Methadone, a prescription opioid used in the treatment of opioid dependence, is primarily used for detoxification and maintenance treatment for people struggling to overcome opioid dependence.1,2 It helps to stabilize individuals by reducing withdrawal symptoms and blocking the high from other opioids, thereby also often helping them to better engage in addiction treatment.1,2 Available in pill, liquid, and wafer forms, methadone changes how the brain and nervous system react to pain and is also prescribed for pain relief.1,2
Methadone must be given at an opioid treatment program (OTPs) certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) under the supervision of an authorized medical provider. It is a mainstay of treatment for many opioid-dependent individuals attempting to avoid relapse. 1 While there is some controversy among certain recovery groups about using medication in addiction recovery, methadone can be a safe and effective tool when used appropriately. Like other opioid medications, methadone carries some risk of unwanted side effects, but these are less likely when the medication is not overused and it can be an effective treatment method for opioid dependency.1,3,5
How Methadone Treatment Works
When methadone is used in the treatment of opioid-dependent individuals, it is often referred to as methadone maintenance treatment (MMT) or medication-assisted treatment (MAT).1
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MAT for opioid addiction and/or dependence is a treatment approach that:1,10
- Includes the use of an approved medication for detoxification from opioids, for maintenance treatment, and/or for the treatment of opioid addiction.
- Can be provided in various treatment settings.
- Can be implemented with methadone, buprenorphine, or naltrexone, all of which are FDA-approved for the management of opioid dependence or addiction (depending on the drug).
- Involves different stages of treatment including:
- Induction stage—focused on getting steady blood levels of the medication.
- Stabilization stage—focused on ending drug-seeking behavior, other opioid use, and cravings.
- Maintenance stage—focused on keeping a patient abstinent from substance misuse and away from people, things, and places connected to their addiction, as well as helping them maintain a productive lifestyle (without regular adjustments to the dose).
- For best results, should integrate behavioral therapy and social support, which can help address underlying causes of the drug use and establish healthy patterns and skills for long-term recovery.
Like heroin and many prescription pain medications, methadone is an opioid medication.1,2 The difference is that it has a more gradual onset and causes more stable drug levels in the brain.11 At the same time, methadone will help to alleviate the desire to use other more destructive opioid drugs.11
Methadone works as MAT by providing two beneficial effects:1
- Methadone will minimize the painful symptoms of opioid withdrawal.
- Methadone will block the euphoric feelings produced by other opioid substances like heroin and painkillers, reducing cravings and discouraging abuse.
Methadone users are sometimes accused of replacing one addiction with another.11 However, despite common misconceptions, as part of MAT, methadone is prescribed and dispensed in a supervised and controlled way with an emphasis on safety.11
People that abuse opioids may find themselves in a dangerous cycle of seeking an intense “rush,” feeling the “crash” after the short-lived high, and experiencing strong cravings for more of the drug.11 Methadone eliminates the “rush,” “crash,” and craving pattern to help break the cycle of addiction.11 With a notably decreased compulsion to seek out and use opioids, the individual can commit more of their time and energy toward activities that contribute to their mental, physical, and social health.
Is It Right for Me?
Methadone is a good treatment option for many people. It has a long record of success in opioid treatment and is one of the medications most frequently used in MAT for opioid addiction.1,13 Methadone makes the brain think it’s still getting the used drug when in reality the person is not getting high and feels normal so that withdrawal is not experienced. It is recommended that individuals stay on methadone for at least 12 months, but some people may need it for years.1 However, other treatment options may be a better choice than methadone for some people, which is why they must work with a medical provider to find the best option for them.
Benefits of methadone include the following:1,5,7,9,11,14
- It’s a full opioid agonist. Methadone helps prevent or alleviate withdrawal and staves off or reduces cravings by powerfully binding to opioid receptors in the brain (displacing other opioids) and producing a stable level of the drug.
- It is generally safe. When used as directed under supervision, methadone has few risks with chronic use and is safer than using illicit opioids.
- Pregnant and breastfeeding women can take it. It is recommended that pregnant women dependent on opioids should take methadone rather than go through withdrawal, and it is recommended that mothers on methadone should still breastfeed their baby. However, these are general recommendations and any pregnant or breastfeeding women should discuss their treatment plan with their medical provider.
Potential Risks and Side Effects
Like other medications, methadone has a variety of potential side effects that range from mild to serious. A person experiencing side effects from methadone should consult with their prescriber or, if it is an emergency, call 911. Side effects of methadone may include:1,5,9
- Changes in mood.
- Stomach pain.
- Chest pain.
- Fast or pounding heartbeat.
- Trouble breathing or swallowing.
- Feeling sleepy or very drowsy.
- Dry mouth.
- Tongue soreness.
- Urination problems.
- Impaired vision.
- Difficulty sleeping.
- Hoarse or scratchy voice.
- Sexual dysfunction.
