Risks and Benefits of Methadone Treatment

Author: Brittany Tackett

Methadone is a prescription medication used as a medication-assisted treatment for opioid use disorder. It is a long-acting opioid agonist that helps reduce cravings, prevents withdrawal symptoms, and blocks or minimizes the effects of other opioids.¹ It is important to consider the risks and benefits of methadone treatment when deciding if it is right for you.

Why Is Methadone Prescribed?

Methadone is either prescribed for the management of severe pain or as medication-assisted treatment for opioid addiction. It can help people to achieve and maintain recovery and prevent relapse. Methadone is typically taken daily as an alternative to other opioids. It is available in liquid, powder, and diskette forms.¹

Methadone relieves pain, provides similar effects to other opioids, and reduces withdrawal symptoms when people stop using other opioids. For best results, it is administered as part of a comprehensive treatment program that also addresses the psychological and behavioral components of addiction.²

Methadone is a Schedule II controlled medication with many regulations in place regarding its use. Methadone is dispensed by SAMHSA-certified treatment center. People must go to the facility daily and take the medication under the supervision of a medical provider. In some cases, after a period of stability, patients may be allowed to take methadone home between office visits.¹

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What Are the Benefits of Methadone Treatment?

Methadone benefits the whole person in recovery, providing physical, mental, emotional, and social measures.

Physiological Benefits of Methadone

Some physiological benefits of methadone include:^{1, 3, 6}

• Prevents or reduces withdrawal symptoms—Methadone binds to opioid receptors to reduce withdrawal symptoms.
• Decreases or eliminates drug cravings—Taking an opioid replacement medication like methadone decreases opioid cravings.
• Does not induce euphoria—Physicians can tailor the dose so that it prevents withdrawal symptoms but doesn’t give users the “high” they are looking for when taking other opioid medications.
• Long half-life—Methadone lasts longer than most other opiates. This allows methadone to be administered once or twice each day.
• Safe and effective—When taken under the care of a trained and certified physician, methadone is considered safe.
• Effectively relieves pain—Methadone relieves pain by changing the way the brain and nervous system respond to pain. It is comparable to morphine in terms of pain relief.
• Lowers risk of overdose—When taken under the supervision of a physician, methadone treatment lowers the risk of opioid overdose.

Psychosocial Benefits of Methadone

Some psychosocial benefits of methadone include:^{1, 3, 5}

• Low cost—Methadone is cost-effective and covered by most insurance.
• Effectively reduces opioid use disorder symptoms—Taking methadone as a replacement for other opioids, like heroin, reduces psychosocial symptoms of the disorder.
• Increases retention in treatment—Patients taking methadone have 33% fewer opioid-positive drug tests and are 4.44 times more likely to stay in treatment.
• Significantly improves treatment outcomes—Even without any therapy, research indicates that treatment outcomes are improved from methadone-assisted treatment alone.
• Helps people maintain abstinence and reduces relapse—Relapse is so common in individuals with opioid use disorder that it is generally considered part of the recovery process. Taking an opioid replacement medication helps reduce the risk of relapse and promotes long-term abstinence.
• Is correlated with gainful employment—Studies associate methadone treatment with an increased ability in participants to work full time.
• Is associated with a lower risk of disease—For many people, choosing to take methadone means they are no longer using intravenous drugs, which lowers their risk of contracting infectious diseases that can be contracted through use of nonsterile needles, such as hepatitis C and HIV.
• Is associated with reduced criminalized behaviors—Research shows that rates of criminalized behaviors are lower amongst those in methadone treatment. This reduces the recidivism, or reincarceration, for patients who have previously served jail time.

Methadone is also a treatment that can be taken during pregnancy and is associated with improved birth outcomes compared to when treatment is not provided. Patients should talk with their doctor about their unique situation to determine what is safest for their pregnancy and give informed consent based on the risks and benefits of methadone treatment.

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What Are the Risks of Methadone Treatment?

While methadone is generally considered safe when taken as prescribed and under medical supervision, there are risks to consider.

