Methadone Side Effects, Treatment and Dosage
Methadone is the most commonly used drug to aid in opioid detox and eventual recovery. Management of opioid addiction with methadone is a carefully controlled process in which methadone is prescribed and given under strict regulations. The use of methadone is a controversial practice, though it has helped many people addicted to opioids.
This article will explore:
- What is methadone?
- Are there side effects from methadone?
- How it is used to treat opioid addiction?
- Can you overdose on methadone?
- Does methadone really work?
What Is Methadone?Methadone is a legally prescribed medication that affects the opioid receptors in the brain in much the same way as illicit opiates and abused prescription opioids. In a sense, methadone replaces the need for the abused drugs while reducing opioid withdrawal symptoms. It can be used to detox from heroin and other opioids such as oxycodone. 1
Methadone can help a person to detox from opioids who otherwise may not be able to stop using them. It can be used for short-term methadone stabilization at the start of opioid detox or for longer-term methadone maintenance. 1
Where Can You Get It?
Methadone is a highly regulated medication, and not all physicians can prescribe it. Methadone detox can only be conducted if a person is in a hospital for some other medical condition, or if the person goes to a methadone clinic regulated by the Substance Abuse and Mental Health Services Administration (SAMHSA).
SAMHSA has developed strict regulations on methadone clinics and provides oversight to ensure that methadone is being administered properly to people in methadone detox and on methadone maintenance. 2
How Does It Work?
People are typically started on a dosage of methadone that can be titrated up daily until an adequate dose is determined that will keep withdrawal symptoms in check. After this point is reached, the recovering individual is eventually tapered to a lower dose for maintenance. People with severe opioid dependence may be started on doses as high as 30 to 40 mg of methadone daily. Most people receive a taper of 10 mg per day over 3 to 5 days.
Although methadone is a prescribed medication, it is possible to overdose on it. So it must be administered appropriately and carefully monitored.1
Methadone is usually given in oral forms, which can include powders, liquids and pills. One of the benefits of methadone as a treatment drug is its relatively long half-life – methadone effects last about 24 to 36 hours.
Doses can go as high as 80 to 100 mg per day, but will rarely exceed this amount. The amount of the dosage for methadone varies, and it depends on the person’s age, weight and history of dependency on opioids.
The administration of methadone can be fine-tuned in its liquid form to ensure that the person who is on methadone maintenance does not receive too little or too much. If the person is on too low of a dose, he or she may experience withdrawal symptoms and cravings for opioids. On the other hand, too much methadone results in intoxication. 3
What to Do if You Miss a Dose
If you miss a dose, do not “double up” on the next dose. Take the missed dose as soon as you remember it, but skip the missed dose if it is almost time for your next scheduled dose.
Do not take extra methadone if you feel that the dosage you are on is not strong enough. 2
Methadone Side Effects
Methadone can cause intoxication and drowsiness if too high a dose is used during detox. Some people experience drowsiness during the short-term methadone detox, but this usually decreases after the medication is used for a while – unless it is used at too high of a dosage. 1
Other possible side effects include:
- Pounding heart.
- Chest pain.
- Difficulty breathing.
- Swelling of the face.2
Some people taking methadone have also experienced constipation, nausea, severe sweating and sexual dysfunction. 3
Methadone has some possible long-term side effects. For some women, long-term methadone use can result in irregular menstrual cycles. Occasionally, people who use methadone for a long period of time may also develop lung and other respiratory problems. 3
Do not take methadone with other medications, such as benzodiazepines, alcohol, painkillers, muscle relaxers and/or any other type of medication that is not carefully supervised by a physician. These medications can increase methadone’s effects and lead to overdoses and drug interactions.
Treatments Used With MethadoneMethadone is a tool used in the overall treatment process for opioid addiction. Most individuals in recovery need help to learn skills to resist using drugs, enhance their motivation to stay drug free and find new social outlets that do not involve people who use drugs.
Therapy and other forms of intervention can help the recovering person stay sober. Many people recovering from opioid addiction also need family therapy to help rebuild relationships damaged by active drug use.
Many different forms of ongoing treatment can be used after the person detoxes from opioids:
- 12-step program meetings are free and exist in almost every community. Narcotics Anonymous (NA) provides the recovering person with a supportive environment to help prevent relapse and to help maintain a healthy lifestyle. Twelve-step programs are a critical part of many aftercare plans following other forms of treatment.
