Methadone is an opioid substance that was developed to be a less addictive painkiller than morphine. It eventually came to be used to aid in the treatment of opioid addiction.
As a full opioid agonist, methadone acts similarly at the same subset of opioid receptors in the brain that other opioids such as heroin, morphine, and oxycodone do, but in contrast with many of these commonly abused drugs, methadone has a relatively slower onset of effect and is comparably longer-acting.
Its pharmacologic properties make it a relatively safe treatment approach but also introduce particular risks should the drug be misused. Methadone, when used therapeutically, should not elicit a euphoric high in an opioid-dependent person (i.e., tolerance that develops in association with other, abused opioids). However, because it activates opioid receptors in the brain, it can alleviate withdrawal symptoms from and cravings for heroin, opioid painkillers, and other opioid drugs to which an individual has become physically dependent.1,2
Methadone treatment is meant to be part of a larger approach called medication-assisted treatment (MAT) that incorporates both medication and behavioral interventions to help people recovering from opioid use disorders. The amount of time a person spends on methadone will vary according to the individual’s needs and treatment plan. Some people will be stabilized on methadone and stay on for a period of months before tapering off slowly, while others may stay on maintenance doses for years.3
According to the National Institute on Drug Abuse (NIDA), methadone maintenance alleviates a huge economic burden linked to opioid abuse and associated social issues such as criminal behavior. NIDA estimates that every $1 spent on methadone treatment results in $38 in economic savings. In addition to its role in addiction medicine, methadone continues to be used as a potent analgesic for certain types of pain, including cancer pain and other chronic pain states.4
While methadone may be a valuable tool in the treatment of pain and recovery from opioid addiction, it has its own set of risks. Methadone does have significant potential for abuse and overdose, and treatment with methadone is highly regulated and controlled. To ensure appropriate use in the management of opioid dependence, it must be dispersed in opioid treatment programs (OTPs), or methadone clinics.1, 2
Signs of Methadone Abuse
Most people who take any medications as directed will not develop an addiction, but misuse of certain drugs increases that risk. Misuse of methadone may include:3,5
- Taking more than prescribed.
- Taking it more often than prescribed.
- Skipping an intended dose and then combining it with a later dose.
- Sharing it with others.
- Taking someone else’s prescription.
- Using it in combination with other substances, including alcohol.
- Using it in ways other than directed, such as by injection.
Even though methadone is commonly used in the treatment of opioid addiction, it has inherent abuse and addiction liability of its own.5 To minimize the risk of abuse and overdose, methadone is carefully dispensed as a treatment medication only through opioid treatment programs.3
Methadone Side Effects
Even those who aren’t abusing methadone are subject to side effects, some of which are more serious than others. Methadone may cause:2
- Changing mood.
- Weight gain.
- Dryness of the mouth.
- Urinary retention.
Long-Term Effects of Methadone Use
Like any opioid, consistent methadone misuse can result in serious health effects. Methadone abuse over time may cause such as:2
- Lowered sexual desire and sexual dysfunction.
- Decreased fertility in both men and women.
- Problems with menstruation in women.
- Chronic constipation, which may result in serious gastrointestinal issues such as bowel blockage and perforation.
Methadone Withdrawal Symptoms
Withdrawal from methadone is unlikely to be deadly; however, it can be very uncomfortable. Methadone withdrawal is often described as feeling like a severe case of the flu. Methadone withdrawal symptoms may include:8
- Dilated pupils.
- Runny nose.
- Nausea and vomiting.
- Aching muscles.
- Stomach cramps.
Generally, with a long-acting opioid like methadone that stays in the system for significantly longer than shorter-acting opioids such as heroin, the withdrawal timeline may be relatively prolonged. Methadone withdrawal may not begin until 12-48 hours after the last use and may not fully resolve for up to 20 days.9
It can be very difficult to deal with withdrawal symptoms and cravings for multiple weeks, and in some cases, withdrawal may precipitate potentially dangerous complications. For example, sweating, vomiting, and diarrhea may lead to severe dehydration and electrolyte disturbances that could require fluid repletion in a hospital setting.
Withdrawing from methadone with the help and supervision of medical detox provides the safest, most comfortable way to get off this medication. Inpatient detox programs can help to keep you comfortable during the acute phase of withdrawal and medical staff can provide supportive care to ease your symptoms.
Can You Overdose On Methadone?
In 2014, deaths from methadone overdose accounted for an estimated 23% of all prescription opioid deaths that year, despite methadone accounting for only 1% of all opioids prescribed for pain.6
Methadone remains in the body long after the perceived benefits wear off, which may lead people to take more and then overdose as a result of cumulative toxicity.6
Methadone Overdose Symptoms
Overdosing on methadone may be deadly. Signs of methadone overdose are like those of overdose of other opioids such as heroin and include:7
- Extreme drowsiness.
- Pinpoint pupils.
- Weak pulse.
- Bluish tint to skin or fingernails.
- Slowed or labored breathing.
- Stopped breathing.
If you are concerned that you or someone close to you may be experiencing a methadone overdose, seek immediate emergency medical care. As an overdose progresses, respiratory depression can result in brain damage or death.7
- Tiny, pinpoint pupils
- Difficulty breathing
- Stomach or intestinal spasms
- Low blood pressure
- Weak pulse
- Spastic muscle twitches
- Clammy skin
- Blue lips and/or fingertips
Methadone Addiction Treatment
For those who began abusing methadone after being prescribed the medication as part of an opioid addiction treatment approach, a new treatment method may need to be crafted either utilizing either a new medication or eliminating medications and focusing solely on therapy and recovery support groups, such as Narcotics Anonymous.
Those who began abusing methadone after being prescribed the drug for chronic pain may need help exploring non-narcotic options for pain relief, including alternative treatments like acupuncture, physical therapy, massage, etc.
Regardless of the circumstances that led a person to abuse methadone, the importance of treatment cannot be overstated. Methadone abuse and addiction can be debilitating and even deadly. An accredited addiction treatment program can help you manage withdrawal and then guide you in gaining the tools you need to live in recovery from addiction to opioids.
- National Institute on Drug Abuse. (2018). Medications to Treat Opioid Use Disorder.
- U.S. National Library of Medicine. (2018). Methadone.
- Substance Abuse and Mental Health Services Administration. (2019). Methadone.
- JAMES D. TOOMBS, M.D., and LEE A. KRAL, PHARM.D. (2005). Methadone Treatment for Pain States. Am Fam Physician, 71(7), 1353-1358
- Substance Abuse and Mental Health Services Administration. (2019). Follow Directions: How to Use Methadone Safely.
- Faul M, Bohm M, Alexander C. Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies — United States, 2007–2014. MMWR Morb Mortal Wkly Rep 2017;66:320–323
- U.S. National Library of Medicine. (2017). Methadone overdose.
- U.S. National Library of Medicine. (2018). Opiate and opioid withdrawal.
- Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management.