Methadone is a synthetic opioid drug that works to relieve pain. Its effects are similar to those of morphine or other narcotics used for pain reduction. Methadone works much in the same way that morphine does, but without the feelings of pleasure or “high” that many opiates provide.
Methadone is often used during medication-assisted therapy (MAT) during addiction treatment. It is sometimes called replacement therapy because methadone takes the place of the addictive drug without the cravings and withdrawal.
Today methadone is mostly used in addiction treatment programs to help people who are suffering from an addiction to heroin or other opioids. It can also be prescribed to treat pain. Methadone is in the class of drugs known as opioid or narcotic analgesics.
Block the effects of opiates
Minimize cravings for opiates that can result in addiction relapse
Relieve withdrawal symptoms during addiction treatment
Replace a illegal drug use with medication management guided by a medical professional
Some brand names for methadone include Methadose and Dolophine.
Methadone comes in oral tablets, tablets that can be dissolved in a liquid, concentrated liquids, and solutions. They are all taken by mouth. There is an IV form that can only be injected by a healthcare professional.
In 2017, over 70,000 Americans died from drug overdose. Sixty-eight percent of those deaths were the result of prescription or illegal opioid use.1
According to the Center for Disease Control, the death rate linked to an overdose of prescription opioid drugs (including natural and synthetic drugs plus methadone) increased by 300% between 1999 and 2014, going from 3,442 people in 1999 to 14,838 in 2014.
The rate of deaths due to methadone overdose fatalities increased by 600% from 784 in 1999 to 5,406 in 2006. These numbers remained stable in 2007, but then overdose deaths from methadone decreased 39% (3,400 people) in 2014.2
Although it appears that methadone overdose deaths have declined, this medication still accounts for almost one in every four opioid prescription overdose deaths.
Methadone is used not only in medication-assisted therapy but is also widely used to relieve pain. Close to 4 million methadone prescriptions are written yearly to treat pain. In addition, 1.5 million people over the age of 12 have used methadone for non-medical or recreational purposes at least once.3
In the 1930s, German scientists were seeking a painkilling drug that wasn’t as addictive as morphine. Max Bockmuehl and Gustav Ehrhart discovered a substance they called Hoechst 10820.4
During World War II, Germany’s supply of morphine and other painkillers for its soldiers was getting low. A different German scientific team expanded upon the research that Bockmuehl and Ehrhart had begun. They started manufacturing supplies of Hoechst 10820 for wartime use.
When the war was over, the United States won the rights to study and use this drug. The medication was introduced for use in the US in 1947 as a pain reliever by the drug company Eli-Lilly.5
The company began making the medication and selling it under the name Dolophine. It was soon found to be most useful in the treatment of narcotic addiction. Heroin addiction had by then become an epidemic in New York City after the war. 6
When heroin addiction again became a public health issue in the 1960s, methadone found its place in addiction treatment for its ability to reduce cravings and withdrawal symptoms. The medication was also used as replacement therapy to manage heroin addiction.
In 1971, treatment for heroin addiction using methadone expanded. Many of the soldiers returning home from the Vietnam War and a lot of the American youth had developed a heroin addiction in the 60s and 70s. As many as 900 deaths in one year in New York City were reported as a result of heroin addiction.7
The federal government began regulating the use of methadone for heroin addiction treatment in response to this domestic drug problem. It wasn’t until 2001 that these regulations were looked at once again for more effective and consistent use by health care professionals who were treating addiction.
MAT with methadone will help a person battle drug cravings and deal with painful withdrawal symptoms.
A dramatic decrease for risk of infection for those who were injecting opioids
Criminal activity will be reduced, as illegal drugs are no longer being used
Quality of life will improve
Methadone provides a better chance for successful, long-term recovery
Without the distractions of cravings and withdrawal pain, there is more interest in participating fully in recovery treatment programs
If someone is taking methadone to help in their recovery from substance use, adding on other drugs or alcohol can cause serious side effects. For example, mixing methadone with alcohol or sedatives can lead to slowed breathing, loss of consciousness, coma, or perhaps even death.
Using methadone for the long term can cause changes to take place in the brain that may affect learning and memory.
Although methadone blocks the pleasurable effects that other opiates provide, there are still some side effects to contend with when using this drug. It can cause varying degrees of:
Decreased reactions times
Lowered blood pressure
Slowed or shallow breathing
Decreased attention span
Decreased sensitivity to light
Change in heartbeat rates
Methadone is a successful tool when used properly as maintenance treatment for opioid addiction. When used improperly or recreationally, this medication can be very dangerous.
Severe breathing difficulties
Reduced blood pressure and heart rate
Excess fluid in the lungs
Death can also result when methadone is taken with other drugs, such as cocaine, Valium, or Xanax.
Methadone does not react well with certain other medications, especially sedatives that treat seizures, insomnia, or anxiety.
