Methadone is a synthetic opioid that is used to relieve pain and treat heroin, fentanyl and oxycodone addiction. Methadone is similar to morphine but has a gradual onset and milder effects. Methadone is a Schedule II drug, as classified by the Drug Enforcement Administration, meaning that it is associated with a high potential for abuse but has accepted medical uses and can be prescribed.

What is Methadone?

The definition of methadone is, “…a medication used in medication-assisted treatment to help people reduce or quit their use of heroin or other opiates.” Methadone is a synthetic opioid narcotic (technically, opioids are synthetic versions of naturally occurring opiates) that was first synthesized in the 1930s in an attempt to find a less-addictive version of morphine. In the 1960s, methadone was evaluated as a way to curb the rapid rise of heroin use and was found to be an effective narcotic substitute that could reduce heroin withdrawal symptoms. Several brand names exist, but the active ingredient in all of them is methadone hydrochloride.

Is Methadone an Opiate?

Methadone is commonly referred to as an opiate, although it is technically an opioid. Opioids are synthetic versions of naturally occurring opiates, but the terms opiate and opioid are frequently used interchangeably. Opioids and opiates are both narcotics.

What is Methadone Used For?

Legal methadone uses are limited to relieving severe pain and as a way to manage withdrawal symptoms associated with heroin (or other narcotic) addiction. Due to its addictive nature, illicit use of methadone is common.

Pain Management

Opioids manage pain symptoms by binding to opioid receptors located in the central nervous system, thereby blocking pain signaling in the brain. Prescriptions of methadone for pain management have become somewhat controversial in recent years, mainly due to the addictive nature and the risk of selling or giving away prescribed pills.

  • Chronic Pain: Chronic pain affects more than 40% of older Americans. Prescriptions of methadone for chronic pain management were common until recently, but mounting evidence suggests that long term opioid use for chronic pain management may cause more problems than solutions. Many people who use methadone to manage chronic pain report that they develop tolerance to the medication, resulting in the requirement for ever-increasing doses in order to continue to manage their pain. Consequently, long-term methadone use for pain management leads to addiction, withdrawal symptoms, and unmanaged pain.
  • Cancer Pain: Many people undergoing treatment for various cancers suffer from moderate to severe pain, and methadone has been shown to be a reliable first-line therapy in the management of cancer pain. Interestingly, many lines of tumor cells have been shown to have opioid receptors. In these patients, methadone could have “tumor thermalgesic” properties; that is, methadone could control pain as well as enhance the efficacy of anti-tumor agents.
  • Back Pain: Chronic lower back pain is one of the most prevalent pain syndromes among adults in the United States, affecting 13.1% of adults ages  20 to 69. Methadone can be an effective short-term management strategy for acute back pain, but it should not be used to manage chronic back pain.

Addiction Treatment: How Does Methadone Work for Addiction?

Opioids are among the most powerfully addictive drugs known to man. Common opioids of abuse include heroin, fentanyl, oxycodone, and morphine. Although methadone is an opioid, it has a more gradual onset of action than other opioids and the overall effect is mild enough that users do not experience the euphoric high that is associated with other opioids of abuse.

Underlying all opioid addictions are significant changes in brain chemistry, primarily associated with mu-opioid receptors and the dopamine-mediated reward system. Opioid use rapidly induces a state of tolerance, meaning that a person must take ever-increasing doses of the drug to feel the desired effect.

Physical dependence and addiction quickly develop with regular opioid use, and withdrawal symptoms can be profoundly debilitating. When people discontinue opioid use, physical symptoms generally subside within days or weeks, but the chemical changes in the brain may persist for years. Because methadone acts on the same brain regions as other opioids without delivering the euphoric high, methadone can stave off physical and psychological withdrawal symptoms associated with heroin and other opioids. For individuals who struggle with chronic opioid addiction, methadone treatment may be a lifelong strategy that allows them to avoid relapse. However, methadone itself is associated with dependence and addiction. Long-term methadone treatment strategies should be reserved for extreme cases of opioid addiction.

