Methadone Treatment

Author: Mona Bapat, Phd, HSPP

Methadone treatment is a safe and effective treatment for opioid use disorder. However, as with all treatments, it has benefits and risks. Knowing these can help determine if it could be the right treatment for you.

How Methadone Works

Methadone is a medication approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder (OUD).¹ There are a couple of ways in which methadone works as part of treatment for OUD.²

Methadone blocks the positive effects of opioids, reducing cravings and urges. The second way in which methadone works is that it changes the way your brain and nervous system respond to pain. It lowers the pain and discomfort associated with withdrawal from opioids.²

Opioids are highly addictive, and if you have been using them for a long time, your body develops a dependency on them. This means your body has become accustomed to the presence of opioids and as a result, needs them to function.³

When you stop using opioids or significantly reduce the amount you take, you go through withdrawal. This is a painful and uncomfortable experience because your body is struggling to function without opioids.³

The withdrawal symptoms can include: ³

Agitation
Anxiety
Muscle aches
Insomnia
Sweating
Abdominal cramping
Diarrhea
Goosebumps
Nausea and vomiting

Types of Methadone Treatment

Federal law requires that only a certified and accredited opioid treatment program (OTP) can dispense methadone.² Health providers can prescribe the medication in each stage of treatment for opioid use disorder.⁴

Withdrawal Management Services

If you are physically dependent on opioids, the first step in the treatment of an OUD is withdrawal management services, more commonly known as “detox.” These services are provided to reduce the medical risks and distress caused by withdrawal. Medical providers supervise the detox process and may administer methadone to reduce withdrawal symptoms.⁴

During detox, medical providers may also taper down the amount of the opioid. They do this by slowly giving you smaller and smaller doses of the opioid or a replacement substance over time.⁵

Methadone Maintenance Treatment

After detox, a medical provider may prescribe methadone for you on an ongoing basis. This may be for an indefinite period, or they may reduce the dose slowly over time until you no longer continue to take the medication.⁴ Methadone is typically taken once per day.²

The length of time for methadone maintenance treatment (MMT) varies from person to person and depends on your situation and the severity of your OUD. Experts recommend that methadone treatment lasts for a minimum of 12 months.²

About 25% of patients eventually stop taking methadone, 25% continue to take the medication, and about 50% go on and off methadone.⁴

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What Happens in Methadone Treatment

Methadone treatment includes more components than simply being prescribed medication.

Dosage Adjustments

If methadone is part of your treatment plan, the prescriber starts at a low dose and slowly increases it over time, depending on how you respond to it. You come to the treatment center daily to receive your dose.⁵

You may not feel the effects of methadone for four or more days. Continue to take the medication only as prescribed by your provider. If you stop taking the medication on your own, there is a possibility for relapse to using opioids and overdosing.

Also, note that a dose may initially seem inadequate. Even if that is the case, do not take more than the prescribed dose. Methadone builds up in the body, and thus doses higher than prescribed can become toxic later.

Methadone treatment works best when combined with counseling or psychotherapy. Therefore, providers refer you to therapists and support groups.⁵

Peer Support

Support groups such as Narcotics Anonymous (NA) allow you to get interpersonal support from others who also struggle with substance use disorders. You can feel heard and understood in a non-judgmental setting and learn from others’ stories. Consistent attendance at such 12-step programs also increases your chances of maintaining sobriety. You can attend a group before, during, and after you get professional treatment.⁶

Behavioral Therapy

Because it is backed by research, cognitive-behavioral therapy (CBT) is a common type of therapy used by mental health professionals in addiction treatment. CBT involves examining how your thoughts contribute to your emotions and behavior. In therapy, you work to change your thoughts to more helpful ones so that you can have more positive emotional experiences and use healthier coping strategies.⁷ Recent research is finding CBT to also be effective in treating OUD specifically.⁸

A provider may also refer you to family or couples therapy. Since addiction most often impacts interpersonal relationships, these forms of therapy can help you develop mutual understanding and enhance communication.⁷

Candidates for Methadone Treatment

There are several options for opioid use disorder treatment. When considering whether to prescribe methadone, medical professionals consider several factors.

Ideal Candidates for Methadone Treatment

Methadone is a first line treatment for individuals who are:

Pregnant or breastfeeding
Entering detox for the first time

An intake assessment is the first thing that occurs after you enter a treatment center. A health provider conducts the intake to determine the severity level of your OUD your treatment needs, and your goals for treatment.⁵ This information is used in establishing a treatment plan.

During the intake, the health provider interviews you to gather information such as your:⁵

Medical and psychological history
Substance use history
Relationship dynamics and what social supports you have
Frequency and method of opioid use
Prescription drug use history
Previous attempts to stop using opioids
Previous treatments and responses to treatment

The intake also has a physical examination that may include:⁵

Urine drug testing
Blood testing to see if there are signs of infection
Testing for HIV and hepatitis B/C (if you use intravenously)
Blood testing to assess liver and kidney function

Based on the assessment by the health provider, you may get referred to a higher level of care if office-based treatment can’t meet your needs. This would be more intensive treatment, such as inpatient or residential treatment.

