Methadone Addiction Treatment
Methadone is a synthetic opioid medication used for two purposes: drug addiction treatment and pain management. However, methadone itself can be addictive and if not used exactly as prescribed by a doctor, it can have dangerous health effects.1
The Introduction of Methadone
Methadone was originally developed in the 1930s as an opioid analgesic, intended to be less addictive than heroin or morphine. As heroin addiction spread across the U.S., methadone treatment became an important element of overcoming illicit drug addiction.
Methadone was introduced to the U.S. as a prescription painkiller somewhat later, but the use of methadone to manage pain began increasing in the 1990s.2 Since then, methadone has become responsible for overdoses caused by prescription drugs. For example, in 2009, of the total number of prescription drug overdoses, over 30% were attributed to methadone. Until 2014, the rate of methadone overdose deaths was increasing. Research data suggest that the rise in methadone overdose deaths was due to its use for pain management, not its use to mitigate symptoms of heroin or opioid withdrawal.3
These alarming figures made it clear that it was necessary to pay more attention to how methadone is prescribed in order to avoid accidental overdose deaths. Since in some cases methadone became habit forming, in addition to the originally intended addiction treatment with methadone, it has become necessary to provide treatment for methadone.
How Is Methadone Used?
Methadone can be obtained in the following forms:
- Oral concentrate
- Oral solution
In the U.S. it is sold under two brand names: Methadose and Dolophine.
When methadone drug treatment is used for opiate addiction, the drug is given only to people who have struggled with high-dose opiate addiction that has lasted a long time. Methadone’s potency helps reduce or prevent withdrawal symptoms. However, the person must have a high tolerance to opioids, otherwise, they will experience an intense and potentially addictive euphoria.
As a prescription painkiller, methadone has become popular because it can reduce pain for a full day or sometimes up to 36 hours.1 For people with chronic pain, the duration of methadone’s effects is a huge benefit. Using methadone as a painkiller makes it possible to:
- Take less of the potent narcotic.
- Worry less about taking their medication on time.
- Get relief that lasts long enough for them to live a normal daily life.
Medicaid patients are the primary recipients of this drug since it is inexpensive. In 33 states in the U.S., methadone is listed as a preferred medication for Medicaid patients.4
How Is Methadone Abused?
Since methadone has re-emerged as a prescription painkiller, it is more available in people’s homes, which means it can be abused for nonmedical reasons. Research conducted by the Substance Abuse and Mental Health Service Administration estimated that as many as 23.5% of past-year users of methadone misused this drug.5 Moreover, methadone is sometimes sold or traded for other drugs, as well as acquired through fraudulent prescriptions or theft.6
For people who do not have a high tolerance to narcotics, the high from methadone can be intense and addictive. While methadone may be an effective addiction treatment when use is closely monitored and the drug is taken as prescribed, inappropriate use can be responsible for overdose death.7
With prolonged use, people can become dependent on methadone. Furthermore, some might develop tolerance as with any opioid, which means that they may need a larger dose for the same effect and experience withdrawal symptoms when stopping taking methadone suddenly.8 In these cases, a person is advised to consider entering a methadone treatment program.
What Are the Signs of Methadone Abuse?
If a person is abusing methadone recreationally, they may display symptoms similar to those of people who struggle with heroin use, OxyContin, or other opiates. However, the symptoms may last longer, as methadone stays in the body for several hours. Symptoms include:
- Nausea and vomiting
- Other stomach aches and pains
- Loss of physical coordination
- Severe sweating
- Slow or irregular breathing
- Fatigue, sleepiness, or falling unconscious
These signs indicate that a person needs to undergo methadone addiction treatment so that some even more serious issues, including overdose, can be prevented.
How Does Methadone Overdose Happen?
There are two high-risk scenarios for methadone overdose:
- Many people are acquiring methadone through illicit sources and taking larger doses than intended.
- Some people may overdose because methadone stays in the body for a longer period of time than its analgesic effects last; adding more narcotics on top of a narcotic already in the body can cause an overdose. Moreover, people may accidentally mix their medication with other prescription drugs or alcohol.2
Warnings on methadone prescriptions tell those who have these medications that they should not consume other intoxicating substances with methadone, but people who struggle with opioid addiction, dependence, and tolerance are less likely to follow those instructions.8
What Is Methadone Treatment & How Does It Work?
