Methadone is a synthetic opioid drug developed in Germany in WWII as an analgesic (pain killer). Today it is most commonly used to treat dependence (addiction) of other opiates, for example codeine, oxycodone, hydromorphone, hydrocodone, morphine, fentanyl and heroin. It’s benefit in addiction treatment was first discovered in the 1960’s but the use has become more widespread since the 1990’s. It is not useful in treating an addiction to cocaine, methamphetamine, MDMA (ecstasy), benzodiazepines (valium and others), marijuana or alcohol.
How methadone works
Methadone is very effective in reducing the symptoms of opiate withdrawal and therefore also the craving to use opiates. Motivated patients usually take the chance to get their lives back on track once they no longer have to spend considerable time and resources to locate opiate drugs to take care of their withdrawal. In this way opiate dependency can be thought of as an opiate deficiency – if people have the right amount of opiates in their system they can function. If they don’t then they don’t function very well.
How well does methadone work?
Methadone can be effective whether you inject, smoke, snort or swallow opiates. Several scientific studies have proven that people on a methadone programs are less likely to have legal or medical problems and are more likely to hold down a job, stay in school and keep their family together. The evidence is overwhelming – the patient benefits but so do their family and society. Methadone maintenance treatment is recommended by the CRISM guidelines.
How is methadone taken?
Methadone is prepared in a liquid (usually orange or grape drink) and taken once a day. Initially patients must go to a pharmacy every day to get their dose. The pharmacist will witness the doses being taken. As patients progress in the treatment program they may be allowed to take doses home to take on their own. Likewise, initially they attend clinic twice per week during stabilization (while their ideal dose is being determined) then weekly. As they progress they attend clinic less often.
Effects & Side Effects
Euphoria (feeling high) or sedation or nausea is possible if too high a dose of methadone is taken. Typically patients feel no effect except a decreased need for opiates – a low dose is started for safety reasons. During the stabilization phase some patients experience withdrawal and may decide to continue using to prevent these symptoms. Once stabilized patients do not get “high” on methadone and they do not suffer withdrawal or craving for opiates. Patients usually do not get high if they take other opiates because methadone occupies most of the opiate receptors. Taking other opiates while stable on methadone more likely leads to sedation than euphoria – this helps to decrease the desire to use opiates.
Methadone is useful to prevent withdrawal because it has a long duration of action. For most people a single dose prevents withdrawal for 24 hours. By slowly decreasing the dose over months patients can become opiate free without having to go through withdrawal. This is called a taper. Patients at BMC are never forced to go off MMT and a some do prefer to stay on chronic therapy as this decreases the chance of a relapse.
Some people do get some side effects but overall methadone is well tolerated. Most common are constipation (typical of all opiates), sweating and weight gain, and decreased libido (sex drive). These effects are dose related – one of the reasons you will want to be on the lowest effective dose. Withdrawal symptoms like abdominal cramps, nausea, diarrhea, insomnia, restlessness, irritability, anxiety, and muscle or joint pain may be part of the stabilization phase but resolve once you are stabilized.
Taken as directed, methadone is very safe and does not cause long-term damage to organs, even after several years. However, it is a powerful drug and a typical dose for an addict can be fatal to someone that has not developed tolerance.
Methadone is approved and recommended for use in pregnancy. Please see the sections in FAQ that deal with pregnancy
Will I become addicted to Methadone?
Patients on methadone maintenance are already dependent on opioids and as methadone is an opioid this doesn’t change unless they taper their dose. Most patients lose the maladaptive behaviors that define opioid use disorder so by definition these patients are not addicted to methadone although they still have dependence or an opioid deficit. See the section in Key Concepts.
Methadone Maintenance Therapy (MMT)
The CPSO (College of Physicians and Surgeons of Ontario) has set out very specific guidelines (rules that should be followed but can be adjusted for cause) and standards (rules that must be followed). Patients initially must get their dose daily at a pharmacy. After a period of at least 8 weeks they may be considered for a take home dose if stable, able to safely store a dose of methadone and largely drug free. Every 4 weeks after that they may be eligible for another carry. Eventually they go to the pharmacy once per week to pick up their weeks worth of doses. Some exceptions can be made for family emergencies, work and vacations but you must have at least some carries to qualify. See your BMC doctor for details.
Many scientific studies have shown that opioid replacement remains the most successful treatment currently available for opiate addiction.