Poor Candidates for Methadone Treatment

Providers are not likely to prescribe methadone if you are at risk for an overdose. You are at increased risk for overdose on methadone if you:^5,9

Have experienced a drug overdose before
Have a history of a substance use disorder
Take opioids in very high amounts
Are also using benzodiazepines, which are prescribed for anxiety or insomnia and include Xanax, Valium, and Klonopin

If you have one or more of these risk factors, a medical provider may prescribe a different medication called naloxone.⁵

Methadone could be an appropriate treatment for you if you:^5,10,11

Do not have any of the above risk factors
Have experienced withdrawal from opioids
Take opioids to avoid withdrawal symptoms
Have been taking higher and higher doses of an opioid to feel the same effects
Are motivated to enter a comprehensive treatment plan that includes daily methadone clinic visits

Benefits of Methadone Treatment

Studies indicate that methadone effectively reduces opioid use, and that patients on methadone treatment are more than 4 times as likely to remain in treatment.¹⁰

Research on the benefits of taking methadone long-term has been limited. One recent study examined the impacts of methadone treatment for patients over 10 years. The researchers found that methadone maintenance therapy over 10 years:¹²

Lowered heroin use
Improved social functioning
Reduced physical symptoms of opioid addiction
Improved quality of life. Patients also experienced a better quality of life

Methadone is considered particularly beneficial for perinatal use. Methadone is not associated with pregnancy complications or birth defects and minimizes any withdrawal symptoms experienced by infants. Methadone is also safe when breastfeeding, unlike many prescription medications.²

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Risks of Methadone Treatment

Methadone treatment, as with any treatment, comes with some risks that are discussed below.

Serious Side Effects of Methadone

As with any prescription medication, you can experience an allergic reaction or other negative side effects when taking it. While these are rare, any of the following side effects should be considered a medical emergency:²

Experience difficulty breathing or shallow breathing
Feel lightheaded or faint
Get hives or a rash
Experience swelling of the face, lips, tongue, or throat
Feel chest pain
Experience a fast heartbeat
Experience hallucinations or confusion

It’s also important to talk to your doctor about any other medications you are taking because some drugs can interact with methadone and cause negative effects.

Addiction to Methadone

Methadone is an opioid. While the risk of misuse of and addiction to methadone is minimal during methadone treatment, it is possible to misuse methadone. This typically occurs in individuals taking methadone for pain.¹⁰

Opioid treatment programs (OTP) are required to have a plan in place to minimize the risk of developing an addiction to methadone. An OTP usually requires you to come in daily to receive the medication, and they strictly monitor the doses taken at home.¹⁰

Overdose on Methadone

Methadone has a greater risk for overdose compared to buprenorphine, another medication used to treat OUD. This is because methadone is long-acting and can build up in the body. If an individual takes an additional dose or a dose bigger than prescribed, this can result in overdose.

However, the risk for overdose is greater when prescribed for pain than in treating an OUD.¹⁰ If you take methadone for OUD treatment as prescribed, it is safe and effective.²

How to Find a Methadone Treatment Center

Opioid treatment programs must be certified and accredited by the Substance Abuse and Mental Health Services Administration (SAMHSA). As part of this process, OTPs are required to do an initial medical exam, provide special services for pregnant patients, and offer counseling services.¹⁴

There are a few ways you can locate an OTP, such as through a:

Referral from your primary care provider for an OTP in your area
Referral from your mental health provider for an OTP in your area
Search of our methadone treatment center directory
Search of the SAMHSA OTP directory

For assistance with locating a methadone treatment center, please call 800-994-1867Who Answers? 24/7 to learn more about treatment options near you.

Resources

U.S. Food and Drug Administration. (2019, February 14). Information about Medication-Assisted Treatment (MAT).
University of Arkansas for Medical Services. (2022). What is Methadone? Psychiatric Research Institute.
U.S. Library of Medicine. (2022, January 3). Opiate and Opioid Withdrawal. MedlinePlus.
Harvard Medical School. (2019, June 27). Treating opiate addiction, Part I: Detoxification and maintenance. Harvard Health Publishing.
Centers for Disease Control and Prevention. Assessing and Addressing Opioid Use Disorder (OUD).
Vederhus, J., & Kristensen, O. (2006). High Effectiveness of Self-Help Programs After Drug Addiction Therapy. BioMed Central Psychiatry, 6, 1-6.
National Institutes of Health. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
Barry, D.T., Beitel, M., Cutter, C.J., Fiellin, D.A., Kerns, R.D., Moore, B.A., Oberleitner, L., Madden, L.M., Liong, C., Ginn, J., & Schottenfeld, R.S. (2019). An Evaluation of the Feasibility, Acceptability, and Preliminary Efficacy of Cognitive-Behavioral Therapy for Opioid Use Disorder and Chronic Pain. Drug and Alcohol Dependence, 194, 460-467.
Fishbain, D.A. (2021, January 27). Opioid Tapering/Detoxification Protocols, A Compendium: Narrative Review. Pain Medicine, 22(7), 1676-1697.
National Institute on Drug Abuse. Medications to Treat Opioid Use Disorder Research Report.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Publishing.
Fei, J.T.B, Yee, A., Habil, M.H.B., & Danaee, M. (2016). Effectiveness of Methadone Maintenance Therapy and Improvement in Quality of Life Following a Decade of Implementation. Journal of Substance Abuse Treatment, 69, 50-56.
National Institutes of Health. (2021, February 3). Benzodiazepines and Opioids.
Substance Abuse and Mental Health Services Administration. (2021, November 4). Certification of Opioid Treatment Programs (OTPs).