How is Methadone Taken?

Methadone administration is generally oral (pill or liquid). In hospitals or clinics, injections may be used. Illicit methadone use is often associated with smoking or snorting.

  • Pill: Methadone pills typically come in 5 mg or 10 mg doses, and may come in wafer or tablet formulations.
  • Liquid: Methadone liquid may come as a concentrate (10 mg) or ready-to-use solutions (1 mg or 2 mg). Liquid methadone for oral delivery must be precisely measured. There is also a soluble tablet available.
  • Injection: Subcutaneous, intravenous or intramuscular injections are generally given by health care providers in clinical settings for pain management or acute withdrawal symptoms. Some people use methadone injections illicitly for the fast-acting effect, the results of which can be lethal.
  • Smoke inhalation: Smoking methadone is dangerous and is never medically sanctioned. Smoking methadone delivers effects quickly, which is why it is so popular among recreational users.
  • Snorting: Snorting methadone is also popular among recreational users. Snorting does not provide the near-immediate onset that injecting or smoking does, but it has a more rapid onset compared to oral administration.

Proper Dosage

The most appropriate methadone dose is the one identified and prescribed for a person by their doctor. Dosages depend on why a client is taking methadone (pain or withdrawal), age, gender, weight, and other factors. Adults who are prescribed methadone to manage pain will generally be prescribed a dose of 2.5 mg to 10 mg every 8 to 12 hours. Adults who are prescribed methadone for opiate withdrawal are generally prescribed a dose of 5 mg to 10 mg, with a maximum initial dose of 30 mg and a maximum day one dose of 40 mg. It is imperative that people not exceed the dose specified by your doctor.

What Does Methadone Look Like?

Methadone generally comes in the form of round, white pills, although some may be beige or orange, depending on the manufacturer and dosage. Methadone can be dissolved in water, so liquid methadone is clear and flavorless, although it may be flavored cherry or citrus and colored red or orange.

Other Names for Methadone

Methadone hydrochloride is the active component in methadone formulations. There are a number of brand names for methadone, and recreational users created several street names.

  • Generic: Methadone hydrochloride
  • Brand: Dolophine, Diskets, Methadose
  • Street: Fizzies, amidone, chocolate chip cookies

Methadone Side Effects

Methadone is associated with a number of common side effects, including restlessness, anxiety, sleepiness, dizziness, nausea, vomiting, itchy skin, pupil contraction, sweating, constipation, and sexual dysfunction. In rare cases, or in cases of overdose, respiratory depression (slowed breathing) or slowed heart rate can occur, which may lead to coma or death.

How Long Does Methadone Stay in Your System?

The length of time that methadone is measurable in your system can be variable depending on the quantity used and route of administration. In addition, different tests have different sensitivities.

  • Blood: Up to two-and-a-half days
  • Urine: Up to seven days
  • Hair: Up to several months
  • Breastmilk: The American Academy of Pediatrics indicates that breastfeeding women can safely use methadone as prescribed by their medical doctor

Methadone’s Addictive Qualities

Like all opioids, methadone causes dependence and addiction with regular use. Methadone addiction can be difficult to overcome. Chronic methadone use should be strictly limited to individuals who participate in methadone maintenance programs that aim to prevent heroin or opioid relapse. Methadone for pain management should be short term and used with caution. It is imperative that methadone is used as prescribed and not be given to people who are not on the prescription.

Key Points: Understanding Methadone

Keep the following key points in mind when considering methadone:

  • Methadone acts on the same brain pathways as heroin and other opioids but is not associated with a euphoric high
  • Methadone has been successfully used to treat acute and chronic pain, but because it is an addictive drug, methadone use should be short term. Methadone should never be used in any way other than as prescribed
  • Methadone hydrochloride is the active compound in all methadone formulations
  • Methadone can be detected in blood or urine for up to a week after use, and in hair for several months after use
  • It is crucial that methadone is used only as prescribed.

Contact The Recovery Village Palm Beach to speak with a representative about how professional treatment for a substance use disorder can put you on the path to a healthier future.