Methadone is a medication frequently used in the treatment of opioid use disorders. As a part of medication-assisted treatment (MAT) for opioid use disorder (MOUD), methadone can help limit the discomfort of withdrawal symptoms and reduce urges to use throughout the recovery process. Though methadone can be abused, when used as part of a comprehensive and supervised treatment program, it is safe and effective.
What Is Methadone?
Methadone is a prescription medication and opioid that is primarily used to treat severe pain and opioid use disorders (OUDs) where the person is psychologically addicted to and physically dependent on another opioid. When completely quitting is not considered the best approach for someone, methadone offers a safe, regulated, and supervised alternative.1,2,3 If a person is abusing illicit or prescription opioid substances, like heroin, oxycodone, or has a fentanyl addiction, they could utilize methadone to help end their addiction.
Methadone is typically taken once a day, and it may only be available at specific methadone treatment centers. People may receive methadone in as a liquid, pill, or wafer-like diskette.1
Methadone works as part of MOUD treatment because it is a long-acting opioid agonist. In the body, methadone attaches to the same receptors as other opioids. The difference is that, when taken as prescribed, methadone creates a predictable and steady effect, so the person does not have to experience the drastic highs and lows of short-acting opioids, like heroin.1,2
How Is Methadone Used in Treatment?
In opioid addiction treatment, methadone is used as an alternative to immediate opioid cessation or tapering from the problematic drug over time. Methadone replaces the dangerous opioid as a way to manage the body and brain’s reaction. Ideally, methadone will prevent the uncomfortable withdrawal symptoms of detoxification and eliminate any cravings for other opioids.1,2
Patients using methadone could be tapered off of the medication over a few months or use it long-term. People should always work to establish treatment goals with their treatment team.2 The minimal duration of methadone treatment varies, but patients should plan on taking the medication for at least one year.1
To receive methadone treatment, a prescriber must authorize use and supervise the treatment, which involves getting daily doses at the treatment center. When there is significant progress and consistency, some patients may be allowed to take their doses home.1
Here are some tips to help you stay safe and be successful while taking methadone:
- Be honest about your experience with professionals
- Engage in therapy and support groups to complement methadone treatment
- Try to take your dose at the same time each day
- Avoid driving until you see how methadone affects you
- Don’t take more or less than what is prescribed by a doctor
- Don’t consume alcohol or other substances while taking methadone
- View methadone as a helpful tool for recovery, not as a “crutch” or substitute for other opioids
- Dispose of unused methadone safely with the direction of your care team
Risks & Safety Concerns of Methadone
When used as recommended for pain or opioid use disorders, methadone is generally safe and effective, but it may not be the best choice for all people. Methadone is a powerful opioid substance and does carry some risks, so having a thorough evaluation by your doctor is essential.
To ensure health and safety while using methadone, be sure to tell your doctor if you have any of the following conditions: 3
- Glaucoma
- Irritable bowel disease (IBS)
- Parkinson’s disease
- Ulcers
- Urinary problems
- HIV
- Mental health conditions
- Seizures
- Heart disease or a heart rhythm disorder
- Liver, thyroid, pancreas, gallbladder, or liver disease
- Head injuries or brain tumors
- Breathing problems
Methadone Addiction
Because it is a substance of abuse, taking methadone may result in an opioid addiction. It’s never possible to predict who is likely to become addicted to methadone, but the benefits of the medication seem to far outweigh the risks.
Just because someone is using methadone, it does not mean they are addicted. As long as the person is taking the medication as directed, their risk for addiction is low. However, they may become physically dependent on the substance, meaning that they need it to feel well and function normally.2 Someone using methadone will likely be physically dependent on it, but this response is expected. Plus, they were already dependent on another opioid, which is why methadone treatment was required.
Using Methadone While Pregnant
Methadone has been used safely and effectively for pregnant women at all stages of pregnancy since the 1970s.2,4. If mothers are able to safely stop using opioids before pregnancy, that is ideal. But for some mothers, taking methadone can help reduce unwanted outcomes.
Breastfeeding on methadone may be possible. If you are prescribed methadone while breastfeeding, follow your doctor’s instructions for dosing and timing of breastfeeding.3
Methadone Side Effects
Like many other safe and effective medications, methadone has some level of side effects that occur with use. Some effects may decrease over time, while some will be more persistent and actually worsen throughout treatment. Each person will have a unique experience, and those with side effects should always consult with their prescriber to weigh the risks and benefits of methadone treatment.
Common side effects of methadone include:1,3
- Restlessness
- Nausea, vomiting, and constipation
- Headache
- Weight gain
- Dry mouth or sore tongue
- Stomach pain
- Sleep problems
- Mood changes
- Feeling flushed
- Trouble urinating
Serious side effects of methadone may include:
- Trouble breathing or swallowing
- Feeling lightheaded
- Chest pain
- Confusion, agitation, or hallucinations
- Trouble staying awake
- Rash or swelling
- Itching or hives
If you or someone you know is experiencing any of these serious side effects, it is essential to seek emergency services immediately. These side effects could be life-threatening.
