Frequently Asked Questions About Methadone Treatment

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Understanding Methadone Treatment

Methadone is a synthetic opioid medication. It was invented in 1937 as a replacement for morphine, which was then in short supply. Similar to naturally occurring opiates such as morphine, codeine, thebaine, and oripavine, it binds to and activates the opioid receptors in the brain and spinal cord. However, methadone is longer-acting and more potent than its natural counterparts. This means that it can produce the same effects with smaller amounts.

What is in Methadone?

The primary ingredient in methadone is methadone hydrochloride. This is a synthetic opioid medication known as a full opioid agonist, which means it completely activates the opioid receptor. The response is dose-dependent: the more you give, the greater the effect. In addition to methadone hydrochloride, the medication might also contain inactive ingredients that vary based on the formulation (liquid, tablet, or dispersible tablet). These might include fillers, flavorings, or preservatives. Methadone hydrochloride is the key component, especially in methadone maintenance programs where it is often found in liquid form.

Why is Methadone Used?

Methadone is primarily used to treat opioid use disorder, also referred to as opioid addiction. It is considered the most effective treatment for this condition. People undergoing methadone treatment do so to stop misusing other opioids, such as heroin, fentanyl, or prescription pain relievers. Methadone minimizes cravings and relieves uncomfortable withdrawal symptoms that occur when someone halts opioid use. As part of a comprehensive treatment plan known as Medication-Assisted Treatment (MAT), methadone helps individuals overcome addiction and improve their quality of life. It is generally regarded as safe and effective for long-term use.

Beyond opioid use disorder, methadone is also employed in pain management. Due to its extended half-life, a single dose can provide pain relief for 8 to 12 hours.

Benefits of MAT with Methadone

Earlier, I mentioned that methadone is recognized as the most effective therapy for opioid addiction. Many medical studies support this claim, showcasing various benefits of using methadone compared to alternative methods:

Benefit	Description
Improved survival rates	Reduces the risk of overdose and death associated with opioid use.
Reduced overdose risk	Helps prevent overdoses by blocking the effects of other opioids.
Increased treatment retention	Improves the likelihood of staying in treatment and completing the program.
Reduced opioid use	Decreases the frequency and intensity of opioid cravings and use.
Reduced criminal activity	Lowers the risk of engaging in criminal behavior to obtain opioids.
Improved employment	Increases the ability to find and maintain stable employment.
Improved birth outcomes	Reduces the risk of complications for pregnant women with OUD and their babies.
Reduced risk of infectious diseases	Decreases the risk of contracting HIV or hepatitis B or C through intravenous drug use.

What is a Methadone Clinic?

A methadone clinic is a specialized healthcare facility. It provides methadone maintenance treatment or detoxification for individuals with opioid use disorder. These clinics are certified opioid treatment programs regulated by state and federal laws. They employ doctors, nurses, and counselors trained in addiction treatment. At a methadone clinic, patients receive a daily dose of methadone to manage withdrawal symptoms and reduce cravings. In addition to medication, clinics offer counseling, therapy, and other support services as part of a comprehensive treatment plan. The goal is to help patients end opioid misuse and pursue a healthier lifestyle.

Don't forget, on this page, you can search for a methadone treatment program near you. The directory is updated weekly.

Cost and Insurance Coverage for Methadone Treatment

Many insurance plans, including Medicaid and Medicare, cover methadone treatment for opioid use disorder. However, the specifics of coverage may vary. It’s essential to check with your insurance provider to understand your benefits and any potential out-of-pocket costs. Some clinics may also provide assistance with treatment costs through grants or sliding scale payments.

The Stigma of Methadone and MAT

Some people worry that MAT with methadone is only substituting one addiction for another. This concern is common, but it’s vital to recognize that MAT isn’t merely an exchange of addictions. When methadone is prescribed correctly, it stabilizes brain chemistry, minimizes cravings, and prevents withdrawal symptoms without causing the harmful effects of illicit opioid use. This stability allows individuals to focus on therapy and other aspects of recovery.

Unfortunately, there is stigma surrounding MAT. Some may think that taking medication for opioid addiction isn’t true recovery. I would challenge those opinions. Is taking medication for managing blood pressure or diabetes truly replacing unhealthy lifestyle habits? Addiction is a chronic disease like any other, differing only in public perception of patients.

What if I Miss a Dose of Methadone?

