Will Methadone Treatment Get Me Off Hydrocodone?

Author: Susanne Reed, Ph.D.

Methadone has been a preferred choice in treating opioid use disorder since 1964.¹ Methadone treatment for hydrocodone addiction is a frontline treatment.

What Is Methadone?

The 2020 National Survey of Substance Abuse Treatment Services received feedback from over 16,000 treatment programs across the nation. Of that number, 17% are methadone-only providers.²

Methadone is a synthetic opioid in a class called opiate narcotic analgesics. It comes in pill, liquid, and wafer forms. Synthetic drugs are created in a lab and designed to change how the brain and central nervous system respond to pain or discomfort. Methadone has a longer half-life than shorter-acting opioids.³

The number one use for methadone is to treat opioid use disorders, such as hydrocodone addiction. However, methadone also has other uses, including:⁴

• Alleviates pain that persists after using non-narcotic pain relievers
• Alleviates withdrawal symptoms present during detox from opioid misuse
• Helps prevent opioid relapse
• Treats neonatal abstinence syndrome in babies, which occurs when opioids are misused during pregnancy

In 2018, doctors wrote 2.2 million prescriptions for methadone in the United States, a decrease from previous years.⁵

Isn’t Methadone Treatment Just for Heroin?

Many people believe that methadone treatment is just for heroin abusers, but this is not the case. According to the National Institute on Drug Abuse (NIDA):

Hydrocodone addiction causes cravings and withdrawal, just like heroin addiction, and methadone can be a successful treatment for both.

Are Methadone and Hydrocodone the Same Kind of Drug?

Methadone and hydrocodone are both opioids and both can be prescribed for pain. However, methadone is a long-acting opioid, and hydrocodone is a short-acting opioid. This leads to differences in the effects and timing of the impact.

When you take a long-acting drug like methadone, only part of the dose is released immediately. Long-acting drugs continue to work over a designated period of time—some as long as 1-3 months—requiring fewer doses and decreasing the likelihood of extreme “highs” and “crashes.” Methadone also accumulates in the body, creating new baseline of symptoms.

Short-acting opioids like hydrocodone are prescribed for intense, acute pain because they begin working quickly, but they also must be taken frequently to maintain the effects.

Dispensing rates of opioids reached an all-time high in 2012, with 255 million. As the risk of dependency, addiction, and overdose has become clear, doctors and pharmacies have made a push to decrease the number of prescriptions.⁶

Synthetic opioids, not including methadone, are the leading cause of overdose deaths in the United States.⁷

Hydrocodone and other opioids may cause hyperalgesia, a condition where the opioids create pain in the body, making you hypersensitive to pain. Reports also suggest opioids may not be effective for medical use after three months. Opioids produce side effects that can interfere with daily functioning, including:⁷

• Nausea
• Vomiting
• Constipation
• Mood swings
• Pruritis, or an uncontrollable urge to scratch
• Slowed or stopped breathing

What Is Hydrocodone Use Disorder?

Hydrocodone, also known as Vicodin, Lorcet, or Norco, is a partially synthetic drug prescribed to ease pain and reduce coughs for those who have tried other medicines without success.

The latest Surveillance Report by the Center for Disease Control and Prevention shows that hydrocodone is a drug involved in thousands of opioid overdose deaths. About 1 in 4 people participating in long-term opioid therapy report having an opioid use disorder, and over 48 million Americans report misuse of illicit substances. Of that number, 4.3% reported specifically misusing prescription pain killers such as hydrocodone.⁸

If you develop a hydrocodone use disorder, you may try to stop using hydrocodone multiple times after you stop needing it for pain without success. You may experience severe withdrawal symptoms, along with obsessive thoughts about pain, pain relief, and how to get hydrocodone. Methadone treatment for hydrocodone use disorder is one of the most effective treatments currently in use.

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How Is Methadone for Treatment for Hydrocodone Used?

Multiple studies on the use of methadone for opioid use disorder prove that it:⁹

• Increases treatment retention
• Reduces opioid misuse
• Lowers risk of overdose
• Can be used in pregnancy
• Can be used in outpatient programs
• Blunts or blocks effects of illicit opioids

Hydrocodone is not a drug to quit cold turkey. Additionally, while tapering off an opioid (i.e., gradually reducing and then stopping the dose) is safer, you should avoid rapid tapering. Rapid tapering comes with risks leading to:¹⁰

• Psychological stress
• Physical pain
• Immediate withdrawal syndrome
• Sleep disturbances
• Suicidal thoughts
• Illegal use of buying and misusing opioids

Your prescribing doctor can help you taper off of hydrocodone safely.

What Are the Benefits of Methadone Treatment for Hydrocodone Addiction?

