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Methadone and Addiction Treatment

Methadone is one of three medications approved by the Food and Drug Administration (FDA) to treat opioid use disorder (OUD).1 When methadone is used to treat opioid addiction in conjunction with an individualized, comprehensive recovery treatment plan, it is referred to as medication-assisted treatment (MAT).

Studies show that methadone therapy is more effective at keeping patients in treatment and in reducing illicit opioid use more effectively than placebo, medical detox, or no treatment. As part of MAT, methadone is tailored to a person’s treatment plan, with dosage adjustments based on individual need.14

For several decades, methadone has given—and continues to give—people the opportunity to make the necessary life changes associated with long-term remission and recovery from opioid use disorder (OUD). The World Health Organization lists methadone as an “essential medication.”14


What Is an Opioid Use Disorder?

Substance use disorders (SUD) occur when a person’s use of a substance, including a drug or alcohol, leads to significant negative consequences, like health issues, problems at work or school and with social relationships.2 When a person compulsively uses opioids (including heroin, morphine, codeine, fentanyl, and oxycodone) despite negative health, social and professional consequences, that person is suffering from an opioid use disorder (OUD).4

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition—known as DSM-5—sets out the criteria that physician’s use to diagnose mental health disorders. To be diagnosed with an opioid use disorder (OUD), a person must meet at least 2 of the following criteria within a 12-month period:3

  • Opioids are taken in larger amounts over a longer period than intended.
  • There is a persistent desire or unsuccessful effort to cut down or control opioid use.
  • There is a great deal of time spent obtaining opioids, using them, or recovering from their effects.
  • Having cravings, or a strong desire or urge to use opioids.
  • Recurrent opioid use resulting in failure to fulfill obligations at work, school, or home.
  • Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or worsened by opioid use.
  • Important social, work-related, or recreational activities given up due to opioid use.
  • Recurrent opioid use in situations where it is dangerous.
  • Continuing use despite knowing that a persistent or recurrent physical or psychological problem is caused or worsened by opioid use.
  • Needing more opioids to achieve the previous effect, known as tolerance.
  • Experiencing any of the withdrawal symptoms, like nausea, vomiting, muscle aches, tearing, diarrhea, yawning, and insomnia.

OUD is a debilitating condition, and there is currently an OUD epidemic in the United States that affects more than 2.1 million people and has been associated with more than 47,000 deaths.4


What Is Methadone?

Methadone works as a long-acting full opioid agonist, meaning that it binds to the same brain receptors that opioids bind to, providing similar effects to other opioids (e.g., morphine, heroin, fentanyl, codeine, or oxycodone).1 Methadone is an oral mu-opioid receptor agonist that is prescribed as an opioid replacement. 4 This means it works on the same brain receptors that opioids like heroin, morphine, fentanyl, and others do, but it does not produce the intense euphoric effects of those drugs, which helps to decrease the person’s craving to use opioids.

Methadone also helps to decrease the risk of getting or spreading infectious diseases like HIV, hepatitis C, or blood-borne bacterial infections.4

When used as directed by a physician, the use of methadone to treat OUDs is medically safe, and if taken as prescribed, it shouldn’t have an impact on a person’s respiratory drive. Respiratory depression, or slow and ineffective breathing, as is experienced with an opioid overdose, shouldn’t occur. However, it is important to remember that methadone can still cause serious or life-threatening breathing problems, especially during the initial stages of treatment, if the dose is increased, or if you misuse the medication.5

Methadone is offered only in federally certified, accredited opioid treatment programs (OTP). To qualify as an OTP, a clinic specializing in treating people suffering from opioid addiction must also offer counseling and drug testing as part of treatment. Some programs also offer additional services and support, including treatment of co-occurring mental health disorders.4,14 Clinical staff will carefully monitor you during your treatment, especially if you have other chronic medical conditions, such as a history of lung disease, like asthma, or chronic obstructive pulmonary disease (COPD).5

Methadone is a Schedule II drug which means it has a high potential for abuse and may lead to dependence and tolerance if misused; in 2019, an estimated 240,000 Americans reported misusing it in the past year.6,15

How Does Methadone Work?

Methadone is taken orally. It is classified as an opioid because it works the way other opioids do—as an opioid agonist that binds to the same opioid receptors as illicit and other opioid medications. These opioid receptors are in the central nervous system, which includes the brain and spinal cord, as well as in parts of the gastrointestinal tract. When activated, opioid receptors provide the effects of pain relief and drowsiness, as well as euphoria when taken at higher doses.8 Methadone can produce similar effects, but the dosage is controlled to avoid over sedation and minimize feelings of euphoria.8

Methadone’s half-life, which is the amount of time it takes for the concentration of a drug in the blood or the body to decrease by half, varies anywhere from 8 to 59 hours.14 This means it takes longer than other opioids for withdrawal symptoms to appear.8 The half-life variability is due to considerable variance in the time it takes different people to clear the drug from their system, and is one reason why individualized treatment is critical when methadone is used for MAT of OUD.14

Uses of Methadone

When methadone is prescribed for the treatment of opioid addiction, it will be started at a low dose that will gradually be increased over a few days or even weeks with the goal of preventing withdrawal symptoms. Methadone therapy prevents other opioids from binding to the receptors, thus preventing the euphoria caused by illicit opioids like heroin or the misuse of opioids like fentanyl and oxycodone.8


Side Effects of Methadone

Some of the most common general side effects of methadone include:8,14

  • Constipation.
  • Nausea and vomiting.
  • Dizziness.
  • Increased sweating and flushing.
  • Dry mouth.
  • Sexual dysfunction (in men and women) and changes in menstruation (in women).
  • Sedation and lethargy.