If you miss a single dose, you may take it as soon as you remember, as long as it’s within a specific timeframe. However, if hours go by or you miss multiple doses, your clinic may recommend waiting until your next scheduled dose or coming in for evaluation. Never take more methadone than prescribed to make up for a missed dose, as this can increase the risk of side effects or overdose. Each methadone program has specific guidelines for missed doses, so adhere to your treatment team's instructions.

Potential Side Effects of Methadone

When prescribed and supervised appropriately, methadone is safe and effective. However, it may have side effects, including:

• Nausea

• Constipation

• Drowsiness

• Restlessness

• Sweating

• Headache

• Insomnia

• Agitation

• Disorientation

  
  

It’s essential to discuss any concerns about side effects with your doctor. They can help manage these effects and adjust your dosage if needed.

Patients on methadone must also be aware of potential negative interactions with other substances, including alcohol and opioids. Always inform your treatment team about any prescription medications, over-the-counter drugs, or substances you are taking before starting treatment.

How to Take Methadone

A typical methadone dose is generally taken once a day. In an opioid treatment program, patients receive methadone around the same time each day. The timing can vary slightly based on the treatment center and individual needs. In some cases, split doses may be prescribed.

Following the treatment plan is crucial for maintaining stable medication levels in the body, effectively managing withdrawal symptoms, and reducing cravings for other opioids like heroin. While some individuals use methadone short-term to detoxify, others may require long-term maintenance as part of their recovery.

Duration of Methadone Treatment

The length of methadone treatment can differ based on individual needs and progress. Opioid addiction is a chronic disease that often alters brain chemistry, and these changes might be permanent. Research indicates that longer MAT durations yield better long-term outcomes.

After 26 years of treating thousands of patients, I’ve learned that successful recovery often involves focusing on improving life aspects. Think about your job, relationships, and health. Once these areas are solidified, tapering off of methadone can be considered.

Methadone Treatment During Pregnancy

Methadone is crucial for helping women stay sober from illicit opioids. It is regarded as a safe and effective treatment for pregnant women with opioid use disorder. The American College of Obstetricians and Gynecologists (ACOG) recommends MAT for expectant mothers with opioid addiction. This approach can lower the risk of complications for both mothers and babies. While a few infants might experience neonatal abstinence syndrome (NAS) post-birth, it's usually mild and manageable with medical support. Women can also continue methadone while breastfeeding.

The Importance of Therapy Alongside Methadone

Yes, therapy and counseling are vital parts of MAT. Certified methadone programs require some form of counseling. Many patients also face other substance use issues in addition to opioid addiction. While methadone manages the physical side, therapy addresses the root causes of addiction, develops coping skills, and offers relapse prevention strategies.

Can You Become Addicted to Methadone?

Methadone may lead to physical dependence, but it is not the same as addiction. Physical dependence means your body adjusts to the medication, causing withdrawal symptoms if you stop suddenly. Addiction, however, involves compulsive drug use despite adverse outcomes. When used properly in MAT, methadone helps manage withdrawal and cravings, allowing individuals to regain control over their lives.

Determining the Right Methadone Dose for Opioid Use Disorder

Each person’s ideal methadone dose varies based on factors like history of opioid use, tolerance, and metabolism. Treatment typically starts with low doses (10 to 50 milligrams) to avoid side effects like drowsiness or slowed breathing. As of 2024, US law permits a maximum of 50 milligrams on the first treatment day. From there, doses can be adjusted gradually until withdrawal symptoms and cravings are managed.

During the initial weeks of methadone treatment, there is a higher risk of accidental overdose, so most programs will gradually increase dosage.

Maintenance doses usually range between 60 to 120 milligrams per day, though some may need more or less. With the increasing concerns around fentanyl abuse, maintenance doses for fentanyl users can often be higher, around 120 to 240 milligrams.

About the Author

Harold Pierre, MD, is a board-certified anesthesiologist, board-certified addiction medicine specialist, and a concierge addiction doctor with over 26 years of experience. He is board-certified by the American Board of Anesthesiology, the American Board of Preventive Medicine and has extension experience managing hormones. He is licensed in Florida, Texas, Oklahoma, South Carolina, Louisiana, and Arizona. If you are seeking care, you may schedule an appointment with him by calling or texting 918-518-1636. LinkedIn 

Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek guidance from your healthcare provider for any health-related questions or concerns before making changes.

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