- Menstrual changes.
- Weight gain.
- Gastrointestinal issues (nausea, vomiting, decreased appetite).
Additional risks and drawbacks of methadone include:1
- Potential for misuse. As an opioid, it is possible for a person to use methadone in ways other than prescribed, including in an attempt to experience the euphoric effects. This can result in the individual becoming addicted to methadone.
- The impact on infants. Although methadone is safe for pregnant mothers, the substance imparts a risk to the babies after birth. Babies may experience uncomfortable withdrawal symptoms that typically begin a few days after birth but could start two to four weeks after birth.
While methadone is generally safe when used appropriately, misusing it may lead to an overdose. Even if the person is no longer feeling the effects of the last dose, the medication can still be in the body, leading to overdose if they take more.1 Overdosing on methadone can be fatal. Symptoms of overdose may include:2,5,9
- Markedly constricted pupils (aka pinpoint, or pinprick pupils).
- Sedation/intermittent loss of consciousness.
- Cold, damp, and/or blue skin.
- Limp/flaccid muscles.
- Slowed, shallow, or stopped breathing.
Taking more methadone than prescribed, using it too frequently, or combining it with other substances can result in overdose.1,9 Only use methadone as directed.
Viewpoints on Methadone and Sobriety
Support groups, including those that are organized and led by peers, can help members stay abstinent and augment therapy.3,10 However, some groups do not support the use of medications in recovery.10 Individual groups, even within the same organization, may have different policies or attitudes, however, so don’t hesitate to ask about your local organizations for their viewpoints on MAT. Never go with a program that doesn’t feel right to you. If you and your medical provider have decided that MAT is in your best interest, find a group that supports your choice to get treatment in this manner.
Medication-Assisted Recovery Anonymous (MARA) is a 12-step group that supports the use of medication to treat substance use disorders. As a fairly new organization, there is not much information on MARA aside from what they share on their website, and no outside expert evaluations of the program could be found. However, there is a list of meetings posted on their website, so an individual could go to one and determine for himself or herself if it seems like regularly attending would be helpful for them.
Because people have different needs, it is important to remember that there is no one set path to recovery.3 Whatever treatment method safely helps you to overcome your addiction is the right treatment method.
Finding Methadone Clinics
What is a methadone clinic? A methadone clinic is a SAMHSA-certified opioid treatment program (OTP) that specializes in MAT with methadone. When used to treat opioid addiction, methadone may only be prescribed and dispensed at a certified OTP or, if the patient is in the hospital for another condition, at that hospital.1,7 There are many ways to find methadone clinics, such as:
- Calling your insurance company.
- Researching available options online.
- Contacting a local mental health or substance use clinic or treatment facility.
- Using the Opioid Treatment Program Directory on SAMHSA’s website.
If you are taking methadone at an inpatient or residential facility but still need methadone when you discharge, either because methadone detoxification is not complete or you need methadone maintenance, the program should refer you to an appropriate outpatient OTP to continue treatment.10
When looking for a clinic, read reviews about the methadone clinic and ask plenty of questions like:
- How often do I have to come to the center?
- When is the clinic open? Are there times that are generally more or less busy?
- What is the average duration of appointments and treatment overall?
- What other services and programs are offered at the clinic?
- What if I am sick or must miss a day?
- What if I am traveling?
- Is my insurance accepted? Is there a sliding-scale payment option for self-pay?
Remember that one person’s experience with a methadone clinic will not be shared by all patients. Explore different options to find one that seems to meet your own unique needs.
What Does Treatment Cost?
Cost will vary depending not only on personal factors like insurance benefits but also possibly on:8
- Location of the clinic.
- Duration of the treatment.
- Amenities, programs, and services.
- Staff expertise and availability.
When you contact the center or receive your referral, ask specifically about the cost of treatment, insurance coverage, and ways to reduce the expenses. Clinics might offer sliding scales or separate programs to lower the costs for people in need.
What to Expect When at a Clinic
Each methadone clinic will be slightly different, but there will be some general similarities regarding the staff and the routine. Reputable methadone clinics will have:9
- Medical providers to complete an assessments, prescribe the substance if appropriate, and participate in treatment planning.
- Nurses to dispense and observe the consumption of methadone. The medication may be given as a liquid, pill, or wafer.1
- Counselors to provide additional support, such as by offering motivational interviewing to help reduce illegal drug use and counseling on other issues.
After you are given a dose of methadone from a nurse, you should be observed in a post-dosing supervision room for about 20 minutes in order to ensure you don’t leave with any unconsumed methadone.9
Methadone detoxification or methadone maintenance treatment will not be the best choice for every person dependent on opioids, but it can be a lifesaving treatment for some. Anyone who thinks they may have an opioid use disorder or another substance use disorder should see a treatment provider to be evaluated and discuss treatment options if needed, which may include medication-assisted treatment.