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  • Writer's pictureDr. Harold Pierre

The Pros and Cons of Methadone Assisted Treatment

Updated: Dec 12, 2023

Is Methadone the Best Treatment Option for My Opioid Addiction?


If you are reading this post, you or a loved one might be in a tough battle with an addiction to drugs like heroin or prescription pain medications. You may be wondering if methadone treatment is the best treatment option for opioid addiction. Methadone is commonly used in medication-assisted treatment (MAT) programs to help people overcome opioid addictions. Well, there are both pros and cons to using methadone.


I am Dr. Harold Pierre. I am a board-certified addiction medicine specialist and anesthesiologist. Since 1999, I've helped thousands of opioid addicts change their lives with buprenorphine and methadone. In this blog post, we'll take an in-depth look at methadone, how it works, and weigh the potential benefits and downsides. My goal is to provide you with objective information to discuss with your doctor or addiction specialist when deciding on a treatment program for opioid use disorder.


Methadone is a prescription opioid drug. Text concept background copy

A Brief History of Methadone


Methadone was developed in 1937s in Germany and was initially created as an analgesic. Among other things, it was used on the battlefield by the Germans in World War II. But after the war, it was mostly forgotten.


Dr. Vincent Dole is the pioneering researcher who decided to study methadone for opiate addiction. He found that providing regular, measured therapeutic doses of the synthetic opioid seemed to help stabilize patients by relieving cravings and withdrawal symptoms without inducing euphoria. Since Dr. Dole's early clinical trials, methadone maintenance therapy has evolved into an extensively studied and standardized treatment protocol for opioid use disorder, helping millions gain sobriety. However, controversy remains around substituting one substance for another rather than achieving complete drug abstinence. Still, the body of evidence supports methadone's effectiveness when programs follow strict supervised dosing guidelines.


What is Methadone and How Does It Work?


Methadone is a synthetic opioid medication that works by binding to the same opioid receptors in the brain that heroin, fentanyl, buprenorphine and prescription opiates like oxycodone activate. However, methadone activates these receptors more slowly than other fast-acting opioids. It also blocks the euphoric high caused by heroin or prescription opiates while preventing withdrawal symptoms.


People struggling with opioid addictions often feel unable to function without the drugs due to extremely painful withdrawal symptoms and cravings. The cravings and flu-like withdrawal symptoms can be extremely intense, painful and drive addicted individuals to seek out more heroin or pain pills. Methadone helps manage these symptoms for hours longer than the illegal drugs. Therefore, people focus on getting their lives back on track without being controlled by the need to get high or get a fix for their painful withdrawal.


When used properly under medical supervision as part of an medication assisted treatment program, methadone can be a valuable tool in overcoming opioid addiction. However, it does come with some risks and downsides. In the next sections, we'll take a balanced look at both the potential upsides and downsides of utilizing methadone for opioid addiction treatment.


What Are the Potential Benefits of Methadone Treatment?


While methadone is not a "magic bullet" cure for opioid addiction, it can provide several valuable benefits when used properly:

  • Prevents Withdrawal and Cravings: One of the main upsides of methadone is that it alleviates the intense cravings and flu-like withdrawal symptoms from other opiates like heroin. It activates the opioid receptors enough to prevent withdrawals but not enough to cause a strong euphoric high.

  • Allows Stability for Counseling: Since methadone stabilizes patients and prevents cravings, it provides a window where addicted individuals can focus on counseling and other psychological treatments without being controlled by the drive to get high. This can greatly improve outcomes.

  • Reduces Risk of Overdose: People struggling with opioid addiction often overdose accidentally when they relapse after a period of abstinence and take too much. On methadone, the risk of accidental overdose death is greatly reduced.

  • Improves Health: People freed from the bind of addiction through methadone therapy can often improve their overall health, restore relationships, hold steady jobs and achieve a better quality of life.

  • Reduces crime, HIV and Hepatitis transmission, and increases employment. People can focus on being productive and not seeking illicit drugs.

  • Low Supervision Requirements: After an initial stabilization period, many patients only need to visit the clinic once per week to receive their methadone dose, allowing them to function normally.

What Are the Potential Downsides of Methadone Treatment?


While methadone therapy can be very useful in addiction recovery when used correctly, there are also some risks and downsides to consider:

  • Remains Physically Addictive: Patients who take methadone will become physiologically dependent on it and can experience withdrawal if it is stopped.

  • Risk of Overdose: If misused or taken in too high of a dose, methadone can slow breathing, cause coma and even cause overdose death in some cases.

  • Medication Interactions: Various other medications like benzodiazepines and antibiotics can potentially interact with methadone leading to enhanced side effects or overdose if not managed properly.

  • Physical Side Effects: Common side effects of methadone include constipation, nausea, sweating and sexual dysfunction. These can negatively impact quality of life for some.

