Can Methadone Maintenance Treatment Help Me?

Author: Brittany Tackett

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately two million people were diagnosed with opioid use disorder (OUD) in 2018.¹ Medication-assisted treatment programs like methadone maintenance treatment are clinically proven to treat OUD symptoms and improve patient survival, and reduce the need for inpatient addiction treatment. Methadone maintenance treatment has been used for more than 40 years as an effective treatment for opioid addiction.²

The Need for Methadone Maintenance Treatment

Many people may be tempted to quit using opioids on their own. However, research has shown that people with opioid use disorder who complete opioid detoxification and follow with abstinence are have a high risk of relapse.²

While relapse is considered a normal part of the recovery process, it can be dangerous and even fatal for people with opioid addiction.

Opioid relapse increases the risk of overdose when it happens after a period of abstinence. Methadone maintenance treatment programs can help ease withdrawal symptoms during the detox process, reduce the risk of relapse, and help support and sustain long-term recovery.²

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Benefits of Methadone Maintenance Treatment

Many people turn to a methadone maintenance treatment program to stop using illegal opioids, like heroin, or misusing prescription opioids. Methadone is a synthetic, long-acting full opioid agonist. It acts on the opioid receptors in a similar way but works more slowly. Methadone reduces withdrawal symptoms and cravings for opioids, but it does not induce euphoria or give the user a “high.”²

Researched benefits of methadone maintenance treatment programs include:^1,2

• Reduced withdrawal symptoms when detoxing from other opioids
• Fewer cravings for opioids
• Decreased illicit opiate use
• Reduced risk of overdose
• Improved patient survival
• Increased treatment retention
• Reduced need for inpatient treatment
• Lowered risk of contracting an infectious disease
• Improved social functioning
• Increased ability to gain and sustain employment
• Decreased criminal activity among people with addiction
• Improved birth outcomes for pregnant patients

One study found that patients receiving methadone maintenance treatment were 4.44 times more likely to stay in treatment and 33% less opioid-positive drug screens than the control group.²

While short-term methadone maintenance programs are available, research shows that abstinence rates are higher in those who undergo long-term methadone maintenance treatment that is six months or longer.² Long-term treatment works best when the treatment lasts for at least 14 months.³

The National Institute on Drug Abuse recommends that methadone treatment last at least 12 months.⁴

Contraindications for Methadone Maintenance Treatment

Because methadone can cause central nervous system (CNS) depression and inhibit healthy respiration, it must be used with extreme caution in people with the following conditions:^3,5

• Dementia
• Delirium
• Head trauma
• Chronic obstructive pulmonary disease (COPD)
• Brain tumor
• Increased intracranial pressure
• Other disorders of the central nervous system

Methadone should not be mixed with other CNS depressant drugs unless absolutely necessary.

Other drugs can also inhibit the effects of methadone and may cause more withdrawal symptoms. Always talk to your doctor and methadone maintenance treatment team if you take any other medications.

Substances that may interact adversely with methadone include:^3,5

• Alcohol
• Benzodiazepines
• Antidepressants such as fluoxetine (Prozac)
• Ciprofloxacin
• Fluconazole
• Phenobarbital
• Phenytoin
• Ritonavir
• Urine alkalizing or acidifying agents

Getting a Methadone Prescription

Methadone is a Schedule II controlled substance with a high potential for misuse. However, it is a safe and effective treatment for opioid use disorder when taken as prescribed.⁴

Methadone is usually one component of a comprehensive treatment plan that includes counseling, therapy, and peer support.⁴ When you decide you want to receive methadone maintenance treatment, you will need to find a licensed addiction treatment program that can prescribe it to you.⁶

Only a SAMHSA-certified opioid treatment program (OTP) can dispense methadone to treat opioid use disorder. The physicians at these facilities receive specific training on administering methadone to treat opioid addiction.⁶

Both inpatient and outpatient treatment facilities may offer methadone. Depending on your unique needs and the severity of your addiction, you may choose a residential facility or outpatient treatment center.