When used over a lengthy period, methadone can lead to lung or respiratory problems. The drugs place you at risk for serious side effects if you have any of the following health issues:8
You can also become addicted to methadone. If taken for pain, your brain may come to rely upon you taking it to relieve discomfort.
Aside from overcoming an addiction to heroin or other opioid drugs, methadone is also sometimes prescribed to treat severe pain. Methadone, however, is itself an opioid, which means it also has the risk of causing a dependency or addiction.
It is not safe to stop using methadone suddenly. It’s safest to have a healthcare provider help you taper off this drug over time, known as detox.
Some people experience withdrawal symptoms after stopping the intake of methadone within 24-36 hours. This withdrawal period can last anywhere from 2 weeks to 6 months. It varies from person to person. For the majority of people, the withdrawal symptoms peak during the first week.
Methadone withdrawal might include some of the following flu-like symptoms:
Watery discharge from the eyes
After the third day, these symptoms may become stronger:
After methadone withdrawal is completed, some may feel an urge to return to using other opioids. For that population, it’s often recommended that they remain on a low dose of methadone for some time, and then try weaning off the drug again.
If someone is having a difficult time during methadone detox, a physician may lessen the symptoms with medications, such as buprenorphine, suboxone, or clonidine.
Buprenorphine and suboxone are very similar in makeup to methadone. These synthetic drugs can help ease the discomfort of withdrawal and shorten the length of time for completion. Clonidine helps lessen anxiety and nervousness, and it also helps relieve achiness and runny noses. To reduce cravings for opiates, naltrexone is a helpful medication.
It’s important to keep in mind that a doctor must oversee your withdrawal from methadone to ensure its safety and effectiveness.
How much and how you should take methadone, and in which form, will depend on the following:
The dosages come in either 5 to 10 mg tablets.
For short-term pain that is moderate to severe, the adult dosage will usually begin at 2.5 mg every 8-12 hours. The dose can then be increased slowly over the next five days.
For help with withdrawal from opioids, adults are typically prescribed 20-30 mg of methadone, with an additional 5-10 mg provided after 2-4 hours, if needed.
When a maintenance dose of methadone is required for an addiction to opioids, adults are given 80-120 mg per day.
All of the above dosages are different for children who are 17 years old and under and for adults who are over the age of 64.
The benefits of medications like methadone that are used to treat addiction are often overshadowed by some misconceptions about this type of medically assisted therapy.
Here are some myths about methadone and the facts:
Fact: Health professionals do not prescribe methadone to act simply as a substitute for another substance. A medication such as methadone is longer acting in the body’s system and safer in helping someone overcome addiction to opioids.
Methadone does not provide users with the same “high” as other opioids do, and it works to block those effects if opioids are used in relapse. Its use on a maintenance level keeps a person healthier and decreases the criminal activity that often accompanies illegal drug-seeking.
Fact: Instead of thinking of addiction as a medical disease, some people believe it to be a spiritual or moral failing. With this in mind, they consider methadone treatment as a crutch or a bad moral choice due to a weakness of the soul, because a substance is still being regularly used.
It’s thought by some that replacing heroin or opioids with methadone means there is no serious effort to become sober. In actuality, addiction is a medical disease that leads to changes in the brain’s opioid receptors. Just as with many other diseases, medicines can be used to help.
Fact: Addiction to substances is a chronic condition that cannot be cured in the way antibiotics can cure an infection. Drug dependency is a chronic disease, much in the way as diabetes. It can be treated and managed with medications. The same is true for long-term use of methadone.
Fact: This is not true because methadone doesn’t impair someone’s daily ability to function in life. Methadone is a federally regulated drug, meaning you know what you are getting. It isn’t the same as other substances that can be dangerous.
Methadone is a prescribed drug. A person doesn’t have to commit crimes or become self-destructive to obtain and use it. It’s also very difficult to overdose on methadone, especially when taken as ordered.
Fact: The effects of withdrawal from a substance vary from person to person. Some discover that the withdrawal process from methadone may take longer than with heroin or other opioids. Other people have no issues at all breaking away from methadone use.
So, while withdrawal may take longer for some, the effects are milder than with other narcotics, particularly when done safely and under supervision.
Fact: While there may be a few clinics that aren’t upholding the strict federal and state regulatory standards, most are providing excellent services in a clean, safe atmosphere. There are usually at least two clinics from which to choose from in a major metropolitan area. You may prefer a private clinic as opposed to a public one.
Although there are some drawbacks associated with the use of methadone in heroin and opioid addiction treatment, the positives tend to far outweigh the negatives.
Methadone is a highly effective, FDA-approved medication used to treat opioid use disorders. Considering all the causes of death among people who are receiving methadone for a substance disorder, it was found that one-third of them were less likely to die than those who were not being treated with methadone.
Aside from saving many lives in the past, this medication has the potential to save many more lives in the future.