- Group counseling provides positive peer support for the person recovering from opioid addiction. For most addicts, isolation is a serious issue, and groups can provide a social outlet and help to keep the addicted person from feeling lonely during the recovery process. The person can also discover that recovery from opioid abuse is possible by interacting with people who have been in a sustained period of recovery.7
- Individual counseling typically involves cognitive behavioral therapy. This therapy can help a person struggling with addiction and dependency to learn to change the behavioral patterns that trigger the use of substances such as opioids. Some treatment programs also use contingency management, which provides a person with rewards for remaining abstinent.8
You can overdose on methadone. An overdose is unlikely under a doctor’s supervision, but illicit methadone users can overdose quite easily.
A methadone overdose can result in:
- Shallow breathing or cessation of breathing.
- Sleepiness, intermittent loss of consciousness and possibly coma.
- Cold skin.
- Cyanosis – or blue appearance to lips and fingernails.
- Muscle twitches.4
What to Do
A methadone overdose is a serious emergency that requires immediate medical attention. A person who is suspected to have overdosed should be treated at the nearest emergency room or should call 911.Because of the risk of aspiration, under no circumstances should vomiting be induced in a person suspected to have overdosed on methadone. Typically, emergency treatment involves heart monitoring, and administration of IV fluids, laxatives and activated charcoal. The person who has overdosed may also require other medications – such as the opioid antagonist naloxone – to counteract methadone’s effects. At times, the person may need breathing support, such as a ventilator.4
The average cost for a year of maintenance methadone is $4,700. 5 Many insurance programs cover the cost of methadone detox and methadone maintenance.
For those who do not have insurance, community programs may be able to assist with the cost. Many state and local governments offer programs that help provide for the cost of methadone maintenance, and various programs may offer free services to those in need who meet certain criteria.
How Effective Is It?
Numerous studies have evaluated the effectiveness of methadone maintenance.
These studies have found that methadone can:
- Decrease deaths from overdoses.
- Lead to less criminal activity.
- Reduce the spread of AIDS.
- Provide a greater sense of well-being in those who were formerly dependent on opioids.
Other studies have shown that methadone can lead to reduced participation in prostitution, fewer suicides and fewer incarcerations. 3, 6
Frequently Asked Questions
Why Is Methadone Maintenance Treatment Controversial?
One of the reasons methadone is controversial is because it’s expensive. However, studies have shown that the cost of the medication is far less than the cost of the consequences of untreated opioid addiction.6
Other groups have argued that in effect, the person taking methadone is still addicted to a drug. In other words, critics of methadone claim that methadone is substituting one addictive substance for another. However, it is also argued by those who support the use of methadone that the person is in a controlled situation that does not lead to dangerous behaviors.
Does Methadone Get You High?
Yes, methadone can lead to intoxication. Too much methadone will typically result in sleepiness and confusion. Overdosing on methadone is dangerous and often fatal.
Is Methadone Addictive?
Methadone can be addictive at high doses. But a person on methadone maintenance is not likely to become addicted under proper medical supervision and correct dosing.
Technically, someone on methadone maintenance is physically dependent on methadone. However, with controlled dosages, the person does not have cravings that lead to the compulsive behaviors associated with opioid addiction.
Sometimes, a person can develop a tolerance to methadone. In these cases, methadone may not have the same effect as before. But tolerance is relatively rare under proper supervision. 3
Can I Undergo Methadone Detox if I’m Pregnant?
Methadone has not been shown to cause birth defects, and pregnant women can go through methadone detox.
The use of methadone to detox from opioids can also prevent a miscarriage, which can occur due to uterine contractions if a woman goes through an opioid withdrawal. Methadone use during pregnancy may, however, result in a withdrawal syndrome in the baby after delivery.2
Can I Still Use Methadone After I Have My Baby and Want to Breastfeed?
It is also safe to take methadone while breastfeeding. However, a pregnant woman still requires strict medical oversight while undergoing methadone detox or methadone maintenance. 2
Find an Opioid Abuse Treatment Program
Whether you have concerns about your own opioid addiction or about the addiction of a family member or friend, call today. One of our specialists will help you locate a treatment center in your area based on your insurance coverage and your needs for treatment and recovery. Your insurance can be verified, and a specialist can help you locate covered programs for you or your loved one.
If you do not have health insurance, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357) for referrals to low-cost or free programs in your area.
. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal From Specific Substances.
. Substance Abuse and Mental Health Services Administration. (2015). Methadone.
. Center for Substance Abuse and Research. (2016). Methadone.
. U.S. National Library of Medicine. Medline Plus (2014). Methadone Overdose.
. National Institute on Drug Abuse (2012). Is Drug Addiction Treatment Worth the Cost?
. National Institute on Drug Abuse. Part B. 20 Questions and Answers Regarding Methadone Maintenance Treatment Research.
. Center for Substance Abuse Treatment. Substance Abuse Treatment: Group Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 41.) 1 Groups and Substance Abuse Treatment
. Substance Abuse and Mental Health Services Administration (US); 2015. Treatments for substance use disorders