Methadone

What it is

Methadone is a long-acting opioid medication that reduces cravings and withdrawal symptoms. It usually comes in liquid form, is taken orally, and dispensed daily.

What it does

Methadone satisfies the areas of the brain that opioids act on, calms withdrawal symptoms, and reduces drug cravings. It can block the euphoric effects of short-acting opioids, such as heroin.

People taking a prescribed dose of methadone that is right for them feel normal, can continue to work, and can usually perform tasks like driving.

Because methadone controls withdrawal symptoms and blocks cravings, people who are addicted to opioids tend to stick with it. This allows them to build a life in recovery and avoid the hazards and problems that come with illegal drug use.

Where do you get it?

Methadone is usually given daily. It can be dispensed only at licensed, federally-regulated opioid treatment programs. Limited take-home dosing may be permitted, and can become more frequent for those doing well in long-term treatment. The provider can explain the guidelines about “take-home medication.”

Cost

Methadone is typically the least expensive of the three Medication Assisted Treatment (MAT) options. However, the real cost to an individual varies depending on the state where the person lives, health insurance coverage, and other factors. The provider will have information about real cost and payment options.

Who it works for

Methadone can work for people who have made other unsuccessful attempts to stop. It is a recommended treatment for opioid use disorder during pregnancy.

Research outcomes

Methadone has been in use for many years. It is the best-studied approach to MAT for opioid use disorder. Research shows that methadone treatment can be highly effective when combined with counseling and recovery support.

Starting methadone

Methadone can be started at any time. There is no need to wait for withdrawal symptoms to begin after the last use. However, providers will not start methadone treatment with anyone who seems to have just used or who appears intoxicated.

After the first dose of methadone, people typically stay at the clinic for a few hours. The doctor or nurse usually checks on them regularly to watch their reaction. If withdrawal symptoms are a problem, 2–4 hours after the first dose another small dose may be given. The goal is to find the dose that controls withdrawal symptoms with the fewest side effects by beginning low and increasing slowly.

Side effects

Most people have some side effects from methadone such as constipation, sleepiness, and sweating. Long-term use of methadone may cause sexual side effects and heart problems.

Warnings

Some warnings are listed below. For complete information, visit the websites at the end of this section.

  • Highest risk of overdose at start of treatment.
  • High risk of overdose when combined with benzodiazepines (Valium, Ativan, Xanax).
  • High risk of overdose when combined with other substances, including alcohol.
  • Increased risk of serious heart problems and sudden cardiac death.
  • Risk of driving impairment at the start of treatment or during dosage adjustments.
  • May affect ability to get a commercial driver’s license (CDL) in some states.

To reduce the risk of heart problems, experts recommend:

  1. You know about the heart risks;
  2. You are screened for heart health and history;
  3. You may get heart tests as part of your treatment program; and
  4. If a problem is found, the methadone dose should be lowered or stopped.

All medications can interact with alcohol, other prescription and over-the-counter medications, as well as vitamins, herbs, and supplements. If you use alcohol or other drugs in addition to opioids, your situation may be more complex. Talk to your doctor about all the medications and substances you use. To learn more about medication interactions, visit: Avoiding Drug Interactions.

Risks to others

All medications should be stored in a locked cabinet out of reach of children or pets. Doses tolerated by some individuals can cause serious harm, even death, to others. Medications should only be taken by the person they were intended for. Excess medication should be disposed of properly. More information on how to dispose of excess medication where you live, and where you can drop off unused medicine during annual take-back days can be found here.

How long do I need to take it?

The decision about how long to take methadone is an individual choice people discuss with their treatment provider. Most of the time, methadone treatment for less than 90 days has little effect. People who take it a year or more have the best rates of success.

Some take methadone for many years. Others choose to taper off very gradually with the help of their treatment providers. Some research shows that many people return to drug use when they stop taking methadone. This is one reason people stay on methadone maintenance for a long time. It is best to periodically assess the need for ongoing treatment with your doctor or counselor.

There is withdrawal from methadone when it is stopped quickly. Methadone withdrawal is less intense than heroin withdrawal, but it lasts longer. Withdrawal symptoms can be reduced by slowly cutting down the methadone dose over a number of months.

Pregnancy

Methadone has been used for years to safely treat opioid problems during pregnancy. As with any treatment, there are some risks; but they are not nearly as high as the risks pregnant women with untreated opioid use disorder may face. Infants born to mothers treated with methadone during pregnancy are at risk for withdrawal symptoms, sometimes severe enough to require medication and delay discharge from the hospital. These symptoms can be monitored and are easily managed in most hospitals, and there is no evidence of permanent effects. Women are encouraged to breastfeed, although trace amounts of methadone may be found in breast milk. Researchers agree that these low levels are not a cause for concern, and that the benefits of breastfeeding for the infant far outweigh any risk.

HIV/AIDS

Structured methadone programs may be beneficial for people who are being treated with HIV medications. Methadone doses may need to be adjusted for those on certain medications. It can interact with some of the drugs that are used to treat HIV. Talk with your doctors about your situation.

Hepatitis and liver disease

Methadone is usually safe for people with hepatitis unless the liver is functioning very poorly. It has been used safely in combination with interferon by people undergoing treatment for hepatitis. Talk with your doctors about your situation.

Pain

Methadone can be used with other opioid medications prescribed for pain. Dosage is watched carefully due to overdose risk. Methadone for maintenance therapy is only taken once a day, which is not enough to control pain.

People who use methadone for MAT may have a high tolerance for opioid pain medications. They may not get relief from their pain at typical dosages. They can benefit from working with a doctor experienced with managing pain in people with histories of opioid use disorder.

Legal issues

  • Methadone does not affect the ability to get a driver’s license, as long as the person is not using illegal drugs or abusing prescription medications.
  • Methadone may affect eligibility for commercial driver’s licenses in some states.
  • People receiving methadone treatment are protected by confidentiality laws and anti-discrimination laws as long as they are not using illegal drugs or abusing prescribed medications.
  • Methadone may show up on a drug screen.
  • An employer legally cannot fire you for being treated with methadone as long as you can document that it is prescribed as part of your medical treatment.
  • People involved with the criminal justice system often have a difficult time getting methadone while in jail or prison, or while under court supervision.

For more information

More information on methadone
www.nlm.nih.gov/medlineplus/druginfo/meds/a682134.html

FDA approved package inserts and product labeling:
https://www.dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=human&query=METHADONE

How To Use Methadone Safely
http://dptbeta.samhsa.gov/methadonesafety/text_publications/follow_directions_brochure.aspx

Methadone Treatment for Pregnant Women
store.samhsa.gov/product/Methadone-Treatment-for-Pregnant-Women/SMA09-4124

Know Your Rights: Rights for People on MAT
www.lac.org/doc_library/lac/publications/Know_Your_Rts_-_MAT_final,_9.28.10.pdf

Female

I've heard a lot about methadone. It has worked for a lot of my friends. Can it help me recover?