What is methadone?

Methadone is one of the two FDA-approved options clinicians have when prescribing medications for addiction treatment (MAT). It was originally developed to treat pain and has long been considered an effective treatment for opioid use disorder (OUD). You might be familiar with this medication through depictions in movies and TV shows, but how does it actually work? Is it automatically the right choice for everyone going through addiction treatment? Here’s what you should know about methadone and how it compares to other treatment options.

What is methadone used for?

A long-lasting, full opioid agonist, methadone alters the brain and nervous system’s response to pain. When it was first synthesized during World War II, methadone was designed with this specific purpose in mind: to act as a painkiller. It has since been used to treat chronic pain as well. Unlike other opioids, however, methadone doesn’t produce a euphoric effect when used as directed.

Today, methadone is used to control pain following surgery or an injury, or to manage discomfort for people with long-term illnesses. It can also be used to block the effects of oxycodone, codeine, morphine, heroin, and other opioids as part of an OUD treatment plan. Methadone controls cravings and reduces withdrawal symptoms, offering fast-acting relief that can last as long as 36 hours. However, incorrect dosage or improper usage can result in euphoric effects—especially if the person taking it is considered opiate naïve.

There are several forms of methadone available. It may be prescribed in powder, liquid, or tablet form. Sometimes, methadone is prescribed in dispersible form, which means the medication must be dissolved fully in a liquid. Healthcare providers must prescribe the medication and offer dosing recommendations based on each patient’s unique needs.

Typically, methadone is taken once a day, usually for a period of at least 12 months. Some patients stay on methadone long-term as part of their OUD treatment plan. It’s important to follow your provider’s instructions precisely throughout the entire duration of your treatment plan since it must be stopped slowly over time to prevent withdrawal.

Methadone side effects

As with any medication, methadone can lead to side effects. Some patients experience restlessness or sleep changes. Gastrointestinal side effects, such as constipation, upset stomach, vomiting, and appetite changes, may occur. It’s also possible to experience heavy sweating, weight changes, headache, dry mouth, flushing, and itchy skin. Some patients report mood changes and vision problems as well.

In rare cases, methadone can also lead to more serious side effects that call for immediate medical assistance. Call your provider right away if you experience serious issues, such as signs of an allergic reaction; these typically include swelling in the mouth or face, chest pain, or hives. Difficulty swallowing, severe drowsiness, fainting, hallucinations, and chest pain or rapid heartbeat are also signs of a potentially serious reaction that calls for prompt medical treatment.

Safe methadone usage

Whether you’ve received methadone for pain relief or as part of an OUD treatment plan, it’s critical to take it exactly as prescribed by following the recommended dose and time. If you miss a dose, do not double up and take an extra dose. Do not drink alcohol while taking methadone, and use caution when operating vehicles or machinery.

If you are prescribed methadone for pain, store the medication away from direct light sources and at room temperature. Keep methadone out of reach from children and pets. If an overdose is suspected, call 911 immediately.

Methadone as an OUD treatment is administered under medical supervision at a specific facility, not at home.

How does methadone compare to Suboxone®?

Suboxone is the other FDA-approved MAT option. While methadone is still used to treat OUD today, Suboxone is considered a safer alternative because it is a partial agonist, meaning it partly activates opioid receptors in the brain. Methadone is classified as a Schedule II drug. Since methadone is a full opioid agonist, it activates more opioid receptors in the brain, introducing a greater risk of misuse or overdose. Suboxone, on the other hand, is a Schedule III drug because it has a better safety profile (important safety information). The medication contains buprenorphine, which has a “ceiling effect,” meaning the effects don’t compound after a certain dosage. Suboxone also contains naloxone, an opioid antagonist that further mitigates a drug’s harmful effects. Unlike methadone, Suboxone can block the effects of other opioids. 

Methadone’s classification and abuse potential present certain barriers to treatment. For one, patients who start methadone need to receive in-person care from a provider every day for the first 90 days of their treatment program. Patients must typically attend their program every day, as no “take home” doses are provided initially. This is because taking methadone calls for close monitoring, and providers gradually increase doses to 60 to 100 mg so the medication can achieve its intended therapeutic effect.

While provider oversight is necessary for safe use of methadone, this arrangement can be challenging to keep up with for an extended period. From transportation difficulties to schedule conflicts, there are many obstacles that could prevent someone from getting consistent in-person care for 90 days. These barriers to care could render the MAT ineffective and lead to severe withdrawal symptoms, which could ultimately drive someone to go back to opioids for relief.

Unlike methadone, Suboxone can be prescribed via telemedicine and picked up at a local pharmacy. Scheduling check-ins with a care provider is more flexible since these appointments can also be held virtually. These convenience factors can significantly reduce the risk of relapse and help individuals feel more in control of their treatment program.

Safe, effective care that fits into your life

Ophelia provides Suboxone-based treatment as a safe and effective methadone alternative that’s widely available to many people who need it. If you or a loved one is facing an opioid use disorder, set up a free consultation. If our clinical providers feel that Suboxone is the right approach, we’ll make sure you have access to it through a local pharmacy and continue meeting with you virtually on your schedule.