Frequently Asked Questions About Methadone Treatment

Medication-assisted treatment (MAT) is often used with behavioral services, like therapy, to help individuals detox from and find long-term sobriety from substance like opioids. Your prescribing doctor can answer questions about methadone specific to your treatment plan, but the answers to many questions are the same for most individuals who enter methadone MAT for opioid addiction.

What Is Methadone?

Methadone is an opioid pain reliever.¹ It is used to treat severe, chronic all-day pain and opioid use disorder (OUD), which is the clinical term used to describe the behaviors and symptoms associated with opioid addiction.²

It might seem surprising that an opioid can treat OUD. However, methadone blocks the positive effects of other, more addictive and more dangerous opioids, leading to fewer cravings for them. Methadone changes the way your body responds to pain to change the physical response to opioid withdrawal.³

How Effective Is Methadone Treatment?

When taken as prescribed, methadone is safe and effective in treating opioid addiction.³ Studies show that methadone reduces opioid use. They also show that patients on methadone treatment are more than 4 times as likely to remain in treatment.⁸

One study on the efficacy of methadone treatment studied patients over 10 years. The study found that methadone treatment over those 10 years: ⁹

• Lowered heroin use
• Improved social functioning
• Reduced physical symptoms of opioid addiction
• Improved quality of life

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Is Methadone Treatment Substituting One Addiction for Another?

If you take methadone as prescribed, it is safe with a low risk for addiction despite being an opioid.

Pain Management

The risk of addiction exists primarily when methadone is taken for pain management because the dosages, in that case, are larger and may not be monitored as closely. However, addiction risk is much lower when treating opioid use disorder (OUD).⁸

Medication-Assisted Treatment

Opioid treatment programs (OTPs) are required to have a plan in place to minimize the risk for addiction to methadone. This is why they initially require you to come to the facility to receive your medication. They also monitor your dose taken at home very closely and you are required to answer questions about methadone storage, administration, and so on.⁸

Providers prescribe methadone in smaller doses to treat addiction to ensure that it does not produce “a high.”⁸

Who Is Prescribed Methadone?

Methadone is used to treat a few different populations and addiction to all opioids.

Populations

Medical providers prescribe methadone for:^2,3,4,5,6

• Patients with severe chronic pain
• Patients with opioid use disorder (OUD) that are physically dependent on opioids
• Infants with neonatal abstinence syndrome (NAS), which can occur in infants exposed to opioids during pregnancy
• Pregnant patients with opioid addiction or chronic pain

Opioids

Methadone is used to treat addiction to natural opioids (opiates) and synthetic opioids. Opiates include:¹

• Opium
• Morphine
• Codeine

Semisynthetic and synthetic opioids include:¹

• Heroin, which is made from morphine
• Fentanyl
• Oxycodone (OxyContin)
• Hydrocodone
• Hydromorphone
• Oxymorphone
• Tramadol

All opioids, except heroin, are pain relievers available only by prescription from a medical provider. Heroin is an illegal substance.

Is Methadone Safe During Pregnancy?

Methadone is safe while pregnant and breastfeeding, and is not related to any birth defects. Because it prevents opioid withdrawal symptoms, methadone reduces the risk of potentially dangerous withdrawal symptoms, which can include miscarriage and premature birth.³

Oral methadone has been shown to successfully ween infants with neonatal abstinence syndrome from other opioids off off opioids without complications.⁵

Who Can Prescribe Methadone?

By law, methadone can only be dispensed by a treatment program certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). These programs are called Opioid Treatment Programs (OTP). OTPs are required to provide counseling along with medication treatment.³

You can receive methadone treatment only under the supervision of a medical provider in an OTP who can answer your questions about methadone.

Initially, you go to the OTP clinic daily to receive your dose. When are medically stable, you may receive an at-home dose and go to the OTP facility for counseling.³

Sometimes a medical provider who is a part of medical unit rather than an OTP. Medication units can be mobile or non-mobile. If a medication unit can only provide methadone and no other services, all other required services such as counseling must occur at the OTP by law.⁷

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How Is Methadone Prescribed?

Methadone is available in pill, liquid, and wafer form, and you take it once per day.³

Providers usually start with a methadone dose of 20-40 mg per day. They slowly increase the dose by 10 mg about every 4-7 days.⁶

Some individuals also enter methadone maintenance treatment (MMT), in which your dose is only adjusted if there is a significant change in your medical history.

How Long Does Methadone Treatment Last?

Experts recommend that methadone treatment last for at least 12 months.³

Do not change how you take methadone or stop taking methadone without meeting with your doctor to ask questions about your methadone treatment plan. You might find that your opioid use disorder (OUD) symptoms improve. However, if you stop taking methadone, you risk relapse.¹⁰

Are There Risks Related to Methadone Treatment?

As with any drug treatment, there are risks associated with taking methadone. If you have questions about methadone, discuss any symptoms with your prescribing doctor.

