diarrhoeaWhere you frequently pass watery or loose faeces,
• flu like symptoms (fever, sweating and chills),
• hallucinationswhere someone sees, hears, smells, tastes or feels things that don't exist outside of their mind,
• increased heart rate,
• insomniadifficulty in going to sleep or in getting enough sleep,
• irritability,
• loss of energy,
• muscle aches and pains,
• nausea and/or vomiting,
• paranoiasuspicion, distrust or fear of other people,
• stomach cramps,
• suicidal thoughts ²⁸,
• yawning,
• coughing,
• sneezing,
• runny nose,
• lachrymation,
• raised blood pressure,
• increased pulse,
• dilated pupils,
• cool, clammy skin,
• diarrhoeaWhere you frequently pass watery or loose faeces,
• nausea,
• fine muscle tremor,
• restlessness,
• irritability,
• sleep disorders,
• depression,
• drug craving,
• abdominal cramps ³¹.

Methadone is one of the most researched medicines available, and if used correctly, is safe. Specific care should be taken to keep out of the reach of children, they seem to find the green syrup visually attractive. This is another area where methadone receives negative attention as thoughtless storage has caused infant fatalities leading to a call for stricter controls.

Methadone is available as a mixture, tablets, ampules and suppositories. The usual strength is Mist. Methadone 1:1 (Drug Tariff Formula). The tablets are 5 mg, white.

Although they are relatively rare, there is some concern over the acidity of methadone ampules. Certain clients seem to suffer tissue damage at injection sites. Injecting oral methadone in any of its formulations should not be attempted.

Dosing levels are, of course, critical to the success of any treatment intervention. The evidence shows that doses between 60 – 120mg of methadone daily are most effective at reducing heroin use and improving health and social functioning. Many services are not yet up to speed on this, but the situation is slowly improving in most areas. Release’s survey of 2002 found that of 1,689 heroin users questioned, 728 were on methadone scripts and on top of these another 116 (16%) of people regularly increased their intake by buying extra ‘grey’ market supplies, this strongly suggests many are on inadequate doses ⁷.

Estimating how long methadone is detectable in the body depends on several factors, including which kind drug test is being used. Methadone – also known as Westadone, Dolophine, Methadose – can be detected for a shorter time with some tests, but can be ‘visible’ for up to three months in other tests.

The timetable for detecting methadone in the system is also dependent upon each individual’s metabolism, body mass, age, hydration level, physical activity, health conditions and other factors, making it almost impossible to determine an exact time methadone will show up on a drug test.

How long methadone has been used, the frequency of use and the dosage can also be factors in how long it might be detectable in drug testing ²⁴.

The following is an estimated range of times, or detection windows, during which methadone can be detected by various testing methods –

• Class A drug (unless it has been prescribed to you). Penalties for possession are up to seven years in prison and/or an unlimited fine. Supply holds penalties of up to life in prison and/or an unlimited fine. Remember ‘looking after’ someone else’s methadone is still an offence.
• Your driving licence is invalid on a methadone treatment programme unless agreed by the DVLADriver Vehicle Licensing Authority - the UK authority that manage driving licences. More following receipt of supportive medical advice ³².

Cracker – device used for opening methadone cartridges ²⁰. Brown medicine bottles for mixture and linctus; syringes, ampules, tourniquetA tie, rubber hose, shoe lace, belt or similar used to tie around an arm or leg in order to build up blood pressure and thus 'pump up' a vein prior to injection. More etc if injected ⁹.

Methadone overdose can also occur if a person takes methadone with certain painkillers. These painkillers include oxycontin, hydrocodone (Vicodin), or morphine ³⁷.

According to the Drug Enforcement Administration –

• In 2012, almost 2.5 million people over the age of 12 reported abusing methadone in their lifetime; marking an increase from 2.1 million in 2011.
• In 2011, more than 65,000 emergency room visits were related to methadone use.
• From 1999 to 2005, methadone overdose deaths increased by about 460% ³⁸.

Methadone was developed in 1937 in Germany by scientists working for the Nazi conglomerate I G Farbenindustie. The reason for its swift abandonment as an alternative to morphine was due to the adverse effects it had in early trials. The doses used were however colossal by modern standards.

After the war, all German patents, trade names and research records were requisitioned and expropriated by the Allies, as reparations.

Despite some early trials, it was not until studies in New York City by Professor Vincent Dole along with Marie Nyswander that methadone was systematically studied as a potential substitution therapy. Their studies introduced a sweeping change in the notion that drug addiction was not necessarily a simple character flaw, but rather a disorder to be treated in the same way as other diseases. Dole and Nyswander are seminal figures in the history of drug treatment. Sadly, methadone rather than taking a place in the armatorium of possible pharmacological treatments for opiate dependence it has emerged as the treatment of choice (alone with Subutex/Suboxone), at the expense of a wider range of choices amongst which it once stood ⁷.

Methadone was developed in Germany in 1937 by Gustav Ehrhart and Max Bockmühl, that could be created with readily available precursors.

On September 11, 1941 Bockmühl and Ehrhart filed an application for a patent for a synthetic substance they called Polamidon, and whose structure had only a slight relation to morphine or other opiate alkaloids. It was brought to market in 1944 and was widely used by the German army during World War 2.

Methadone was introduced into the United States in 1947 by Eli Lilly and Company, as an analgesicpain relieving under the trade name Dolophine ¹⁵.

The chemical structure of methadone was first produced in the 1930’s as a team of German scientists were searching for a pain-killing drug (analgesicpain relieving) that would not be as addictive as morphine. In 1937, two scientists (Max Bockmhl and Gustav Ehrhart) uncovered a synthetic substance that they called Hoechst 10820 or polamidon. Years later during World War II another team of German scientists expanded on earlier research and began synthesising the substance as a result of short supplies of morphine and other analgesics ³⁹. By the end of the war, the United States had obtained the rights to the drug from war requisitions and later coined the name methadone. Soon after in 1947 methadone was introduced into the United States to be used as a pain reliever for a variety of conditions, but eventually uncovered its usefulness in treating narcotic addictions ³⁹. Until the 1960’s, little scientific advancement was made with regard to methadone. But with a resurgence of heroin addiction, researchers began to search for a substance that could reduce or eliminate drug craving and withdrawal signs and symptoms ⁴⁰. The idea behind this research was that methadone could be used to manage or maintain heroin addiction. In 1964, the effectiveness and usefulness of using methadone maintenance (i.e., using it as a substitute narcotic to prevent withdrawal) was realized. In the spring of 1971, methadone treatment for opiate dependence began to expand. That year the Federal Government developed regulations governing the use of methadone in the treatment of heroin addiction; final regulations were published in December 1972. Few advancements were made until 2001 when regulations over methadone were modified to allow physicians and other health care professionals to provide methadone more effectively and consistently ⁴¹.