  • Long Withdrawal Period: Weaning off of methadone is a slow process that typically takes months and has a longer withdrawal period compared to other opioids.

  • Stigma Around MAT: There is sometimes social stigma around addiction and being enrolled in a methadone clinic can provoke judgment in work or social settings.

Methadone Pros and Cons


Metaphor of cons an pros staying in balance

Given the potential benefits and risks of medication-assisted treatment with methadone, who is likely to do well with this type of program?


Methadone can be a good option for individuals who:

  • Who needs a very structured environment. This is a big difference between Suboxone treatment at a physician's office.

  • Have struggled unsuccessfully to quit opioid drugs like heroin or prescription painkillers on their own.

  • Want to stop experiencing intense cravings and withdrawal symptoms.

  • Need to stabilize their life and health without being driven compulsively to get high.

  • Are willing to commit to psychological counseling and a long-term plan for achieving sobriety.

  • Have severe underlying chronic pain.

On the other hand, those who may want to consider alternative treatments include:

  • People with severe heart or respiratory issues that could be complicated by the use of methadone.

  • Individuals taking medications that negatively interact with methadone.

  • Those who want to avoid developing dependency on any opioid substance.

  • People who have goals of achieving total drug abstinence rather than harm reduction.

  • Addicts with coexisting severe mental illnesses that require different approaches.

Overall there is no "correct" treatment, and options like methadone, buprenorphine, naltrexone, inpatient rehab and counseling must be considered carefully on a case-by-case basis. I believe that the best treatment is when the right time and right treatment comes together for you. Speaking to an addiction specialist can help determine what makes the most sense for any given individual based on their medical history, addiction severity and personal preferences.


Questions to Ask Your Doctor About Methadone


If you're considering methadone treatment, here are some important questions to ask your doctor or medical professional:

  • How long might I need to remain on methadone treatment to manage my addiction?

  • What additional counseling or behavioral therapies do you recommend combining with medication?

  • How frequently will I need to come for follow-up and dose monitoring?

  • What happens if I relapse or use other substances during treatment?

  • What side effects or risks should I be aware of and monitor for?

  • Do you assist with career, education, housing and other socioeconomic barriers to recovery?

  • Is there flexibility in the treatment plan if methadone doesn't work for me?

  • How do you help taper patients off methadone when ready?

  • Can I hear success stories from other patients you’ve treated with methadone?

What Can I Expect When Starting Methadone Treatment?


If you and your doctor decide a methadone maintenance program is the right fit, here is a general overview of what you can expect at the start:

  • Intake Evaluation: Methadone treatment is highly regulated by state and federal governments. You'll provide a complete medical history, undergo lab testing, and meet with clinic staff to determine the appropriate methadone dosage level.

  • Daily Dosing: During the initial stabilization period, you'll visit the clinic daily to receive your personalized methadone dose under supervision. This ensures proper use.

  • Dosage Titration: Your dose will start low and be gradually increased over days/weeks under guidance from the clinic doctor until withdrawal symptoms subside without oversedation.

  • Side Effect Monitoring: Clinic staff will monitor for potential side effects like constipation, nausea, dizziness or fainting episodes and provide medical management if warranted.

  • Counseling: You'll work with an on-site addiction counselor or case manager throughout treatment to work through the mental aspects of addiction and develop coping tools.

  • Support System Engagement: Clinics encourage family members or friends to actively participate in education and counseling sessions to build a support system.

  • Reduced Supervision: After the stabilization period, you'll graduate to visit the clinic weekly or less often to receive methadone doses, allowing you to focus more on work/life.

Key Takeaways: Weighing the Pros and Cons of Methadone Treatment


Deciding if medication-assisted treatment with methadone is the right choice for you requires carefully weighing the potential benefits and risks. Here are some key takeaways:

Benefits

  • Reduces drug cravings and painful withdrawals.

  • Allows stabilizing life without the drive to get high.

  • Lowers risk of overdose death.

  • Improves family/social relationships.

  • Enables engagement in counseling and recovery.

Cons of Methadone Use

  • Remains physically addictive like other opioids.

  • Methadone withdrawal are painful.

  • Can be misused or abused if not closely monitored.

  • Causes side effects like nausea and dizziness.

  • Long taper period to ultimately wean off methadone.

  • Social stigma still exists around methadone clinics.

Next Steps

  • Speak candidly to your doctor about whether methadone, Suboxone, naltrexone, inpatient rehab or intensive counseling makes the most sense.

  • Be ready to commit to a long-term comprehensive treatment plan if choosing methadone.

  • Take things one day at a time through the ups and downs of medication-assisted recovery.

Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd002209.pub2


Whelan, P.J. and Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of Neurosciences in Rural Practice, 3(1), 45-50. https://doi.org/10.4103/0976-3147.91934


World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. https://www.ncbi.nlm.nih.gov/books/NBK310658/


About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.



This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.





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