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Entering a Methadone Maintenance Treatment Program

To be eligible for methadone maintenance treatment, you must meet the following requirements:⁶

• Have a current diagnosis of opioid use disorder with physiologic features or high risks associated with relapse
• Are not currently participating in any other maintenance treatment program
• Do not have increased vulnerabilities to medical complications of methadone (e.g., patients with severe respiratory or cardiac disease)

Before starting MMT, your medical team will establish a clinical baseline and assess any co-occurring physical or mental health conditions.³ Disclose your complete medical and psychological history to your treatment team to determine whether methadone is a safe treatment for you.

Your medical team will have an open discussion with you about the benefits and risks of methadone maintenance treatment. Methadone clinics often provide other sources of support as well, such as links to resources and support groups as well as adjunct therapies.

Receiving Methadone Maintenance Treatment

Methadone is administered in powder, liquid, or diskette forms.⁴

Methadone is typically given daily at the clinic, but you may be given a take-home dose after a period of stability, especially for weekends. However, methadone clinics are open on weekends in order to accommodate patient needs.⁶ You will likely be given routine urine screenings to monitor any drug use that may interfere with methadone treatment.³

During the initial phase of methadone maintenance treatment, you will start with a dosage of 15–30 mg. Your doctor will increase your dosage by 10–15 mg every 3-5 days until you find your appropriate therapeutic dose, which is typically around 50–80 mg per day.

The average dose of methadone maintenance is typically 80–100 mg per day, which is said to be the most effective dosage. Patients receiving doses higher than 100 mg daily must be monitored closely for side effects and complications.

After three to six weeks, you will reach the late stabilization phase, where you will start to develop a tolerance, and your cravings will decrease. Dosages will be adjusted as needed to avoid sedation and euphoria.

Once you have established a therapeutic dose of methadone, you are considered to be in the maintenance phase, which can last years or even a lifetime depending on the person.⁶ You will be monitored every three to six months if you are considered low risk. Patients at higher risk for adverse outcomes will typically be monitored weekly throughout treatment.³

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Safety Precautions for Methadone Maintenance Treatment

To receive the best treatment results and avoid adverse effects or complications, take methadone exactly as prescribed and stay in close contact with your treatment team. You can take some safety precautions to improve treatment outcomes and maintain your safety:^3,4,5

• Take the medication exactly as prescribed. Never take an extra dose of methadone, even if you have missed a dose.
• Talk to your treatment team honestly about your medical history and any medications you are currently taking.
• Stay involved in adjunct therapies such as counseling and peer support groups throughout the treatment process.
• If you are given take-home doses, do not share your methadone prescription with anyone or take methadone that was prescribed for someone else even if you are both on the same average dose of methadone maintenance treatment.
• Avoid drinking alcohol while receiving methadone maintenance treatment.
• Store methadone at room temperature away from light and heat sources.
• Take caution when driving or operating heavy machinery while taking methadone, especially during the early phases of treatment when your body is adjusting to the medication.
• Keep your medication out of reach of children and pets.
• Keep close track of your medication, so you always know how many doses are left and will recognize if some medication is missing.
• Dispose of unused medication appropriately.
• Do not stop taking methadone or decrease your dose without talking to your doctor first. When MMT ends, your doctor will create a plan to taper off your medication.
• Call 911 immediately if you take too much methadone or suspect an overdose.

Finding a Methadone Maintenance Treatment Program Near You

If you or someone you love is struggling with opioid use disorder, call 800-994-1867Who Answers? to find a methadone maintenance treatment program available near you.

Resources

1. Substance Abuse and Mental Health Services Administration. (2022, January 10). Medication-Assisted Treatment.
2. National Institute on Drug Abuse. (2021). Medications to Treat Opioid Use Disorder Research Report.
3. Durrani, M. & Bansal, K. (2022, February 12). Methadone. StatPearls.
4. Substance Abuse and Mental Health Services Administration. (2022, March 4). Methadone.
5. U.S. National Library of Medicine. (2021, February 15). Methadone.
6. Shuckitt, M. (2016, July 28). Treatment of Opioid Use Disorders. The New England Journal of Medicine, 375, 357-368.