Methadone is a Food and Drug Administration (FDA)-approved medication for the treatment of opioid use disorder in adults.
Methadone is used to prevent opioid withdrawal symptoms and lessen cravings for opioids, and to blocking the effects of opioids. Studies show that people treated with methadone are more likely to stay off opioids, remain in treatment, and reduce their chances of dying of an opioid overdose.
Common side effects of methadone include anxiety, constipation, and diarrhea. Other considerations before taking methadone include negative interactions with other drugs you’re taking, ability to pay, and whether a methadone clinic is available near you.
Methadone can help end your dependency on prescription or illicit opioids by preventing withdrawal symptoms and lessening cravings for the drug as well as blocking its effects. Taken as prescribed — most often in liquid, powder, or tablet form — methadone is a safe and effective drug that for over 40 years has assisted adults with the management and treatment of opioid use disorder.
Uses. Evidence shows that when people with opioid use disorder stop taking the drug — whether it’s heroin, morphine, or an opioid pain medication such as oxycodone — they are apt to go back to using. This happens in part to prevent the onset of opioid withdrawal symptoms such as diarrhea, nausea, and vomiting.
Methadone is a synthetic opioid agonist that is among three FDA-approved medications for addiction treatment, along with buprenorphine and injectable extended-release naltrexone. Methadone assists people in staying off opioids by lessening these symptoms and cravings for the drug Although methadone targets the same opioid receptors as the opiate a person can become dependent on, it’s long-lasting, acts more slowly, and doesn’t generate a “high.”
Methadone is most often taken daily by mouth in tablet or syrup form, although it’s available in other formulations. The initial first-day dosage of methadone for opioid use dependency usually starts at 30 to 40 milligrams per day. If the licensed medical documents that the patient still has opioid abstinence symptoms, dosages may be adjusted by a small amount on a weekly basis until the treatment is working to maximum effect. However, maximum dosages range from 80 to 150 milligrams per day.
Although the medication has been around since 1947, methadone is considered a controlled substance and its distribution is highly regulated. People must receive the medication under the supervision of a practitioner at Substance Abuse and Mental Health Administration-certified opioid treatment programs or methadone maintenance programs. These methadone clinics can be publicly or privately funded. However, people who show they are “stable” (i.e., are taking the correct dosage and are not on other drugs) may be able to take methadone dosages home in between clinic appointments.
Benefits. People treated with methadone — ideally for a long term, or at least 12 months — are more likely to stay off opioids, remain in treatment, and reduce their chances of dying by overdose, studies show. In addition to reducing opioid use, methadone treatment has been proven effective in reducing the spread of infectious disease and even crime.
People treated with methadone treatment tend to have the best outcomes in recovery if they also attend individual and group therapy and receive referrals to other medical, mental health, and social support services. However, methadone treatment, especially lasting longer than six months, can work even in the absence of behavioral counseling.
Methadone not taken as prescribed can cause an overdose. Therefore, your medical provider may recommend that you or your loved ones in treatment with methadone have on hand naloxone, a medication sold over the counter that can reverse opioid overdoses. Learn how to get and use naloxone to prevent an overdose.
Although methadone is considered safe when taken as prescribed, it can cause side effects and pose other health risks, especially if it’s not used properly. Stopping use of methadone abruptly can also lead to withdrawal symptoms such as anxiety, cramps, tremors, and vomiting.
Review the following precautions to determine if methadone treatment is right for you:
Common side effects of methadone include anxiety, constipation, diarrhea, difficulty sleeping, drowsiness, dry mouth, itchiness, sexual issues (e.g., lower sex drive, impotence, or trouble orgasming), nausea, no appetite, sweats, and vomiting.
Report these more serious side effects to a licensed medical professional: chest pain; confusion or hallucinations; feeling faint; hives or a rash; racing heartbeat; shallow breathing; or swelling around the face, in the mouth, or in the throat.
Dependency and/or overdose. You can become dependent on methadone, and so it must be taken just as the doctor ordered — in other words, don’t take a larger dose or take it more often than prescribed. Let your medical provider know if you or someone in your household drinks alcohol in large amounts, obtains drugs on the street, or has misused prescription drugs. You can overdose on methadone, and some doctors may recommend that you or your loved ones have on hand naloxone, an over-the-counter medication that can reverse opioid overdose.
Pregnancy or breastfeeding. You can safely be treated for opioid use disorder with methadone during or if you’re breastfeeding. There is a possibility that babies of mothers taking methadone can experience neonatal abstinence syndrome, which could manifest in withdrawal symptoms. Experts say the small amount of methadone-containing breast milk that could pass to a newborn may be worth the risk, if the medication is effective in treating opioid use disorder.
Interactions. Because methadone is a depressant, the risk of overdose is greater if it’s taken with other drugs that have similar effects. These include alcohol; certain antipsychotics; benzodiazepines; cimetidine, a heartburn medication; ciprofloxacin, an antibiotic; and other opioids. Other drugs may lessen methadone’s effects and increase the risk of withdrawal symptoms. These include the antiretroviral medications efavirenze and ritonavir; and the antiseizure medication carbamazepine. Certain drugs may interact with methadone and lead to heart conditions.
Cost. The cost of methadone varies. One government estimated that opioid use treatment with methadone combined with other counseling and medical support services is $126 per week. The cost of methadone and other opioid use disorder treatments may be fully or partially covered by private insurance, Medicaid, and Medicare, but disparities in coverage exist among states. If you’re uninsured, underinsured, or otherwise have trouble paying for treatment, ask a methadone clinic you if they have financial assistance to help you obtain free or subsidized care.
Other considerations. Consult with a licensed medical provider before taking any medication, including methadone.
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Medications to Treat Opioid Use Disorder Research Report, How do medications to treat opioid use disorder work? Opioid Agonists and Partial Agonists (Maintenance Medications), National Institute on Drug Abuse, Aug. 10, 2022
Naltrexone, Substance Abuse and Mental Health Administration, April 21, 2022 and Lifesaving Addiction Treatment Out of Reach for Many Americans, A state-by-state look at care provided by opioid treatment programs, a critical facility, Feb. 17, 2022