Methadone Maintenance Treatment: Benefits and Risks

Methadone treatment, medication-assistance treatment (MAT) and methadone maintenance treatment (MMT) all use methadone to help with opioid cravings.

Most opioids are used to control the symptoms of pain: codeine, fentanyl, hydrocodone and morphine are all examples. Many people take these medications after minor surgery or after more invasive procedures in a hospital.

Methadone is also an opioid but works a little differently than other opioids. Methadone can treat pain, but it can also treat opioid dependence. It stays in the body much longer than other opioids, effectively satisfying opioid cravings without providing the euphoria that another drug like heroin would provide.

Methadone can be compared to a nicotine patch: it can produce a high in people who have never used an opioid before, but for people with an addiction, it satisfies cravings without providing a high.

Methadone is a schedule II medication, meaning it carries the potential for abuse. To prevent methadone abuse, methadone clinics dispense one dose per day to prevent diversion and sale of the drug.

What Is Methadone?

Methadone is used to treat pain and to treat addiction and cravings in some people. If you are prescribed methadone for pain, you will take the medication every 8 to 12 hours and can pick it up at any pharmacy. There is no additional regulation surrounding methadone prescriptions for pain, but additional rules are in place when used for addiction treatment.

For those taking methadone to treat opioid addiction and cravings, methadone cannot be obtained at a pharmacy. Instead, many people obtain methadone through a methadone clinic where the staff has special addiction training.

• History of Methadone Use in Opioid Addiction Treatment
  When was methadone approved by the FDA? Methadone was originally approved in 1947 for the treatment of pain and coughing. During the 1960s, the medical community started using it for opioid addiction treatment, and the FDA approved it for this use in 1972. When methadone is prescribed for addiction treatment, it is called medication-assisted treatment (MAT). The organization Substance Abuse and Mental Health Services Administration (SAMHSA) handles federal regulation of methadone treatment. SAMSA, along with the FDA, establishes methadone maintenance treatment (MMT) program standards and clinical guidelines for opioid treatment programs (OTPs). Methadone sticks around in the body for about five days, so when dosed correctly, the person should not have any breakthrough symptoms (e.g., cravings). Related Topic: Opioid Addiction Treatment  
• Methadone Maintenance as a Treatment for Opiate Addiction
  In a nutshell, doctors who prescribe methadone treatment for addiction receive extra training, and they must provide education to those whom they prescribe methadone maintenance treatment. Patients then visit a methadone clinic every day to pick up their dose. Even though methadone is taken two to three times per day when treating pain, it can be given once daily for addiction treatment.  

How Is Methadone Treatment Administered?

The dosage of methadone for most people will start at 10–30 mg daily, but this may be higher depending on the history of opioid use.

Methadone doses should not be increased faster than every 2–3 days and by no more than 10 mg daily.

Methadone is increased with the following goals in mind: allow the patient to conduct daily living activities without intoxication, without excessive sedation, without experiencing withdrawal symptoms and without feeling cravings for opiates.

Related Topic: Methadone Detox

Once the patient achieves a stable dose, they are said to be in a stabilization phase. During stabilization, the same daily dose should be administered at the same time every day. The dose should only be changed if the person starts to experience euphoria or withdrawal symptoms.

The average methadone dose can range widely from 10–100 mg daily based on a person’s gender, genetics, size and other drug interactions. Therefore, the safest method to determine an effective dose is to start low and titrate up every few days to a goal dose. The first dose of methadone is between 10–30 mg daily and should never be more than 40 mg, even for people with a heavy history of opioid abuse. Methadone dosages can be taken in different ways, including:

• Liquid Methadone
  Liquid methadone is favored for people who have trouble swallowing or need a large dose of methadone every day. The concentration is 10 mg/mL, so methadone liquid can easily accommodate a large dose. Another advantage of methadone liquid is that it prevents “cheeking,” which is when someone holds a tablet in their cheek without swallowing, with the intention to resell methadone on the street. Are methadone pills stronger than liquid? No, the dosage converts equally. To convert from tablet to liquid, the liquid methadone dosage is the same. So, someone taking a methadone 10 mg tablet daily can take methadone liquid 10 mg (or 2 mL) instead and get the same treatment effect.  
• Methadone Tablets
  Methadone tablets are the most common dosage form of methadone. Methadone tablet strengths are 5 mg and 10 mg. Methadone dispersible tablets are an uncommon dosage form — they come in 40 mg and are dissolved in 120 mL of water to administer smaller dosages of less than 5 mg.  

Methadone Clinics

What is a methadone clinic? As previously discussed, a methadone clinic is a location with staff trained in addiction medicine who can administer and monitor the administration of methadone for opioid addiction.

