Methadone is a generic synthetic opioid that has been used to treat opioid dependence and addiction since the 1970s. The medication has also been used for the treatment of chronic pain since its approval in 1947. Methadone can be sold in its generic form as well as under several brand names, including Dolophine and Methadose.

Dependence on methadone often develops due to prolonged methadone treatment or direct abuse of the drug. Using methadone in ways other than prescribed or abusing it for recreational purposes can also lead to addiction. Being aware of the addictive potential of methadone can help prevent the abuse of this potentially life-saving drug.

What Is Methadone?

Methadone is an opioid used to treat opioid addiction and manage severe around-the-clock pain. Methadone has a long half-life, making it useful for the treatment of chronic pain. This quality also helps prevent withdrawal symptoms, which is why it is used for addiction treatment.

Due to its slow mode of action, it can be substituted for the opioid that is being abused. It can also help alleviate withdrawal symptoms and reduce cravings. For someone with an opioid addiction severe enough to require methadone treatment, the medication will not produce enough euphoria for the person to feel “high.”

What Is Methadone Used For?

For more than 50 years, methadone has been successfully used to treat addiction to heroin and other opioids. Although used for the treatment of opioid addiction, methadone does have the potential for abuse and can cause a fatal overdose. Methadone has a higher addiction potential in people without prior opioid addictions.

Methadone is also used to manage severe pain that requires around-the-clock opioid treatment. Compared to other opioids, methadone’s effect can be difficult to predict, so it is not commonly used for the treatment of pain. It is also a very potent opioid, so even small doses can lead to overdose.

Methadone Dosage

Methadone has a wide range of effective dosages that vary depending on the person’s opioid tolerance and what is being treated. Never take more methadone than what is prescribed by a doctor or health care professional.

For pain, the initial dosage is 2.5 mg to 5 mg by mouth every eight to 12 hours. The dosage may be increased by 2.5 mg per dose every five to seven days to achieve sufficient pain control. The drug stays in the body for far longer than it works to reduce pain, which is why the risk of overdose is very high. Methadone should not be used for breakthrough pain.

For detoxification and addiction, the dosage varies based on opioid tolerance:

• People with low opioid tolerance: 2.5 mg to 10 mg by mouth once daily
• People with moderate opioid tolerance, medical conditions that would be worsened by methadone, or significant drug interaction potential: 10 mg to 20 mg by mouth once daily
• People with high opioid tolerance with evidence of withdrawal: 20 mg to 30 mg by mouth once daily

Never change your dose without speaking to your doctor first.

Side Effects of Methadone

Methadone has a number of side effects, including many that are unique to methadone and do not happen with other opioids. Common side effects may include:

• Agitation
• Confusion
• Coordination problems
• Decreased sexual desire
• Difficulty breathing or swallowing
• Difficulty urinating
• Dizziness
• Drowsiness
• Dry mouth
• Erectile dysfunction
• Fast heartbeat
• Flushing
• Hallucinations
• Headache
• Hives
• Irregular menstruation
• Itching
• Loss of appetite
• Mood changes
• Nausea
• Rash
• Seizures
• Shivering
• Stomach pain
• Swelling of the eyes, face, mouth, tongue or throat
• Trouble sleeping
• Vision problems
• Vomiting
• Weight gain

Methadone also has several warnings for more serious side effects. Like other opioids, it can cause respiratory depression and make it harder for a person to breathe. If an overdose occurs, this is usually what can cause death or permanent injury.

Methadone can also affect the heart rhythm through QT prolongation. This type of arrhythmia causes conduction through the heart to slow, which may cause the heart to suddenly stop beating. This effect is rare but serious. It is more likely to occur in people taking other drugs that also have this effect. Ask your doctor and pharmacist for a full list of warnings that apply to your situation.

Methadone and Alcohol

Methadone and alcohol should never be mixed because they can both cause respiratory depression. In some countries, methadone is contraindicated with alcohol use. Both of these substances are central nervous system (CNS) depressants. At lower doses, this combination will affect coordination and cognition. At higher doses, it can lead to overdose and death.

Methadone Overdose

An overdose is when someone takes too much of a substance and it leads to injury and harm. The injury may be temporary, or it may cause permanent damage. Overdose can cause a person to stop breathing in some cases, which can lead to coma and death.

Symptoms of a methadone overdose include:

• Blue fingers and nails
• Coma
• Confusion
• Constipation
• Death
• Fatigue
• Low blood pressure
• Nausea
• Slow breathing
• Slow or weak pulse
• Small pinpoint pupils
• Vomiting
• Weakness

Is Methadone Addictive?