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How Does Methadone Help Addiction Treatment?

According to the Substance Abuse and Mental Health Services Administration, of all treatment approaches to opioid addiction, “methadone has by far the largest, oldest evidence base of all treatment approaches to opioid addiction.”14

Methadone can be used as medication-assisted treatment (MAT) for opioid abuse disorder. MAT is the use of medications in combination with counseling and behavioral therapies to provide a “whole-patient,” individualized approach to the treatment of opioid addiction and other SUDs.10

The use of methadone as MAT has been shown to be successful in treating addiction and helping those struggling with sustaining recovery. Methadone has demonstrated it can reduce the risk of opioid overdose and has been shown to reduce the need for inpatient detox services. MAT provides a more individually tailored approach in recovery and has been shown to:10

  • Improve patient survival.
  • Decrease illicit opioid use and other criminal activity.
  • Increase a person’s ability to gain and maintain employment.

Co-occurring mental health conditions, such as the coexistence of both opioid addiction and another metal disorder, may exist in people who are treated using MAT.10 Integrated medical and behavioral healthcare delivery can effectively provide patient-focused, comprehensive treatment that address the full range of symptoms and service needs for patients with cooccurring disorders.14


Can Methadone Be Abused?

Since methadone is itself an opioid, it does have the potential to be abused or misused. Risks associated with methadone, especially when starting MAT and as the dosage is adjusted, are overdose and, less so, cardiotoxic effects, which is why people are closely monitored during their treatment. Concurrent misuse of alcohol or benzodiazepines at the same time as methadone increases the risk of potentially fatal respiratory depression.8,11

Close monitoring during treatment, including the use of drug screening, helps to minimize these risks. Patients are given a lengthy treatment plan and stipulations that they need to follow to continue their treatment with methadone. For example, they may be required to complete their dose in front of dosing staff, attend doctor appointments and counseling services, and participate in 12-step groups.11

Methadone therapy is typically used when a person is already physiologically dependent on opioids. When starting MAT with methadone, it is therefore critical to adhere to your medication requirements to avoid experiencing opioid withdrawal symptoms.12


Treatment for Substance Abuse

Addiction is a chronic disease where engaging in continuing substance misuse causes changes in the brain that lead to harmful behaviors.13 Opioid use disorders can be effectively treated, however, it often requires continuing care to completely stop using and sustain long-term recovery.

Effective treatment typically involves counseling and other behavioral therapies. Your treatment plan will be individualized, and it will need regular review. The plan may also address cooccurring mental disorders and may involve medically assisted treatment with methadone or another medication that is FDA approved to reduce the risk of relapse in people with opioid use disorder.13

Treatment that includes medications such as methadone may be delivered in inpatient or residential treatment and sometimes in outpatient treatment settings. With inpatient or residential care, you typically receive 24-hour monitoring in a safe, structured environment that may include intensive medical attention.13

In the outpatient setting, you will visit a clinic to receive your dose of methadone and you may also receive individual and group behavioral health counseling, participating in multiple sessions each week, while continuing to live at home.13


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Sources

  1. Substance Abuse and Mental Health Services Administration. (2020). Methadone.
  2. U.S. National Library of Medicine. (2021). MedlinePlus: Substance use disorder.
  3. American Psychiatric Association. (2013). Substance-related and addictive disorders. Opioid use disorder. Arlington. (VA). Diagnostic and statistical manual of mental disorders (5th ed.)
  4. Dydyk, A.M., Jain, N.K. & Gupta, M. (2021). Opioid Use Disorder. Treasure Island (FL): StatPearls Publishing.
  5. U.S. National Library of Medicine. (2021). MedlinePlus: Methadone
  6. Drug Enforcement Administration. (2019). Methadone.
  7. Drug Enforcement Administration. (2021). List of controlled substances disclaimer.
  8. Durrani, M. & Bansal, K. (2021) Methadone. Treasure Island (FL). StatPearls Publishing.
  9. National Alliance on Mental Illness. (2021). Methadone.
  10. Substance Abuse and Mental Health Services Administration. (2021). Medication-Assisted Treatment (MAT).
  11. Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. Geneva: World Health Organization; 2009. 6, Methadone maintenance treatment.
  12. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition): Is there a difference between physical dependence and addiction?
  13. National Institute on Drug Abuse. (2019). DrugFacts: Treatment approaches for drug addiction DrugFacts.
  14. Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63. Publication No. PEP20-02-01-006. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.
  15. Substance Abuse and Mental Health Services Administration. (2019). NSDUH Detailed Tables: Table 1.1A – Types of Illicit Drug Use in Lifetime, Past Year, and Past Month among Persons Aged 12 or Older: Numbers in Thousands, 2018 and 2019. (HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.

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