Methadone: Treatment Uses, Side Effects, and Withdrawal Management
Methadone is one of three treatment medications used to treat opioid use disorder (OUD) by reducing cravings and eliminating or reducing withdrawal symptoms.4 It is currently the most used medication to treat OUD and is known to be safe and effective when used as prescribed.2, 10
What Is Methadone?
Methadone, also known as dolophine, is a man-made, FDA-approved prescription medication to help a person recover from an opioid use disorder (OUD). It can also be used for pain management.1, 2 Methadone is classified as a Schedule II controlled substance by the Drug Enforcement Administration (DEA), which means it has a high potential for misuse while having legitimate medical uses.2
Studies have shown that for people with an OUD, methadone is more effective than treatment without medication, medically supervised withdrawal, or no treatment. Studies also show that methadone may help reduce overdose deaths.4 Methadone can help people manage their cravings for opioids even after formal treatment for OUD.2
Methadone can be taken as a tablet, oral solution, or injected in liquid form; however, it is highly regulated and must be administered by a qualified treatment professional who can supervise the appropriate dosage and ensure it is individualized to a person’s unique needs.2, 3
While it can be effective at treating OUD, repeated use can lead to physiological dependence, which means a person will experience withdrawal symptoms when they stop taking methadone.3 Methadone should only be stopped under the guidance of the prescribing physician.3, 4
How Does Methadone Work?
Methadone eliminates or relieves symptoms of opioid withdrawal as it binds to and stimulates opioid receptors in the brain similar to other opioids. However, methadone is a long-acting opioid with a strong affinity for the opioid receptors, which means that when an opioid-dependent person taking methadone also uses heroin or a prescription opioid, it will not produce euphoria.4, 8
Withdrawal symptoms are signs that a person’s body has adapted to the presence of the drug, and they can only function normally with the presence of an opioid.6 Withdrawal symptoms are physiological reactions caused by the absence of opioids. They are generally very unpleasant and may be so hard to tolerate that a person may start using opioids again to avoid withdrawal symptoms.6, 7 Opioid withdrawal symptoms are rarely life-threatening; however, certain opioids like heroin may present greater risks.6
Warnings When Taking Methadone
Methadone is a powerful drug, and it is not without some risks in its use. Too much methadone can lead to respiratory depression, as well as create a potential for misuse.4 With the introduction of methadone, a healthcare provider aims to find the optimal dose that will relieve withdrawal symptoms from opioids but not create euphoria or sedation in a person.4
Methadone is only administered in certain federally approved treatment centers, and it is carefully monitored to avoid as many potential complications as possible.2 Providers typically start at the lowest possible dose and adjust the dose higher while regularly monitoring the person until they don’t feel withdrawal symptoms, cravings are eliminated, and effects of illicit opioids or from misusing prescription opioids are blunted.4
Treatment with methadone has been in use for over 40 years and it is generally safe.2, 4, 8 In fact, methadone can be given to pregnant and nursing women to help them detox from opioids without harm to the mother or baby.2
However, some people do experience cardiac issues when taking methadone, including irregular heartbeats or a more serious condition known as prolonged QT. Careful screening before starting methadone can help providers find alternatives to methadone for people who are at higher risk of these heart conditions.4
Although methadone is associated with a reduced risk of overdose, a major risk, particularly toward the beginning of methadone treatment, is overdose often related to combining with CNS depressants, such as alcohol and benzodiazepines.8 For this reason, people should be closely monitored in the initial phases of treatment.8
Drug Interactions with Methadone
There can be harmful drug interactions between methadone and other substances, such as benzodiazepines, certain types of antidepressants, anticonvulsants, and some antibiotics.4, 8 Again, a careful assessment and screening of people before methadone treatment will generally help avoid risky drug interactions.4
Safe methadone administration should include the following:4, 9
- Do not combine methadone with benzodiazepines, alcohol, or other central nervous system (CNS) depressants.
- Share your complete and total health history with your provider before starting methadone.
