What Is Methadone?
Methadone is an FDA-approved medication your doctor can prescribe for ongoing pain or opioid use disorder (OUD). It can help ease pain and prevent withdrawal symptoms when you stop using opioid drugs like heroin, morphine, codeine, or oxycodone.
Methadone changes how your brain and nervous system respond to pain. It’s a long-acting full opioid agonist, which means it activates opioid receptors in the brain the way heroin and morphine do, but at a slower rate. It’s in a drug class called opiate (narcotic) analgesics.
Methadone is most often used as part of a full treatment plan called medication-assisted treatment (MAT). This treatment combines medicine, counseling, and behavioral therapies to better help people with substance use disorders avoid withdrawal and stay in recovery.
How Does Methadone Work?
Methadone works like other opioids in your brain, but because it works slowly and stays in your system, you don’t get high, and you don’t have withdrawal symptoms or cravings. It also blocks the effects of opioid drugs. The drug restores balance to your brain so you can focus on your recovery. For OUD, you can start methadone at the start of your recovery, without having to go through withdrawal from other opioids.
What to Expect When You Take Methadone
Methadone is available as an oral tablet or liquid. In the U.S., it’s available under the brand names Dolophine and Methadose.
If you begin methadone for ongoing pain, your doctor will likely start you off slowly on a low dose. Your doctors will work to find the dose that keeps you from having opioid withdrawal symptoms but doesn’t lead to breathing and heart problems. Unlike other opioids that act in 1 to 3 hours, methadone is a long-acting depressant. It could take a few days until you feel the effect.
Because this drug stays in the body for so long, you can have a fatal overdose if you keep taking too high of a dose. This risk is also high at the times you step up your dose, but the effects may not appear for a few days because the drug acts slowly.
If you take methadone for pain, do not take it as you need it. You must take it daily on a schedule set by your doctor. Follow their exact instructions. Your dose is specific to your needs. You can take it without food, but eat something if you have nausea.
The length of methadone treatment is different for each person. But it takes time for the medication to be effective. The National Institute on Drug Abuse recommends that people stay in treatment for at least 12 months. You can take methadone for maintenance for decades, or your doctor can slowly lower your dose to prepare you to stop taking it. You should never stop taking methadone suddenly.
About 25% of people who take methadone are eventually able to stop. Another 25% keep on taking it, while the other half go into an on-and-off cycle.
What Is an Opioid Treatment Program (OTP)?
You can only get methadone through an opioid treatment program (OTP) that’s certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). This program offers MAT for people with OUD under a doctor’s supervision.
Before you start your treatment, you could have a physical exam with hepatitis and HIV testing. You could give a pee sample that tests for drugs and pregnancy, and possibly take a Breathalyzer test to estimate your blood alcohol level.
The OTP medical staff will watch you when you take your doses early in treatment. They look for how you respond to the medicine. After you’ve been in treatment for a while and have shown that you can take the medication just as prescribed, you may be allowed to take your doses at home. But you’ll still need to visit your doctor regularly so they can track your progress.
Methadone Warnings and Safety Issues
Before you start taking methadone, let your health care provider know about any medications and supplements you take. Other medications may interact with methadone and cause heart conditions.
Taking certain medications with methadone may increase your risk of other life-threatening side effects like breathing problems. Ask your doctor about the many different drugs to avoid. Methadone could cause common interactions with medications, such as:
- Antidepressants
- Muscle relaxants
- Antipsychotics
- Narcotics for pain and cough
- Medications for nausea
- Sleeping pills
Some substances that can have dangerous interactions with methadone are:
- Alcohol
- Other opioids
- Barbiturates
- Benzodiazepines
These depressant drugs have a sedative effect. Combined with methadone, they can make you very drowsy, have breathing problems, and be at risk of a coma or death. Make sure you are used to methadone and know how it affects you before you drive or operate heavy machinery.
If you take methadone at home, follow the instructions your doctor gives you and do not change your dose on your own. Take your methadone as soon as you can if you miss a dose. But if it is close to your regular medication time, take your usual dose. Do not double up.
Before you take methadone, tell your doctor if you have:
- A methadone allergy
- Severe asthma
- Trouble breathing or other lung problems
- A blockage in your intestines
- A narrowing of your stomach
- Heart rhythm problems
- Liver, kidney, or thyroid problems
- A head injury, brain tumor, or seizures
- Pancreas or gallbladder problems
- Drug or alcohol abuse problems or mental health issues
- Trouble peeing
If you’re pregnant, it’s safe to take methadone. Studies have found that taking this drug while pregnant does not raise the risk of birth defects. There is a chance that your baby will show signs of withdrawal in a condition called neonatal abstinence syndrome (NAS). It’s important to work with your care team so they can treat any complications that you or your baby have right away.
Common Side Effects of Methadone
Methadone may cause side effects. Some will go away after you have been taking the methadone for a while. Common side effects include:
- Nausea
- Vomiting
- Constipation
- Dry mouth
- Sweating
- Drowsiness
- Dizziness
Go to the ER or call 911 right away if you have serious side effects. Potentially serious side effects include:
- Trouble breathing
- Chest pain or a fast heartbeat
- Hives, itching, or swelling of your face, lips, tongue, or throat
- Severe dizziness or feeling lightheaded or faint
- Extreme drowsiness and a hard time waking up
- Mental health or mood changes (agitation, confusion, hallucinations)
In rare cases, methadone can cause heart rhythm problems that can be life-threatening. Your doctor will watch you closely during treatment. They may suggest you have an echocardiogram test regularly to see how the drug is affecting your heart function.
How Well Does Methadone Work?
Methadone has been used to treat OUD since the 1950s and was approved by the FDA for that purpose1972. Since then, many studies have shown that methadone reduces opioid use. One review found that people taking methadone with psychosocial treatment had 33% fewer opioid-positive drug tests and were more than 4 times more likely to stay in treatment than those using therapy alone. Even without counseling services, methadone treatment greatly helps people to cut down on using opioid drugs.
