Author: Mona Bapat, Ph.D., HSPP

If you have an opioid use disorder (OUD), or opioid addiction, it can be helpful to know what treatment options are available. Methadone is one commonly used medication to treat opioid dependence and addiction. It is also occasionally prescribed for pain. Methadone relieves opioid withdrawal symptoms, mitigates cravings, and reduces the risk of relapse. While it is a safe and effective medication, there are some potential risks and side effects.

What is Methadone?

Methadone is a full opioid agonist medication approved by the Food and Drug Administration (FDA) for the treatment of opioid dependence and addiction. Methadone is typically combined with therapy in a practice known as medication-assisted treatment (MAT).¹

Methadone maintenance can help those addicted to opioids, such as heroin, oxycodone, and hydrocodone, stop using drugs. Even though methadone is an opioid, it has a slower onset of effects than opioids that are commonly misused, and it doesn’t produce a euphoric high.² However, because of its opioid properties, it does have high potential for misuse. You should always listen to your doctor and take your methadone exactly as prescribed.

Methadone Treatment for Opioid Addiction

Methadone activates opioid receptors in the brain to reduce opioid withdrawal symptoms, ease cravings, and block the euphoric effects of opioids like heroin. For this reason, it is useful for both opioid detox and opioid addiction treatment.

Methadone is a highly effective medication that is proven to help recovering individuals stay in treatment programs longer.^3,4

Medical Detox

The first step in opioid addiction treatment is detoxification. Medical detox involves a set of interventions with the goal of managing opioid withdrawal symptoms and achieving a medically-stable, substance-free state.
Methadone helps relieve opioid withdrawal symptoms, such as:⁵

• Nausea and vomiting
• Diarrhea
• Muscle cramps
• Runny nose and teary eyes
• Insomnia
• Anxiety
• Hot and cold flushes
• Sweating

Medical detox occurs in a hospital setting or inpatient detox center under 24/7 supervision of medical providers. In this process, your treatment team may use methadone to help you detox from opioids, particularly long-acting opioids like morphine.⁵

Methadone Maintenance Treatment (MMT)

After completing detox, your treatment team may include methadone maintenance as a part of your comprehensive treatment program. Methadone maintenance treatment (MMT) involves taking methadone, in wafer, pill, or liquid form, once a day for an extended period of time, with the goal of maintaining abstinence from opioid use. This medication can only be dispensed through specialized opioid treatment programs.^3,6

MMT has shown positive results at high doses when compared to non-medication treatment. These results include decreased heroin use and positive effects on brain function.^4,7

Because methadone can be addictive, usually the doses are dispensed daily at a methadone clinic under the supervision of a physician—this is done to minimize the risk of patients diverting from the treatment regimen by misusing methadone. Doses are established and adjusted based on your individual needs.³

MMT should last at least 12 months.3 Methadone treatment centers often have waitlists, but it is possible to seek out an interim methadone treatment program while you are on a waitlist.⁴

Benefits of Medication-Assisted Treatment

MAT includes behavioral therapy as well as medication like methadone. Behavioral therapy is often done in individual or group modalities and is based on the idea that behaviors are learned and therefore, can be changed or unlearned. This treatment approach has been shown to:⁹

• Increase treatment retention (keeping patients in treatment)
• Decrease illicit opioid use and other criminal activity
• Increase ability to gain and maintain employment
• Improve birth outcomes among people who have substance use disorders and are pregnant

Methadone for Pain Management

Methadone is also sometimes prescribed to manage both acute (short-term), and chronic (long-term) cancer pain in adults. Methadone can be used intravenously during surgery and doing so has shown to lower pain and the need for opioids after surgery.¹⁰

However, as with other medications, there may be some risks associated with using methadone for pain management. One study revealed that individuals who were older and receiving a larger methadone dose (greater than 100 mg per day) were at risk of experiencing heart-related adverse effects.¹¹

Overall, limited research exists regarding the use of methadone for chronic pain, and what research does exist is mostly studying the use of chronic cancer-related pain specifically. Some researchers recommend that methadone be used for cancer pain in only certain situations.¹²

Therefore, talk with your doctor about all of your pain-management options so that you can work together to determine the best treatment plan for you that balances the risks with the benefits.

Methadone Side Effects

Like all medications, methadone may produce some side effects. These may include:¹³

• Headache
• Weight gain
• Stomach pain
• Sore tongue
• Dry mouth
• Difficulty urinating
• Mood changes
• Vision problems
• Sleep problems

Talk to your doctor if these side effects are distressing; they can adjust your dosage to find one that works best for you. More severe methadone side effects may include:³

• Difficulty breathing or shallow breathing
• Lightheadedness or feeling faint
• Hives or rash
• Swelling of the face, lips, tongue, or throat
• Chest pain
• Fast or pounding heartbeat
• Hallucinations (seeing or hearing things that do not exist)
• Confusion
• Seizures
• Agitation
• Loss of coordination
• Severe muscle stiffness

Call 911 right away if you experience any of the above side effects—they could indicate a life-threatening allergic reaction or other medical emergency.

Methadone Overdose Signs

A methadone overdose occurs when you’ve taken a toxic amount of this opioid medication that your body cannot handle. An overdose is a medical emergency, and you should call 911 right away if you suspect you or someone else has overdosed.

Signs of a methadone overdose may include:¹³

• Small, pinpoint pupils
• Slow or shallow breathing or difficulty breathing
• Cool, clammy or blue skin
• Limp muscles
• Inability to respond or wake up

Because of this overdose risk, it’s important to take methadone only as prescribed. If you are misusing or addicted to methadone, seeking treatment can reduce the risks of long-term use.