Known risks of methadone as a medication-assisted treatment include:^{1, 4}

• False positives on drug screenings—Because methadone is an opioid, there is a potential risk of a positive result on drug screenings. You may need to talk to the party conducting the screening about your treatment. This does not necessarily mean that you will have to tell your boss. In most cases, you let a third-party testing organization know and they omit methadone results to maintain your healthcare privacy.
• Drug interactions—Methadone interacts with many different medications, which can cause heart problems. Your doctor will evaluate your medication to determine if methadone is safe for you.
• Possibility of addiction—Methadone has a high potential for misuse and addiction, so it is crucial that people using it as a treatment option use their prescribed dosage and participate in other forms of therapy to address addiction behaviors. Medical professionals weigh the risks and benefits of methadone treatment, considering if a patient is at risk of misuse. One way this is prevented is by doses initially only being administered in person.

Methadone Side Effects

Methadone may cause a variety of side effects. Some of the most commonly experienced side effects include: ^{1, 3}

• Dry mouth
• Sore tongue
• Restlessness
• Headache
• Stomach pain
• Nausea or vomiting
• Constipation
• Loss of appetite
• Mood changes
• Sedation
• Lethargy
• Flushing
• Sweating
• Itching
• Difficulty urinating
• Sleep problems
• Vision changes
• Weight gain

Some more serious potential side effects that may require immediate medical care include: ^{1, 3}

• Dizziness or weakness
• Extreme drowsiness
• Fast or pounding heartbeat
• Agitation
• Hallucinations
• Confusion
• Chest pain
• Erectile dysfunction
• Menstrual problems
• Decreased sexual desire
• Seizures
• Swelling of the eyes, mouth, tongue, face, or throat
• Hives or rash
• Hoarseness
• Difficulty swallowing or breathing, which is most likely to happen after a dose increase

Report your side effects to your prescribing doctor.

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Methadone Overdose

A major risk of methadone treatment is methadone overdose. Unintentional overdose is possible when patients do not take methadone as prescribed.¹ Symptoms of methadone overdose may include: ^2,3

• Pinpoint pupils
• Slow or shallow breathing
• Difficulty breathing
• Cool, clammy, or blue-colored skin
• Limp muscles
• Excessive drowsiness
• Unresponsiveness

If you suspect someone has overdosed, call 911 immediately for help.

You can also get information on opioid overdose by calling the National Poison Control Center at 1-800-222-1222.

If you or someone in your household uses methadone or another opioid, consider having naloxone on hand in the event of overdose. Naloxone is a medication that can quickly reverse the effects of opioid overdose on breathing, giving more time for emergency response.²

How Are the Risks of Methadone Treatment Managed?

Every medication comes with risks and side effects. For many people, the benefits of methadone treatment outweigh the risks. There are many things you can do to help lower your risks and improve your treatment outcomes, including:^1,2

• Take methadone only under the supervision of a medical professional who is legally to administer methadone treatment.
• Take your medication exactly as prescribed. Do not take an extra dose or take your next dose sooner than your regimen calls for.
• Stop using other opioids while taking methadone.
• Do not consume alcohol or other recreational or illicit drugs while using methadone.
• Talk to your doctor about any other medications you take that may interfere with methadone, including over-the-counter medicine.
• Be cautious when driving or operating heavy machinery.
• Do not share your methadone prescription with anyone even if they are also prescribed methadone.
• Store your methadone properly, at room temperature and away from light sources.

If you are interested in methadone-assisted treatment, call 800-994-1867Who Answers? 24/7 to learn more about your options.

Resources

1. Substance Abuse and Mental Health Services Administration (2021, November 04). Methadone.
2. S. National Library of Medicine. (2021, February 15). Methadone. MedlinePlus.
3. Durrani, M. & Bansal, K. (2022, January 09). Methadone.  Treasure Island (FL): StatsPearls Publishing.
4. Faul, M., Bohm, M., & Alexander, C. (2017, March 31). Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies–United States 2007-2014. Morbidity and Mortality Weekly Report, 2017(66), 320-323.
5. National Institute on Drug Abuse. (2021, December 03). Medications to Treat Opioid Use Disorder Research Report.
6. Substance Abuse and Mental Health Services Administration. (2022, January 10). Medication-Assisted Treatment (MAT).