- Tell your provider about all medications you are taking and talk to them before adding any medications after starting methadone.
- Ask about signs of methadone overdose and how to access naloxone (which can reverse the effects of an opioid overdose) and get emergency care if needed.
- Don’t drive or operate heavy machinery right after starting methadone.
- If you become pregnant, tell your provider.
- Let any other healthcare providers you work with know that you are on methadone.
- Take methadone exactly as prescribed; don’t take extra if you think it’s not working.
- Learn about the side effects of methadone.
Side Effects of Methadone
Methadone can produce side effects, which can include: 1, 2, 3
- Nausea and/or vomiting.
- Problems with sexual functioning.
- Shallow breathing.
Potentially serious health effects that occur in some cases and include:2
- Difficulty breathing.
- Lightheadedness or fainting.
- Having hives or a rash.
- Swelling of the face, lips, tongue, or throat.
- Chest pain.
- Rapid or irregular heartbeat.
- Hallucinations or confusion.
If you experience side effects, discuss these with your provider. If you experience more serious effects, contact emergency services immediately.2
Methadone for Withdrawal Management
Methadone is one of two medications used to help manage symptoms of withdrawal and reduce opioid cravings.10 When a person is ready to go through an opioid detox, providers will determine the starting dose of methadone to manage withdrawal symptoms without causing sedation and then increase the dose as required to appropriately manage symptoms.10
Generally, the higher the dose of opioids a person has been using, the higher the dose of methadone needed to prevent withdrawal symptoms.8
Anyone going through an opioid detox who has been regularly taking opioids of any kind and stops using them will have lower tolerance and become more sensitive to the effects of opioids. The risk of overdose can be higher if you start using opioids again after a period of withdrawal.8
What Is Methadone Maintenance Treatment?
Methadone is helpful during detox to help eliminate or reduce opioid withdrawal symptoms, but it also has value for ongoing treatment after detox.4
Cravings for opioids can persist long after someone stops using opioids.4 These cravings can make recovery from an OUD difficult as it makes people want to use opioids again.4 Methadone can help control these cravings and prevent relapse.4
Methadone for maintenance treatment for OUD can be taken on a long-term or short-term basis. Some people use methadone maintenance treatment indefinitely to maintain recovery.4
Benefits of Methadone Maintenance Treatment
The World Health Organization lists methadone as one of its Essential Medicines due to extensive research done on the substance.8 Benefits of using methadone to treat OUD may include:4
- Reduction of illicit opioid use.
- Patient retention in treatment.
- Reduction in the use of opioids by injection.
- Lower rates of HIV and hepatitis C transmission.
- Fewer deaths related to opioid dependence.
- Less criminal activity by those who use opioids.
Other OUD Treatment Medications
Methadone is not the only option for treating an OUD. Other options include:
- Buprenorphine is sold under the brand name Subutex or combined with naloxone and sold as Suboxone. It comes in many different forms, including sublingual tablets, sublingual film, an injectable, and an implant.4 Buprenorphine is a partial opioid agonist that binds to the mu receptors and helps prevent other opioids, such as heroin from attaching to the mu receptors.4 Buprenorphine is not as likely to cause respiratory depression as methadone.4 Buprenorphine also has a ceiling effect, which means once a person takes a certain amount of it, taking more has no added effect.4
- Naltrexone is a non-opioid, non-addictive medication that blocks the effects of opioids so that if a person uses opioids while on it, nothing will happen.8 The person will not experience euphoria or pain relief from opioids, but cravings for opioids are reduced.8 Naltrexone can be taken orally or injected.8 However, unlike methadone and buprenorphine, naltrexone cannot be given to someone in withdrawal. The person must be abstinent from opioids for at least 7 days before they can take naltrexone.8
Find an OUD Treatment Program
If you or a loved one are struggling with opioid misuse and are ready to undergo treatment, American Addiction Centers (AAC) is ready to help. Our caring admissions navigators are available 24/7 via our confidential helpline at . They will listen to your story and explain treatment options to make sure you find the support you need.