If you take methadone for severe pain or opioid use disorder (OUD), you may have some questions. Here are answers to common questions about this medication.
What Is Methadone?
Methadone is in a drug class called opiate (narcotic) analgesics. It eases the symptoms of withdrawal from opiate drugs. If you use opioid drugs like heroin, morphine, codeine, or oxycodone, you may need this medication when you stop. This is called medication-assisted treatment (MAT). Methadone is one part of your total MAT treatment plan, along with some type of behavioral therapy.
Methadone also changes the way your brain and nervous system respond to pain. Your doctor may also prescribe it for long-term pain relief.
Methadone is one of three drugs approved by the FDA for MAT. The other two are buprenorphine and naltrexone. Research shows that methadone is the most-used maintenance treatment to manage OUD. If you take it exactly as prescribed, it’s safe and effective.
How Does Methadone Work to Treat Opioid Addiction?
Methadone acts on the same areas in your brain as other opioids, but it doesn’t make you feel high. Instead, it blocks withdrawal symptoms and cravings so you can focus on your recovery.
What Are the Common Side Effects of Methadone?
The most common side effects of methadone include:
- Nausea or vomiting
- Slow breathing
- Constipation
- Weight gain
- Itchy skin
- Dry mouth
- Heavy sweating
- Restlessness
- Sexual problems
- Decreased fertility
These side effects may go away as your body adjusts to the medication. Let your doctor know if they persist.
Methadone also has side effects that are more serious. Get medical help right away or call 911 if you have any of the following:
- A hard time breathing
- Chest pain
- A fast, pounding heartbeat
- Hives
- Swelling in your face, lips, tongue, or throat
- A skin rash or itching
- Feeling lightheaded or faint
- Confusion or seeing things that aren’t there
What Is the Procedure for Getting and Taking Methadone?
Methadone is available in daily liquid or tablets. The brand names for methadone in the U.S. are Dolophine and Methadose. Generics are also available.
Methadone is only available for OUD through a certified opioid treatment program (OTP). To prescribe methadone, an OTP must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) and approved by a SAMHSA-approved independent accreditation body.
At an OTP, special doctors, nurse practitioners, and physician assistants may prescribe methadone or other MAT medications. The drug will usually be in liquid form. A single dose of methadone lasts 24 to 36 hours. You’ll take a dose every day.
You may first meet with the medical staff and answer questions about your health history and what your recovery goals are. You may also get a medical exam, which could include a drug test by checking your pee.
Your doctor will start you off with the lowest possible dose of the medication. They’ll carefully watch how you respond and talk to you about how you’re feeling. Over time, they’ll raise your dosage to a maintenance level. This is the amount that keeps you from having withdrawal symptoms without feeling “high.”
At first, you’ll only be able to receive your prescription by going to your doctor or to a pharmacy in person. As you continue your treatment, regular drug screens can show if you’re taking the right dose and make sure you aren't mixing drugs. After you’ve made progress in your treatment and have shown that you can take the drug just as prescribed, you may be allowed to take it at home between doctor visits.
How Will I Feel When I First Start Methadone?
You may not feel the full effect of your first dose for 4 or more days, even if you take the same daily dose. A dose may seem fine, but by the third or fourth day, you may feel very tired. Methadone has a long half-life (how long it takes for the drug to leave your system). It can be 24 to 36 hours or even longer. When you’re first starting methadone, your doctor may need to adjust your dose so it’s right for you.
Methadone can make you sleepy, lightheaded, or dizzy when you first start to take it. Don’t drive or do any high-risk activities until you get used to it. It may also cause serious breathing problems, especially during the first 24 to 72 hours or when your dosage goes up. Tell your doctor if you have asthma, a brain injury, or liver, kidney, or lung disease.
If you feel like you have a heart problem, seek emergency medical help. You may receive electrocardiogram tests (EKGs) to check your heart. The tests can show if you have a chance for a serious arrhythmia, a problem with how the heart beats.
You can start methadone without going through withdrawal from other opioids first. You may feel some withdrawal symptoms as you start to adjust, especially if your doctor needs to adjust your dosage. If you do, these may include:
- Anxiety or nervousness
- Yawning or sleep problems
- Sweating more than normal
- Muscle aches and pains
- Nausea, stomach pain, or vomiting
- Weakness
How Long Does Treatment With Methadone Last?