The Food and Drug Administration (FDA) regulates all prescription medications. Methadone, however, has more regulations than any others when used to treat opioid use disorders. Physicians offering medication-assistant treatment to patients are required to be credentialed and register and obtain a number from the Drug Enforcement Agency (DEA). They must also agree to comply with record-keeping policies and physical safety guidelines.¹¹ Safety measures like these ensure close monitoring during methadone treatment and reduce the risk of a secondary addiction.

Benefits of using methadone to treat hydrocodone use disorder include:¹²

• Methadone has no ceiling effect, so as the dose rises, so do the physiological effects.
• As a long-acting drug, methadone is active in the body for a more extended period, preventing the ups and downs that other opioids create.
• Methadone eases withdrawal symptoms without producing the euphoria—or “high”— associated with hydrocodone.
• Methadone treatment for hydrocodone is proven effective by decades of research.

If you have Medicare Part B:¹³

• Medicare Part B pays the total cost of methadone treatment for hydrocodone use disorder.
• Methadone treatment programs consist of medication, counseling, drug testing, individual and group therapy, with some available virtually.

How Does Methadone Treatment for Hydrocodone Addiction Work?

The process of starting methadone treatment for hydrocodone and maintenance therapies includes the following steps:⁹

• Assessment
• Laboratory tests for drugs and alcohol and meds that could interact and pregnancy
• Patient education
• First dose
• Dose adjustment
• Dose stabilization at week 5 and later
• Take-home doses are possible after long-term participation in the program
• Dose tapering
• Discontinuance

The first day and week of methadone treatment for hydrocodone use disorder will likely start with the lowest dose of methadone, between 10 mg and 30 mg. You must stay for observation of the effects. If you do not feel the effects of methadone, your doctor can increase the dose. If you become intoxicated, your doctor will lower your amount.

Your doctor considers weight, age, physical and psychological issues, current prescriptions, and over-the-counter drugs before administering the first dose.⁹

Increases in 5 mg increments over the next few weeks will happen until you find the correct dose. Changes in doses may be required when changes occur, such as:⁹

• Weight changes
• Relapse on hydrocodone
• Medication changes for other physical or psychological health conditions
• Pregnancy

Around week 5, stabilization should occur. The length of time in a methadone program and the dose are based on your unique needs.

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How Effective Is Methadone Treatment for Hydrocodone?

You can avoid withdrawal symptoms altogether with daily supervised methadone treatment for hydrocodone misuse. The National Institute on Drug Abuse reports that methadone treatment participants have 33% fewer opioid-positive drug tests and remain in treatment longer than participants who received psychosocial treatments.¹²

Numerous studies have similar results. Your treatment center may also implement suggestions from the American Society of Addiction Medicine to increase the positive effects of methadone treatment, including:¹⁴

• Basing dosages on how an individual responds rather than generalizing doses
• Monitoring daily administration in a clinical setting prevents misuse and diversion
• Adding psychosocial strategies to methadone treatment for hydrocodone misuse enhances outcomes
• Returning to methadone treatment as soon as possible after a relapse
• Weaning off methadone completely before switching to another medication to treat opioid use disorder
• Treating hydrocodone use disorder during pregnancy with methadone rather than any other medication

If you are ready to seek treatment for misuse of hydrocodone or any opioid use disorder, know that there are many programs from which to choose to obtain an assessment and start the process of enrolling in methadone treatment for hydrocodone use disorder.

Call 800-994-1867Who Answers? to speak with a treatment specialist.

Resources

1. Substance Abuse and Mental Health Services Administration. (2021). Methadone.
2. Substance Abuse and Mental Health Services Administration. (2021). National Survey of Substance Abuse Treatment Services (N-SSATS): 2020 Data on Substance Abuse Treatment Facilities. Department of Health and Human Services.
3. U.S. National Library of Medicine. (2022). Methadone. MedlinePlus.
4. Durrani, M. & Bansal, K. (2022). Methadone. Treasure Island (FL): StatPearls Publishing.
5. U.S. Department of Justice Drug Enforcement Administration. (2019). Methadone.
6. Center for Disease Control and Prevention. (2021, November 10). U.S. Opioid Dispensing Rate Map.
7. U.S. Department of Health and Human Services (2020, August 30). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations.
8. Centers for Disease Control and Prevention. (2019). Annual Surveillance Report of Drug-Related Risks and Outcomes — United States.
9. U.S. Department of Health and Human Services. (2021). Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families. Treatment Improvement Protocol (TIP) No. 63. Rockville (M.D.): Substance Abuse and Mental Health Services Administration.
10. U.S. Department of Health and Human Services. (2019). HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.
11. Substance Abuse and Mental Health Services Administration. (2021, February 01). Statutes, Regulations, and Guidelines.
12. National Institute on Drug Abuse. (2021, April 13). Medications to Treat Opioid Use Disorder Research Report.
13. U.S. Centers for Medicare and Medicaid Services. Opioid Use Disorder Treatment Services.
14. American Society of Addiction Medicine. (2015). The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addictions Involving Opioid Use.