Methadone Treatment: Uses, Benefits, and What to Expect

Disclaimer: This article is for educational purposes only and does not replace expert medical or mental health advice. Opioid use disorder or severe/chronic pain requires a comprehensive psychiatric and physical evaluation by a qualified clinician. So, always refer to a licensed mental health specialist for diagnosis and treatment.

Methadone is a U.S. Food and Drug Administration (FDA)-approved opioid medication used to treat opioid use disorder. It is also used to treat severe and chronic pain. It is classified as a Schedule II substance under the Controlled Substances Act in the U.S., so it is only available under a doctor’s prescription and must be taken under medical supervision.

Methadone is a synthetic opioid agonist. The National Institute on Drug Abuse (NIDA) notes that it has been used for over 50 years now to treat opioid use disorder.

Methadone binds to mu-opioid receptors, similar to other powerful opioids, like morphine, heroin, or even fentanyl. However, the difference here is that methadone slowly activates the mu-opioid receptors and produces a reduced sense of euphoria, which serves to control cravings and opioid withdrawal symptoms.

Methadone comes as a liquid, powder, and tablet. It is only provided under a doctor’s prescription. If prescribed for pain, then the dosage and frequency will be as per the doctor’s instructions.

If it is prescribed for opioid use disorder, then it is prescribed as per the standards cited in 42 Code of Federal Regulations (CFR). It will be integral to medication-assisted treatment (MAT), which also combines behavioral therapies and counseling for a lasting recovery.

Your doctor may begin with a lower dosage of 20 mg per day with a maximum dosage of 40 mg per day, initially. However, it must be noted dosage and frequency of methadone will vary as per the unique needs and circumstances of each person. As it comes with both benefits and side effects, close medical supervision and medication management become very integral to methadone use in opioid use disorder.

The first two to four weeks of methadone treatment - known as induction - are the period of highest overdose risk, even higher than the risk before starting treatment. This is because methadone's pain-relieving effect wears off much faster than the drug actually leaves the body. Because of methadone's long half-life, the drug builds up in the bloodstream over several days even without any dose change, so a dose that felt safe on day one can become dangerous by day four or five - which is why the dose is raised slowly.

Taking extra doses because the effect seems to have worn off is especially dangerous during this period, since earlier doses are often still active in the body even when they no longer feel like it. Most methadone-related deaths happen during this induction window.

Anyone starting methadone, and their household, should have access to naloxone (Narcan) and know the signs of opioid overdose - slow or stopped breathing, extreme drowsiness, and blue-tinged lips or fingertips are a medical emergency. Call 911 immediately.

Methadone can also prolong the QT interval, a measure of the heart's electrical cycle, which is why an ECG may be done before and during treatment and why it is important to tell your prescriber about every other medication and supplement you take.

The benefits of methadone are as follows:

• Reduces or stops opioid misuse
• Reduces the risk of opioid-related overdose deaths
• Reduces the risk of relapse
• Reduces the risk of infections
• Reduces the risk of illegal behaviors
• Helps manage severe or chronic pain where other opioid medications have failed.

The Substance Abuse and Mental Health Services Administration (SAMHSA) cautions regarding the following side effects of methadone:

• Restlessness
• Itchy Skin
• Sweating
• Vomiting
• Constipation
• Sexual problems
• Slowed breathing
• Feeling faint
• Hives or rash
• Chest pain
• Racing heartbeat
• Psychosis.

If you or someone you know is experiencing these side effects, call your doctor immediately.

SAMHSA advises the following precautions you need to take if you have been prescribed methadone:

• Only use methadone as prescribed by your doctor. If you miss a dose, do not take an additional dose on your own. Contact your doctor. If you feel it is not effective, do not stop the medication. Contact your doctor.
• Do not use methadone with alcohol or other drugs, as it can increase the risk and severity of side effects.
• Methadone may lead to slowed reaction times and lightheadedness, so do not drive or operate heavy machinery.
• Store methadone securely and keep it out of the reach of children.
• Dispose of unused or expired methadone safely.
• If you are pregnant or breastfeeding, be open with your doctor about this, as methadone can lead to neonatal abstinence syndrome (NAS) among children, which is when children experience withdrawal symptoms after birth.

If you or a loved one is struggling with opioid use disorder, we understand how challenging it can be. However, more than a million experience recovery with evidence-based and personalized recovery options - like methadone treatment.

Please contact NuView Treatment Center at (323) 307-7997 to connect with our expert team and learn more about the recovery options available to you.

How long does methadone treatment go on for?

While opioid treatment timelines can vary, methadone treatment typically lasts for 12 months.

How effective is methadone treatment for opioid use disorder?

The American Psychiatric Association (APA) notes that treatments for opioid use disorder, including methadone, can reduce opioid misuse by up to 90%.

What should someone expect when starting methadone treatment?

When beginning methadone treatment, your doctor will typically begin with a carefully monitored dose to reduce cravings and withdrawal symptoms while minimizing side effects. Dosages may be adjusted over time based on how you respond, and ongoing medical supervision is crucial to ensure safety and efficacy.

Can methadone itself be addictive?

Methadone has a potential for misuse and dependence, which is why it must be used as per the doctor’s prescription and under medical supervision.

Is medication-assisted treatment (MAT) covered by insurance?

MAT is covered by insurance. You can reach out to your insurance provider or NuView at (323) 307-7997 to understand your insurance coverage.