Methadone Drug Interactions

There are a few types of drugs that are contraindicated with methadone, including:¹⁵

• Sedatives: Alcohol, benzodiazepines, barbiturates, tricyclic and other sedating antidepressants, sedative antihistamines, and adrenergic agonists, such as clonidine
• Partial opioid agonists: Buprenorphine, butorphanol, nalbuphine, and pentazocine
• Opioid antagonists: Naltrexone

Combining methadone with some heart medications could increase the risk of cardiac arrhythmia or irregular heartbeat. Some antipsychotic and antidepressant drugs combined with methadone can also increase the risk of cardiac arrythmias.¹⁵
Anticonvulsant medications for epileptic seizures, when taken with methadone, have caused withdrawal symptoms. Additionally, antimycobacterials (drugs for mycobacterial infections such as tuberculosis and leprosy) combined with methadone can lead to significant reductions in methadone levels in the body.¹⁵

Are there Alternatives to Methadone?

Yes, there are alternatives to methadone. Three other FDA-approved medications for the treatment of opioid use disorder include:^1,17

• Buprenorphine: A partial opioid agonist that relieves withdrawal symptoms and cravings
• Naltrexone: An opioid antagonist that blocks the pleasurable effects of opioids like heroin, fentanyl, and oxycodone and reduces cravings
• Suboxone: A combination medication containing buprenorphine and naloxone, an opioid antagonist used to reverse opioid overdoses

In one study of pregnant people, those who took buprenorphine/naloxone had newborns who were less affected by the medications compared to those whose gestational parent took methadone. In addition, the newborns who were exposed to buprenorphine/naloxone had shorter hospital stays.¹⁸

In terms of the efficacy of Suboxone versus methadone for those who are not pregnant, one research report concluded that Suboxone had lower or similar rates of retention in the treatment program compared to methadone.¹⁹
Therefore, depending on your medical status, a doctor may prescribe you methadone or one of its alternatives. Ultimately, everyone’s needs are a bit different so what works for one person may not be the right fit for you.

How to Prepare for Medication-Assisted Treatment

Here are some things to do if you are considering MAT:³

• Share your complete health history so that medical providers can prescribe the best medication and dosage for you.
• Share any other medications you are currently taking to avoid any drug interactions.
• Share if you are pregnant or are trying to get pregnant.
• Seek a program that has counseling or therapy in addition to medication.
• Arrange reliable transportation to the opioid treatment program.
• Build a solid and sober support system you can rely on.
• Ask about any dietary precautions you should take.
• Ask about what to do if you miss a dose.
• Use the medication only as prescribed.
• Do not drink alcohol while taking methadone or another opioid addiction medication.
• Call 911 if you suspect an overdose.

If you are concerned about your opioid use or that of a loved one, get help today at 800-934-1582(Who Answers?)

Resources

1. Food and Drug Administration. (2019). Information about Medication-Assisted Treatment (MAT).
2. National Institute on Drug Abuse. (2018). Is the use of medications like methadone and buprenorphine simply replacing one addiction with another?
3. University of Arkansas for Medical Sciences. (n.d.). What is Methadone?
4. Fullerton, C.A., Kim, M., Thomas, C.P., Lyman, D.R., Montejano, L.B., Dougherty, R.H., Daniels, A.S., Ghose, S.S., & Delphin-Rittmon, M.E. (2014). Medication-assisted treatment with methadone: Assessing the evidence. Psychiatric Services, 65(2), 146-157.
5. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management.
6. National Institute on Drug Abuse. (2018). How do medications to treat opioid use disorder work?
7. Wang, G.Y., Kydd, R., Wouldes, T.A., Jensen, M., & Russell, B.R. (2015). Changes in resting EEG following methadone treatment in opiate addicts. Clinical Neurophysiology, 126(5), 943-950.
8. Jordan, C.J., Cao, J., Newman, A.H., & Xi, Z. (2019). Progress in agonist therapy for substance use disorders: Lessons learned from methadone and buprenorphine. Neuropharmacology, 158.
9. Substance Abuse and Mental Health Services Administration. (2021). Medication-Assisted Treatment (MAT).
10. Kreutzwiser, D. & Tawfic, Q.A. (2020). Methadone for pain management: A pharmacotherapeutic review. CNS Drugs, 34, 827-839.
11. Price, L.C., Wobeter, B., Delate, T., Kurz, D., & Shanahan, R. (2014). Methadone for pain and the risk of adverse cardiac outcomes. Journal of Pain and Symptom Management, 43(3), 333-342.
12. Theile, D. & Mikus, G. (2018). Methadone against cancer: Lost in translation. International Journal of Cancer, 143(8), 1840-1848.
13. U.S. National Library of Medicine. (2021). Methadone.
14. Vignali, C., Stramesi, C., Morini, L., Pozzi, F., & Groppi, A. (2015). Methadone-related deaths. A ten year overview. Forensic Science International, 257, 172-176.
15. Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva: World Health Organization; 2009. Annex 5, Drug interactions involving methadone and buprenorphine. 
16. Food and Drug Administration. (2018). FDA approves first generic versions of Suboxone sublingual film, which may increase access to treatment for opioid dependence.
17. Canadian Agency for Drugs and Technologies in Health. (2013). Suboxone versus methadone for the treatment of opioid dependence: A review of the clinical and cost-effectiveness. Rapid Response Report: Summary with Critical Appraisal, 1-21.
18. Wiegand, S.L., Stringer, E.M., Stuebe, A.M., Jones, H., Seashore, C., & Thorp, J. (2015). Buprenorphine and naloxone compared with methadone treatment in pregnancy. Obstetrics & Gynecology, 125(2), 363-368.
19. Spooner, R.M., Hudson, J., Coulter, L., & Judkins, H. (2018). Is Suboxone given in the primary care setting more efficacious for opioid addiction than methadone? Evidence-Based Practice, 21(3).