Symptoms of Methadone Overdose
It’s important to remember that methadone is an opioid, and like other opioids, overdosing on the medication is a concern. Any time someone takes more methadone, mixes methadone with other substances, or changes the way they take methadone, there is a risk of overdose.
During a methadone overdose, the person may appear extremely sleepy, limp, and unable to respond to questions. At this point, emergency medical treatment will be necessary. Call 9-1-1 or go to the emergency room and never leave the person alone.
Signs of a methadone overdose include:3,5
- Slow and shallow breathing
- Tiny pupils
- Appearing extremely drowsy, sleepy, and disoriented
- Limp and lifeless muscles
- Blue color on fingernails, toenails, and lips
- Skin that feels cold and clammy
- Convulsions
- Weak pulse
- Coma
It is important to seek immediate medical attention if symptoms of an overdose occur. Overdoses can result in death, but acting quickly upon noticing symptoms can save a life. Opioid-overdose drugs, like naloxone, can quickly reverse the symptoms of methadone overdose and greatly improve a person’s chances of survival.2
Methadone Drug Interactions
Methadone interacts with a long list of prescription drugs, so always consult with your medical team about all the prescription and over-the-counter medications you take. Combining these substances could create dangerous drug interactions, or they could reduce the efficacy of both medications.
Medications and substances that can negatively interact with methadone include:3
- Alcohol: Like opioids, alcohol can affect a person’s breathing, so combining these can have a more dangerous impact on breathing and alertness.
- Benzodiazepines: Benzodiazepines, including alprazolam (Xanax), chlordiazepoxide (Librium), and clonazepam (Klonopin), can increase some of the effects of methadone and potentially result in overdose.
- Other opioids: Prescription pain medications, certain over-the-counter cough medicines, and illicit opioids should always be avoided, and the combined effects can put the individual in danger of dangerous overdose effects.
- Antipsychotics and antidepressants: Using these medications concurrently could produce interactions, so prescription adjustments might be necessary
Vitamins, minerals, herbs, and dietary supplements could create unpredictable complications with methadone as well. Even if you think methadone will not interact with a certain substance, let your doctor know if you are currently or considering taking any substance.
Methadone Withdrawal
When a person misses a dose of methadone or is ending their methadone treatment, they will likely experience methadone withdrawal symptoms. Methadone withdrawal will mirror other opioid withdrawals. However, because methadone is a long-acting opioid, symptoms may be delayed and longer lasting.
With short-acting opioids, a person may begin experiencing the discomfort of withdrawal in just a few hours. However, symptoms may not begin until 48 hours after last use of methadone. Similarly, it may only take four days to complete withdrawal from a short-acting drug like heroin, but methadone withdrawal could take as long as 20.6 Any opioid withdrawal will be uncomfortable, but the duration of methadone withdrawal can be especially frustrating.
Methadone withdrawal may include:6
- Nausea, vomiting, and diarrhea
- Increased anxiety
- Inability to sleep
- Hot and cold flashes
- Sweating
- Cramps and muscle spasms
Sometimes, people refer to methadone as “liquid handcuffs” because they need to continue using the medication to avoid these challenging withdrawal symptoms.7
Questions to Ask Your Health Team
Before starting MOUD with methadone, you’ll want to ask your treatment team various questions about what methadone is, how it works, and if the opioid medication is right for you. Listen carefully to their responses and ask follow-up questions to ensure you thoroughly understand the implications of methadone.
Questions to ask your care team about before taking methadone include:
- Why is methadone a better fit for me compared to buprenorphine or naltrexone?
- Will methadone interfere with my other medications for physical health or mental health concerns?
- For how long should I expect to take methadone?
- What if I can’t make it to the clinic because of work or transportation?
- When can I start using take-home prescriptions for methadone?
- Are there other herbs, medications, or supplements that can help reduce cravings for opioids?
- Will methadone stop working if I take it for a long time?
- Is it possible to overdose on other opioids if I’m taking methadone?
- Why won’t some prescribers recommend sedatives, tranquilizers, or anti-anxiety medications while I’m on methadone?
- Can I switch to other MOUD treatment options if I don’t like taking methadone?
- What happens if I relapse on opioids? Do I have to stop using methadone?
Working with your team means having ongoing conversations about your treatment, your health, and your goals. Feel free to keep the conversation going throughout your treatment.
Final Thoughts
Methadone can be a life-saving treatment for opioid addiction. It’s important to discuss your personal medical history with your doctor and care team to determine if methadone is the right treatment to address your addiction, as it comes with dependence risks and treatment restraints.