Common Side Effects

Common side effects of methadone include:²

• Headache
• Weight gain
• Stomach pain
• Dry mouth
• Sore tongue
• Reddening of the skin
• Difficulty urinating
• Mood changes
• Vision problems
• Difficulty falling asleep or staying asleep

Though these are common side effects, tell your prescriber if they are intense, appear right after your dose changes, or do not go away.²

Serious Side Effects

Stop taking methadone and call 911 right away if you experience:^{2, 3}

• Lightheadedness
• Seizures
• Hives, a rash, or itching
• Swelling of the face, lips, tongue, or throat
• Difficulty breathing or shallow breathing
• Extreme drowsiness
• Fever or sweating
• Shivering
• Severe muscle stiffness or twitching
• Chest pain
• A fast heartbeat
• Nausea, vomiting, or diarrhea
• Loss of appetite
• Weakness
• Inability to get or keep an erection
• Irregular menstruation
• Decreased sexual desire
• Confusion
• Hallucinations (i.e., seeing, feeling sensation, or hearing things that are not really there)

Overdose

While the risk of overdose is low, it is a medical emergency. Signs and symptoms of methadone overdose include:²

• Tiny pupils
• Slow or shallow breathing, or difficulty breathing
• Cool, clammy, or blue skin
• Limp muscles
• Unable to respond or wake up

If you or a loved one is showing any of these symptoms, call 911 immediately. As with other opioids, naloxone can be administered to reverse the breathing issues related to overdose until professional medical care can be administered.

Which Medications Interact with Methadone?

There are a few types of medication that should not be mixed with methadone. An interaction could decrease the efficacy of one or both medications, cause problematic side effects, or cause an overdose.¹¹

Sedatives

Sedatives cause sleepiness or extreme calmness. Examples of sedatives include alcohol, sedative antihistamines, and benzodiazepines or other drugs prescribed for anxiety. Combining sedatives with methadone can cause sedative overdose and be life-threatening.¹¹

Heart Medications

Avoid mixing methadone with heart medications. Doing so could increase the risk of cardiac arrhythmia (i.e., abnormal heartbeat).¹¹

Antipsychotic or Antidepressant Drugs

Some antipsychotic or antidepressant drugs could increase the risk for cardiac arrhythmia if mixed with methadone.¹¹

Anticonvulsant Medications

Anticonvulsants are medications taken for epileptic seizures. Some are also taken off-label for other conditions, such as migraines. If you mix these with methadone, they can cause withdrawal symptoms.¹¹

Antimycobacterial Medications

Antimycobacterial medications are drugs for antimycobacterial infections such as tuberculosis and leprosy. When you combine these with methadone, they can lead to significant reductions of methadone in your body, thus making your methadone treatment less effective.¹¹

Given that these medications should not be mixed with methadone, it is imperative to tell your provider all of the medications that you are taking. Answer questions about methadone and other medications honestly during visits with your provider.

If methadone is not appropriate for you because of your other medications, there are medication-assisted treatment alternatives to methadone.

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Is Methadone Treatment Right for Me?

Methadone could be an appropriate treatment for you if you:^8,12,13,14

• Have experienced opioid withdrawal
• Take opioids to avoid withdrawal symptoms
• Have been taking higher doses of opioids to feel the same effects
• Are motivated to get a comprehensive treatment that includes counseling and daily clinic visits
• Have been abstinent from opioids but were physically dependent on them in the past
• Do not have any of these risk factors for an overdose:
  • Have experienced a drug overdose before
  • Have a history of another substance use disorder
  • Use opioids in extremely high amounts
  • Are also taking benzodiazepines for any condition

As with any treatment, methadone treatment comes with both risks and benefits. By getting assessed at an opioid treatment program (OTP), providers can give you a recommendation for treatment and answer your questions about methadone.

Call 800-994-1867Who Answers? to learn more about methadone treatment options and find a program that’s right for you.

Resources

1. Centers for Disease Control and Prevention. (2021, January 26). Opioids.
2. National Library of Medicine. (2022, January 11). Methadone. MedlinePlus.
3. University of Arkansas for Medical Services. (2022). What is Methadone? Psychiatric Research Institute.
4. Centers for Disease Control and Prevention. (2021, March 10). Key Findings: Public Health Reporting of NAS Offers Opportunities for Treatment and Prevention.
5. Wiles, J.R., Isemann, B., Mizuno, T., Tabangin, M.E., Ward, L.P., Akinbi, H., & Vinks, A.A.. (2015). Pharmacokinetics of oral methadone in the treatment of neonatal abstinence syndrome: A pilot study. The Journal of Pediatrics, 167(6), 1214-1220.
6. Kreek, M.J., Borg, L., Ducat, E., & Ray, B. (2010). Pharmacotherapy in the treatment of addiction: Methadone. Journal of Addiction Disorders, 29(2), 200-216.
7. Substance Abuse and Mental Health Services Administration. (2021, November 4). Certification of opioid treatment programs.
8. National Institute on Drug Abuse. (2021, December 3). Medications to Treat Opioid Use Disorder Research Report.
9. 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.
10. Federal Drug Administration. (2014). Full Prescribing Information.
11. National Center for Biotechnology Information. (2009). Drug interactions involving methadone and buprenorphine. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva: World Health Organization.
12. Centers for Disease Control and Prevention. Module 5: Assessing and Addressing Opioid Use Disorder (OUD). Assessing and Addressing Opioid Use Disorder.
13. National Institute on Drug Abuse. (2021, February 3). Benzodiazepines and Opioids.
14. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing.