• Addiction & recovery

What is Methadone Used For?

Vanessa de la Cruz, MD

February 21, 2022


Methadone is a synthetic opioid that was initially used for treating moderate to chronic pain. But it was later proven to be an effective medication for opioid use disorder (MOUD). This revelation prompted the U.S. Food and Drug Administration (FDA) to officially approve methadone for opioid addiction treatment in the late 1970s. The use of methadone in opioid treatment is known as methadone maintenance treatment (MMT). And according to the Substance Abuse and Mental Health Services Administration (SAMHSA), people on MMT accounted for about 21-25 percent of all individuals receiving treatment for opioid use disorder.


How Does Methadone Work?

Methadone is a long-acting prescription medication that works by changing how the brain and the nervous system react to pain to treat chronic pain. It also works by interacting with opioid receptors in the brain to lessen the symptoms of opioid withdrawal when administered as part of opioid addiction treatment. This interaction also reduces the risk of relapse during recovery by blocking the “high” caused by other opioids like heroin, codeine, and morphine. Methadone treatment, when coupled with counseling, behavioral therapies, and aftercare programs, has a success rate as high as 90%.

Methadone, sold under the brand names Dolophine and Methadose, is a Schedule II controlled medication with a high potential for misuse and dependence. Hence they can only be dispensed through a SAMHSA-certified opioid treatment program (OTP), also known as a methadone clinic.


Methadone Treatment for Pain

Methadone is a powerful painkiller that is made from synthetic opioids. Although it is most typically linked with the treatment of opioid use disorder, it is also prescribed for short-term pain management (such as post-surgery) or cancer pain/hospice treatment.

Methadone appears to be useful in treating cancer pain and has a similar analgesic efficacy and side effect profile as morphine. In a study of cancer patients with uncontrolled pain or considerable opioid side effects, 80% of patients reported pain relief and reduced negative effects after switching to methadone. Because methadone is synthetic and has no shared characteristics, it can be administered in people who are allergic to morphine.


Methadone for Opioid Use Disorder

Methadone is an opioid medication that has been in use for more than 50 years to treat opioid addiction. Methadone decreases opioid cravings and withdrawal symptoms and blunts or decreases the effects of opioids during a relapse. Each person’s methadone maintenance treatment is unique, and dosages are routinely changed and re-adjusted as they progress.

Methadone’s efficacy in reducing opioid misuse has been demonstrated in various studies. MMT has also been shown to have additional benefits, such as:

  • Decrease in infectious diseases 
  • Decrease in criminal activity 
  • Overall improvement in quality of life
  • Higher chance of achieving long-term recovery
  • Improved social functioning 
  • A higher retention rate for addiction treatment
  • Increased employment rate

In addition to lowering opioid misuse, methadone treatment programs strive to return people to productive functioning in their families, workplaces, and communities.


Who Should Not Use Methadone?

Methadone is an effective medication for treating opioid dependence and achieving long-term sobriety. However, it is not the recommended treatment option for everyone.

Methadone should not be used by people who are:

  • Younger than 18 years
  • Allergic to any of the ingredients of methadone 
  • Have asthma or breathing problems 
  • Have a blockage in the stomach or intestines 

It’s also important to inform your health professional if you have any of the following medical conditions to ensure that methadone treatment is safe:

  • Heart problems such as arrhythmia
  • Sleep apnea
  • Head injury, brain tumor, or seizures
  • Alcohol use disorder (AUD)
  • Ulcerative colitis (UC)
  • Thyroid, adrenal glands, kidney or liver problems 
  • Mental illnesses, such as depression 
  • Pregnant or breastfeeding 

Using methadone while pregnant can result in the unborn baby forming a dependence on the opioid medicine and facing neonatal abstinence syndrome upon birth. However, there are situations where continuing methadone maintenance therapy is the best choice during pregnancy. Methadone has also been observed to pass into breastmilk. Thus, pregnant or breastfeeding women should speak with their medical provider about whether or not to continue methadone should they become pregnant. If the benefits of methadone outweigh its potential risks and continuing, it is the safest option for mother and baby; the healthcare professional will recommend continuing with methadone treatment.


Side Effects of Methadone

Methadone can cause side effects that can range from moderate to severe. Most of such side effects tend to dissipate with continued use. However, if the side effects persist or worsen, it’s important to contact a healthcare provider immediately. 

Some of the common side effects of methadone include:

  • Nausea
  • Vomiting 
  • Constipation 
  • Lightheadedness 
  • Dizziness 
  • Dry mouth 
  • Drowsiness 
  • Sweating 
  • Anxiety 
  • Insomnia 
  • Loss of appetite 
  • Stomach pain 
  • Reduced sex drive 

Some of the severe side effects of methadone include:

  • Shallow breathing 
  • Hallucinations 
  • Confusion 
  • Chest pain 
  • Fainting
  • Dizziness 
  • Fast or pounding heartbeat 
  • Severe drowsiness 

It’s advisable to stop taking the medication and contact emergency services when one faces severe side effects of methadone. Methadone’s severe side effects are more common in the elderly and those who are underweight. 


Methadone Withdrawal 

Individuals on methadone maintenance therapy may face withdrawal symptoms upon quitting the medication abruptly. The withdrawal symptoms can appear within 24-36 hours after the last dose and include symptoms such as:

  • Anxiety
  • Tiredness 
  • Restlessness
  • Sweating 
  • Watery eyes
  • Runny nose
  • Insomnia 
  • Muscle aches and pains 
  • Goosebumps 
  • Vomiting 
  • Nausea
  • Diarrhea
  • Depression 
  • Cravings 

Most treatment providers gradually wean individuals off methadone to reduce the risk of methadone withdrawal.


Methadone Overdose 

Methadone can cause an overdose when it’s taken in large doses or more than prescribed. The risk of overdose is even higher in individuals who combine methadone with other substances such as alcohol, cocaine, or other sedatives. 

Methadone overdose is a life-threatening situation that can lead to coma or even death. As such, it’s important to seek immediate medical treatment if one faces symptoms of a methadone overdose.

Symptoms of a methadone overdose include:

  • Low blood pressure
  • Weak pulse
  • Constricted or pinpoint pupils 
  • Cold, clammy skin 
  • Blue lips and fingernails 
  • Loss of consciousness 
  • Slow, labored, or shallow breathing 
  • Generalized weakness throughout the body


Methadone Overdose Treatment

If naloxone is available, it should be administered to the person who has overdosed immediately. The next step would be to call 911 (even if the person appears to wake up or come out of it because the effects of naloxone could wear off) and wait with the person for an ambulance to arrive.

Methadone can be an effective medication for opiate use disorder, but this treatment is not without safety risks. As a result, it’s vital to obtain medical advice before starting methadone treatment.

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