Methadone addiction treatment will likely involve a taper.9 Since methadone is still used as maintenance therapy for other opioid detox processes, a physician may work with their patient to taper how much methadone they take rather than trying to replace the drug.However, a physician may also prescribe buprenorphine to taper their patient’s methadone dependence. The doctor may use the Clinical Opioid Withdrawal Scale (COWS) to determine how severe their patient’s withdrawal symptoms are, which helps them determine how to adjust the length of time they will slowly taper their patient off methadone.10
Frequently Asked Questions
- Signs that a person is overdosing include:
- Small, pinpoint pupils that do not react to light
- Slow, shallow, irregular, or stopped breathing
- Bluish tint to the skin
- Cold and clammy skin
- Stupor (awake but unresponsive)
- Limp muscles
- If a person overdoses on methadone, call 911 immediately. To survive, they need emergency medical treatment. Like other opioid drugs, methadone overdoses stop the person’s breathing, so they suffer oxygen deprivation and may die without treatment. Respiratory depression from a methadone overdose can last up to 59 hours, so people who experience this problem need hospitalization and careful medical monitoring.
- Since methadone remains active in the body for up to 36 hours, withdrawal symptoms may not begin for one or two days after the last dose is taken. Additionally, because methadone has such a long half-life, withdrawal symptoms may last for a week or two longer than other, shorter-acting opioid drugs.9Symptoms of methadone withdrawal during the first 30 hours include:
- Watery eyes
- Runny nose
- Excessive yawning
- Difficulty sleeping
Once methadone withdrawal peaks, typically after three days, symptoms will feel a lot like the flu but may include psychological symptoms and drug craving. These symptoms include:8
- Muscle aches and pains
- Severe nausea
- Stomach cramps
After the peak of withdrawal, some of these symptoms may linger, but they will gradually go away. However, many people who attempt to stop taking opioids like methadone without help are likely to relapse, which puts them at risk for overdose. It is very important to get help from medical professionals and a comprehensive rehabilitation methadone addiction treatment program to safely and successfully detox from methadone. Methadone users are highly advised not to stop taking methadone on their own before talking to their doctor.1
- As with any type of addiction treatment, methadone treatment and recovery should be seen as a long-term process that often involves more than one episode of treatment. According to the Principles of Effective Treatment by the National Institute on Drug Abuse (NIDA), for positive outcomes, it is expected that addiction treatment should last at least 90 days. The exact duration of treatment always depends on the individual condition and treatment needs.11
- As the opioid epidemic is sweeping the nation, many organizations are offering evidence-based treatment for methadone to help people overcome this severe addiction. However, many people who struggle with addiction to methadone or other opioids may not know where to start to get help. Concerns usually involve the following considerations:
- How much methadone treatment will cost
- Whether methadone treatment is covered by insurance.
- How long the treatment for methadone addiction will last.
- Whether an individual should join outpatient treatment for methadone or seek help at an inpatient facility for methadone treatment.
Available Resources & Institutions
This is a list of credible institutions and resources that provide guidelines for those seeking methadone addiction treatment:
- The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a treatment finder, which identifies a variety of mental and behavioral health options across the country.
- Men and women who have served in the Armed Forces can receive treatment for any substance abuse, including methadone addiction treatment, through the Office of Veterans Affairs (VA).12
- Qualifying individuals can receive opioid treatment by signing up with Medicaidor Medicare.13 Since many of those struggling with opioid and prescription drug addiction have a low income or are older adults, these programs are working hard to expand access to this form of treatment. Those who do not qualify for Medicaid coverage may still have access to income-based help through the Office of Disease Prevention and Health Promotion (ODPHP).14
- The American Society of Addiction Medicine (ASAM)15 maintains a list of treatment resources, as does the National Association for Addiction Professionals (NAADAC).16 The Police Assisted Addiction and Recovery Initiative (PAARIUSA) helps train police officers and sheriffs’ departments to assist people struggling with addiction rather than criminalizing them.17 The National Coalition Against Prescription Drug Abuse (NCAPDA) offers resources to help people get started on the path to recovery.18
For those who need ongoing support, Narcotics Anonymous (NA) meetings provide free social support based on the 12-Steps model.19 For those seeking a 12-Step alternative, SMART Recovery offers nationwide meetings.20
1. MedlinePlus. (2019). Methadone.
2. Hendrikson, H. & Hansen, M. (2014). Methadone and Prescription Drug Overdose.
3. Faul M., Bohm M., & Alexander C. (2017). Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States 2007–2014s. MMWR Morb Mortal Wkly Rep 66(12), 320–323.
4. Vestal, C. (2015). Most States List Deadly Methadone as a ‘Preferred Drug’.
5. Substance Abuse and Health Service Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
6. National Drug Intelligence Center. (2003). Information Bulletin: Methadone Abuse Increasing.
7. Vital Signs. (2012). Centers for Disease Control Prevention.
9. Healthline. (2018). Going Through Methadone Withdrawal.
10. Centers for Disease Control and Prevention. Pocket Guide: Tapering Opioids for Chronic Pain.
11. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.
12. US Department of Veterans’ Affairs. Treatment Programs for Substance Use Problems.
14. Office of Disease Prevention and Health Promotion. MyHealthfinder.
16. Association for Addiction Professionals. Links.