There’s no set length of time for methadone treatment, but the National Institute on Drug Abuse recommends that people stay in MAT for at least a year.
How long you’ll take methadone depends on several things, such as how long you used opioids and whether you keep up with the therapy part of your treatment. About 25% of patients in MAT with methadone eventually don’t need it any longer and are able to stop taking the medication. Some people stay in a maintenance program for life.
If you and your doctor think that stopping methadone treatment is right for you, you must slowly lower the dose to prevent withdrawal until you’re no longer taking the drug. Your doctor will watch you closely to be sure you taper off of methadone safely.
How Much Does Methadone Cost? Is It Covered by Insurance?
The pricing for opioid treatment may depend on different things. Recent costs for methadone treatment (including medication and medical support services) are about $126 per week, or $6,552 a year.
If you have Medicare, methadone is covered for OUD treatment when you get it from an OTP.
How Long Does Methadone Stay in the System?
Methadone stays in your system for 24 to 36 hours or even longer. You may not feel the full effect of your first dose for 4 or more days, even if you take the same daily dose. A dose may seem fine, but by the third or fourth day, you may feel very tired.
Even if the effects of methadone wear off, its active ingredients remain in your body for much longer. Methadone can be found in your pee from 1 to 3 days after you stop treatment. Your dose, age, weight, and how often you exercise can decide how fast your body gets rid of it.
Can I Take Methadone if I’m Pregnant?
You can take methadone while you’re pregnant or breastfeeding. If you’re pregnant and go through opioid withdrawal without methadone, your uterus can contract, which can lead to a miscarriage or the baby being born too early. The medication will help to stop withdrawal symptoms, so you can focus on recovery and caring for yourself and your baby.
It’s important to see your doctor regularly during your pregnancy so they can watch you for any complications.
If you take methadone while pregnant, there is a chance that your child may be born with neonatal abstinence syndrome (NAS). This means they are born with an opioid addiction. Your care team will watch your baby closely for signs of NAS and give them the care they need if this happens.
How Do I Take Methadone Safely?
You can take methadone safely if you follow the instructions and guidance that your doctor gives you. Let your doctor know about all medications you take. You may not be able to take methadone if you have certain health conditions. Tell your doctor if you have an allergy to methadone, or if you have asthma, lung disease, or sleep problems.
Other medications may interact with methadone and cause heart conditions. If you take certain medications with methadone, this may increase your chances of life-threatening side effects. These include:
- Breathing problems
- Sedation
- Coma
Methadone may be bad if you take it with other medications, such as:
- Antipsychotics
- Narcotics for pain and cough
- Medications for nausea
- Antidepressants
- Muscle relaxants
- Sleeping pills
The most dangerous ones to take with methadone are:
- Other opioids
- Benzodiazepines
- Alcohol
- Barbiturates
These drugs have a “downer” effect. Methadone is the same. When you take them together, your breath slows, and you have a greater chance of dying.
But even with these risks, for many people, the benefits of taking methadone for opioid dependence may be greater than the possible harm.
Is Methadone Addictive?
It’s possible that your brain can start to rely on methadone. When you get used to it, you may need more of the medication to feel the effects. Talk to your doctor about what dosage will help you as you move forward.
Methadone gets into your system slowly. If you’re taking methadone at home without a doctor watching over you, you may think it’s not working, take too much, and overdose. It’s crucial to take methadone exactly as your doctor has prescribed. Always take the correct dose at a set time. Even if you’ve missed a dose, never take an extra one.
Symptoms of overdose include:
- Shortness of breath or long pauses between each breath
- Extreme sleepiness
- Blurred vision
- Trouble talking, thinking, or walking
- Feeling dizzy, faint, or confused
- Cool, clammy, or blue skin
- Limp muscles
- Small, pinpoint pupils
Call 911 or go to the ER right away if you have any signs of an overdose.
If you take methadone at home, ask your doctor if a prescription for naloxone may be right for you. This is a medication you can take in an emergency to block the opiate effects of methadone.
Do not drink alcohol, take medications that may make you sleepy, or use any drug that can slow your breathing. If you take methadone with any of these in large amounts, this can lead to an overdose or death.