Despite being used in the treatment of opioid addiction, methadone itself is a highly addictive substance. Methadone is considered to have abuse potential similar to that of morphine. It is classified as a Schedule II substance due to its high potential for addiction and is tightly regulated by the government.

Methadone can be safely used for detoxification and treatment of opioid addiction. However, prolonged use of methadone, even as prescribed, can result in physical dependence on the drug. Physical dependence is when the body adapts to drug use, making methadone use necessary for a person to function normally.

Some of the psychological symptoms of methadone addiction include:

• Inability to control the amount or frequency of methadone use
• Continued use of methadone despite the negative effects on social and occupational functioning
• Spending excessive time obtaining, using or recovering from methadone use
• Prioritizing methadone use over social, recreational and work-related activities

It is important to note that when someone with high opioid tolerance uses methadone for withdrawal treatment, the addiction risk is very low. The risk is much higher if someone abuses the drug or has no prior history of opioid use.

Methadone Withdrawal

Long-term methadone use can cause the development of physical dependence, and withdrawal can happen once a person is dependent on a drug. Using an addictive substance causes changes in the chemistry of the body’s cells. Without the drug, the cells do not function properly and try to fix themselves. This readjustment process can be extremely uncomfortable and leads to symptoms of withdrawal.

Withdrawal symptoms are dangerous because they can cause harm and increase the risk of relapse. For methadone, withdrawal may lead to dehydration, which can be life-threatening. Since the symptoms are extremely uncomfortable, people are also often tempted to take more of the drug to treat these symptoms.

Methadone withdrawal should be managed with the help of addiction professionals. The symptoms can be treated with different medications that can make the process safer and less painful.

Methadone Withdrawal Symptoms

Other symptoms caused by methadone withdrawal may include:

• Anxiety
• Diarrhea
• Excessive sweating
• Muscle cramps
• Nausea and vomiting
• Problems with temperature regulation
• Trouble sleeping
• Watery discharge from eyes

Methadone Withdrawal Timeline

Methadone is a long-acting opioid, so withdrawal symptoms may not start until several days after taking the last dose. However, symptoms will typically begin 12 to 48 hours after the last use. They usually continue for 10 to 20 days but can last much longer for some people. The severity and length of symptoms will depend on how severe the methadone addiction was.

Methadone Detox

Detoxification is the process the body goes through as a drug is leaving the body. The length of time this process takes depends on the drug’s half-life, which measures how long it takes for the body to remove half the drug from the bloodstream. The half-life of methadone is extremely variable depending on the dosage being taken. It can range from eight to 59 hours, with an average of 27 hours.

For most drugs, it takes about five half-lives to be removed from the body. This means methadone will stay in the body for 40 to 235 hours, depending on the dosage and the person’s individual characteristics.

Methadone Taper

A taper is when the dose of a drug is slowly decreased in order to limit the possible withdrawal symptoms that occur when quitting. Taper strategies are common for opioids and other drugs that are risky to stop abruptly.

In contrast to quitting “cold turkey,” a taper is a much safer way to stop taking methadone. Tapers are common when participating in an addiction treatment program, and they can make it easier to manage addiction and prevent relapse.

Quitting cold turkey “shocks” the body more severely than a taper, and withdrawal symptoms are likely to be worse. When withdrawal symptoms are severe, a person is at higher risk for relapse.

Methadone Addiction Treatment

Although methadone only accounted for around 1% of total opioid prescriptions in 2014, it was involved in 22.9% of all opioid-related deaths. In the state of Florida in 2017, methadone was responsible for 247 overdose deaths and was present in 173 overdose deaths that also involved other substances.

Methadone was involved in 420 drug overdose deaths in Florida in 2017, a decrease from 499 in 2016. In Orlando in 2017, methadone was responsible for five deaths and was involved in another 11 overdose deaths.

The risk of overdose makes it important to seek treatment if you are struggling with methadone abuse and addiction. There are different levels of treatment available depending on the severity of the addiction. When entering treatment, an addiction professional will evaluate your needs and recommend either outpatient, intensive outpatient (IOP) or inpatient/residential treatment. Outpatient and IOP are less restrictive and more suitable for people with mild to moderate addictions. Inpatient should be used for people who struggle with severe addiction and would benefit from removing the triggers and stressors of everyday life during the recovery period.

Get Help Today!

If you or someone you love is struggling with addiction to prescription opioids like methadone, The Orlando Recovery Center can help. At our full-service rehab treatment facility, we provide evidence-based detoxification and rehabilitation services for substance use disorders and co-occurring conditions.

Our multidisciplinary team of experienced professionals is here to help you take the critical first steps toward a healthier, substance-free future. Contact us today to learn more about addiction treatment programs that can work well for your situation.