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Methadone is a synthetic opioids agonist. It is sometimes prescribed for pain relief. It is also used for people addicted to heroin, morphine, or prescription pain medication to reduce withdrawal symptoms. It does not produce the same high as heroin and other drugs, but it prevents many intense and unpleasant withdrawal symptoms.

Methadone is an effective addiction recovery tool because it has a long duration and there is not a high risk of tolerance. Despite its usefulness, methadone abuse exists. It occurs when someone takes it without a prescription or in combination with other drugs.

Uses & Dosage

Methadone pill

Methadone is taken orally or by injection.

During the detoxification phase, the dose is based on standards in the 42 CFR (Code of Federal Regulations) Section 8.12. Dosage ranges from 20 mg to 40 mg throughout detoxification and maintenance.

Someone using methadone can administer his or her dose with training. However, methadone should be used under the careful supervision of a doctor.

Someone prepared to stop using opioids can detox with methadone. Methadone detox reduces the level of the drug in the body until it is completely removed. If done quickly, it produces intense and potentially dangerous withdrawal symptoms. Medical supervision ensures comfort and safety.

Following the initial detox, someone with a methadone addiction can participate in a rehabilitation program. Treatment is based on a person’s level, frequency, and intensity of methadone dependence. Co-occurring disorders are also considered. 

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Side Effects

Methadone might not be appropriate for people with:

  • Asthma
  • Breathing problems
  • Blockage in the stomach or intestines
  • Heart problems
  • Long QT syndrome (a heart rhythm disorder)
  • Sleep apnea
  • Head injuries
  • Brain tumors
  • Seizures
  • Liver or kidney disease
  • Urination problems
  • Problems with the pancreas, gallbladder, or thyroid

People using methadone hydrochloride tablets are at risk for life-threatening respiratory depression. This is one of the reasons medically supervised detox is so important.

Misusing methadone can lead to addiction, overdose, and death. Do not combine it with alcohol or medications that slow breathing. Do not use methadone while pregnant or breastfeeding. Newborns dependent on opioids often need medical treatment for several weeks after birth. Passing methadone to a baby through breast milk causes drowsiness, breathing problems, or death.

Other side effects that could indicate a serious problem include:

  • Dizziness
  • Headache
  • Heart rhythm problems

Drug Interactions

There are 636 drugs known to interact with methadone, nearly 300 of which have a high risk for major interactions. Medical experts warn against using methadone in combination with any of the following:

  • Ambien (zolpidem)
  • Ativan (lorazepam)
  • Buprenorphine
  • Dilaudid (hydromorphone)
  • Flexeril (cyclobenzaprine)
  • Gabapentin
  • Hydrocodone
  • Klonopin (clonazepam)
  • Lyrica (pregabalin)
  • Morphine
  • Neurontin (gabapentin)
  • Norco (acetaminophen / hydrocodone)
  • Oxycodone
  • Percocet (acetaminophen / oxycodone)
  • Prozac (fluoxetine)
  • Seroquel (quetiapine)
  • Soma (carisoprodol)
  • Suboxone (buprenorphine / naloxone)
  • Subutex (buprenorphine)
  • Tramadol
  • Valium (diazepam)
  • Xanax (alprazolam)
  • Zofran (ondansetron)
  • Zoloft (sertraline)

Is Methadone Addictive?

Yes, methadone is addictive. Methadone is used as an alternative to opioids. It isn’t as dangerous as opioids and provides a controllable tool for withdrawing gradually from opioid addiction

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Abuse & Addiction Symptoms

Signs of methadone addiction include:

  • Doctor shopping or trying to obtain methadone outside of the prescribed amount
  • Using the drug with more frequency or in higher doses than prescribed.
  • Hoarding or skipping doses to 'stockpile' and use a higher dose later
  • Obtaining the drug from sources other than a healthcare professional
  • Using other drugs in combination, such as OxyContin, heroin, or morphine
  • Neglecting other aspects of life in favor of drug use

Methadone is used for extended periods. This might be appropriate but it comes with risks, including:

  • Sexual dysfunction
  • Respiratory problems
  • Impaired judgment

People taking methadone via injection face a higher risk for blood-borne diseases such as HIV and Hepatitis C. Methadone overdose is also a concern.

Withdrawal Symptoms

Methadone withdrawal, sometimes referred to as methadone detox, triggers several mild to severe symptoms. These symptoms begin approximately 24 to 36 hours after the last dose of the drug. Methadone detox should be medically supervised.

The duration of methadone withdrawal varies from person to person but usually lasts from 2 to 3 weeks up to 6 months.

Within the first 55 hours of the last dose, methadone withdrawal symptoms include:

  • Fatigue
  • Anxiety
  • Restlessness
  • Sweating
  • Nasal discharge
  • Watery eyes
  • Yawning
  • Insomnia

Additional symptoms that tend to peak after three days:

  • Muscle aches and pains
  • Irritability and/or anxiousness
  • Fast heart rate
  • High blood pressure
  • Dilated pupils
  • Goosebumps
  • Nausea
  • Vomiting
  • Cramps
  • Diarrhea
  • Depression
  • Drug cravings

All symptoms tend to be most severe during the first week of withdrawal. Symptoms that tend to last longer include low energy levels, anxiety, trouble sleeping, and depression.

Withdrawal is an uncomfortable process that is made easier through medically assisted detox. 

Treatment Options for Opioid Abuse & Addiction

Opioid use disorder is difficult to overcome. Fortunately, there are several options for help. These include:

  • Medication-Assisted Therapy (MAT) When it comes to medication-assisted therapy for opioid use disorder, there are three types approved: buprenorphine, methadone, and naltrexone. Buprenorphine and methadone help manage withdrawal symptoms as you detox. Naltrexone blocks the receptors that opioids bind to, making it impossible to get high from them. Medication-assisted therapy is most effective when combined with other therapies.
  • Inpatient Programs — Inpatient programs are the most intensive addiction treatment options. These programs guide you through medical supervised detoxification, behavioral therapy and other services such as medication-assisted therapy. They typically last 30, 60 or 90 days, but may be longer if necessary.
  • Partial Hospitalization Programs (PHPs) Intensive outpatient programs are the next level of addiction treatment, providing similar services to inpatient programs such as detoxification and behavioral therapy. The difference is that the patient will return home to sleep, and some programs will include transportation and meals. PHPs are ideal for both new patients as well as those who have completed inpatient treatment but still need intensive care.
  • Outpatient Programs Outpatient programs provide a well-rounded treatment program for people with a high motivation to recover. These programs are flexible and can be made around for your schedule, and can be customized to work best for you. These programs work for new patients as well as those that complete an inpatient or partial hospitalization program.

Many people follow-up formal treatment with participation in Narcotics Anonymous, a 12-step program designed to foster recovery and building a sober support system.

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Resources

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“Methadone.” Drugs.Com, Drugs.com, 2019, www.drugs.com/methadone.html

Cherney, Kristeen. “Going Through Methadone Withdrawal.” Healthline, Healthline Media, 24 June 2014, www.healthline.com/health/going-through-methadone-withdrawal

Farrell, Michael, and Wayne Hall. “Methadone and Opioid-Related Deaths.” Methadone Matters, 2003, pp. 155–165., doi:10.1201/b14312-19., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067703/

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