AKA:

Physeptone, Meth, Linctus, Juice, Amps.

SOURCE:

Prescribed drug, also sold illicitly

APPEARANCE:

Liquid mixture, orange, yellow, green or clear; Tablets; Ampoules for injection.

COSTS:

When sold on the streets, ampoules typically sell for £10; tablets are usually under £1 each. Methadone Mixture only has a nominal street value.

QUALITY:

When pharmaceutically pure, methadone comes in a variety of strengths. Methadone Mixture most frequently is mixed at 1mg/ml (i.e. 1mg methadone hydrochloride in 1ml of liquid).

Tablets: 5mg tablets.

Ampoules: Ampoules are usually mixed at strength of 10mg/ml. They come in the following sizes: 1ml (10mg), 2ml (20mg), 3.5ml (35mg), 5ml (50 mg)
Also available are concentrated ampoules, containing 50mg/ml.

METHODS OF USE:

Methadone Mixture is designed to be taken orally; it is mixed with an irritant to deter injecting. Tablets are also designed to be taken orally. However some users grind up tablets and inject them. Concentrated 50mg/ml are not intended for intravenous use, and are actually intended for subcutaneous or intramuscular use. When being used intravenously they should be diluted to prevent vein damage (see below).

EFFECTS:

Methadone is a less powerful painkiller than heroin, though it offers a similar, though less intense, absence of pain combined with euphoric qualities. The combined effects are a sense of well being, feeling warm, and content, drowsy and untroubled. At higher doses, the user may become heavily sedated, be sleepy, unable to talk, and appear to fall asleep for a few minutes at a time Users often experience nausea or vomiting on the first occasions that they use methadone, or when returning to use after a period of abstinence. Side effects include suppression of the cough reflex, more shallow breathing and a slowing of the pulse rate. Some users experience intense, allergy-like itchiness.

HEALTH IMPLICATIONS:

Methadone is physically addictive. After a period of regular use, there is an unpleasant period of withdrawal (often called "cold turkey,") as the drug is cleared from the body and the body adjusts to functioning without the presence of methadone. While unpleasant, sometimes lasting for over a week, it is not a life-threatening process. Far more difficult is to resist the psychological temptation to use during this period, in the knowledge that it would instantly alleviate the symptoms of withdrawal. Methadone remains in the body for longer than heroin, and some users allege that it is harder to withdraw from methadone than heroin. Regular use of methadone leads to an increase of tolerance to the drug. Initially, this means that one needs to take increasingly large amounts to achieve the same sense of euphoria and well being. Subsequently, it means that users find they need to use increasingly large quantities to prevent going into withdrawal, or just to feel "normal." Tolerance takes longer to develop than with heroin.

The flip-side of this is that, when methadone use is reduced (as with a reduction programme) or discontinued (for example after a spell in prison), tolerance drops. A user whose tolerance has dropped, who attempts to use the amount they were using when their tolerance was higher, stands a good chance of overdosing.

Overdosing on methadone is quite a frequent occurrence. Indeed, more deaths are attributed to methadone than heroin; amongst other effects, methadone can depress breathing, and in overdose, breathing can cease altogether ("having a bluey.") At present, there is little information targeted at illicit users of methadone, so ignorance about the variety of concentrations available is widespread.

Methadone, like heroin, does cause severe constipation amongst regular users. In addition, it acts to suppress the cough-reflex, leaving users at risk of chest and bronchial problems. Many health problems relating to methadone use stem from injecting. The injection of undiluted concentrated methadone ampoules has been linked to vein damage, tissue damage, ulceration and other problems.

LEGAL STATUS:

Methadone is a Class A, Schedule 2 drug. It can be legally produced, supplied and possessed under Home Office licence, but otherwise this constitutes an offence under the Misuse of Drugs Act.

OTHER INFORMATION:

Methadone is predominantly prescribed as a substitute for Heroin, for those dependent on Heroin. The advantages are that it is a pure, unadulterated substance whose strength is known, and which can be delivered in precise doses. When prescribed as Methadone Mixture, it offers an oral route of administration, rather than by injection. When prescribed, it also offers an escape from the Heroin lifestyle by removing the need to fund a large heroin habit. Once receiving prescribed methadone, the user is also hopefully drawn into other services such as support, counselling and primary healthcare services.

However Methadone is, in itself, an addictive substance and users can end up exchanging dependency on Heroin for dependency on Methadone. In some areas of the UK, methadone, especially in the form of injectable Methadone ampoules, is overprescribed, and the surplus spills onto the streets and is sold on illicitly. The use of illicitly purchased Methadone negates many of the advantages of methadone use under a therapeutic regime. Problems of injecting, of the financial burden, an unwillingness to use agencies such as primary health-care, and increased risks of overdosing are all prevalent amongst those who use and become dependent on this pharmaceutical overspill. Methadone is very toxic to children; those prescribed methadone are advised to keep it well away from children and babies.

For more information about Methadone, consult the Methadone Briefing available from Drugscope.