In a methadone clinic, the drug will almost always be dispensed in tablet form. Some clinics may choose to stock the liquid formulation for certain patients.

To find a clinic in your area, SAMHSA has a methadone clinic locator that can be used to search by state.

Treatment & Detox Centers

Methadone is made as an injectable formulation, but an injection — which can be subcutaneous, intravenous, or intramuscular — is only given in a hospital or an inpatient detox setting. Injectable methadone is reserved for people who cannot swallow or need medication for pain treatment.

Methadone Side Effects

As an opioid itself, methadone shares side effects with other opioids including constipation, drowsiness and edema (swelling in the legs).

Specific methadone side effects include increased incidence of seizure, cardiac arrhythmias (dangerous heart rhythms) and drug interactions.

People taking medications for anxiety and depression may also be worried about a rare condition called serotonin syndrome, which occurs when serotonin levels are too high. Serotonin syndrome is a medical emergency and requires hospitalization.

Methadone treatment side effects are different from methadone withdrawal symptoms. Withdrawal symptoms may include: diarrhea, increased pain sensitivity and sweating. Withdrawal symptoms should be reported to the methadone clinic because they are a sign the daily dose is too low.

Who Should Avoid Methadone Treatment?

Despite the proven advantages, there are also disadvantages of methadone treatment. For example, people with a history of seizures should not take methadone as it increases the risk of seizures. People with multiple psychiatric conditions should avoid methadone because it has a high potential for negative interactions with drugs used to treat these conditions. People with a history of heart conditions should also avoid using methadone unless they are monitored regularly by their doctor for abnormal heart rhythms.

Treatment Risks

Clinicians who prescribe methadone will weigh methadone risks and benefits. The major methadone health risks are:

• Drowsiness
• Drug interactions
• Heart arrhythmias
• Seizures
• Serotonin syndrome (a medical emergency)

MAT helps individuals avoid the cycle of addiction: euphoria, crash and then craving. Methadone does not switch one addiction for another, with many clinical studies over the last few decades to show the benefit of methadone treatment.

Risks for Pregnant Women

The effects of methadone during pregnancy are somewhat unclear. Methadone effects on the fetus seem to be minimal, but these risks are in comparison to using heroin during pregnancy. In general, MAT in pregnant women is safer than active opioid addiction. Methadone prevents withdrawal symptoms, which can cause miscarriages. MAT also prevents the pregnant mother from using needles, which can introduce blood-borne diseases like hepatitis and HIV to the fetus. Methadone is considered safe in breastfeeding, with about 2–6% of the dose passing from mother to baby. In general, methadone effects on the fetus are safer than the effects of heroin or other opioid withdrawal.

Who Should Receive Methadone Maintenance Treatment?

Methadone maintenance treatment (MMT), which is another term for MAT, is the first-line treatment for people with an opioid use disorder. Clinical trials have shown MAT to be superior to drug-free addiction treatment. People undergoing MAT typically remain symptom-free for longer and have safer health outcomes.

Benefits of Methadone Maintenance Treatment

MAT has been shown by several studies to be the most effective form of treatment for opioid and heroin addiction. MAT has been shown to decrease:

• Criminal behavior
• Heroin use
• Other drug use
• The spread of HIV and other sexually transmitted infections

MAT has also been shown to increase:

• Employment
• Participation in job training
• Retention in treatment
• Stable family relationships

The benefits of methadone maintenance treatment for opiate addiction are numerous and backed by many studies over the last few decades.

Methadone Maintenance Treatment Recovery Statistics

The effectiveness of methadone maintenance treatment is not disputed. Methadone maintenance statistics help illustrate the increased access to care for people with opioid use disorder.

In the United States, 350,000 people received methadone addiction treatment in 2015. The number has been increasing, which could mean that either opioid use is on the rise, or opioid use is down and people are getting treatment more often or more funding is being allocated for OTPs.

Related Topic: Methadone Addiction

The number of OTPs has increased from 1,100 in 2003 to 1,500 in 2016, meaning more people have access to this life-saving therapy.

Overall, the statistics are encouraging for methadone maintenance effectiveness, though MAT programs may not be keeping up with the surge of fentanyl overdoses sweeping through the country.

How Long Is Methadone Treatment?

How long is methadone treatment? Methadone treatment length is usually lifelong. Some people may choose a drug-free treatment option for opioid use disorder, and this should be done with the advice and supervision of the prescribing doctor.

Cost of Methadone Treatment

How much does methadone treatment cost? The cost of methadone treatment varies. Important factors to consider are the state you live in, your insurance carrier, whether assistance programs exist in your area and the funding available for local methadone clinics. The average cost of methadone treatment will need to be discussed with the clinic providing treatment.