Is Methadone Addictive: A Quick Guide

Methadone is an opioid that is usually prescribed to people with painful conditions or to help them recover from addiction to heroin or other prescription painkillers. Before getting started on this drug, many people wonder, Is methadone addictive? Yes, methadone can be addictive, but the risk can be lowered if taken under clinical supervision. 

What Is Methadone?

Methadone is a long-acting synthetic opioid used in both opioid replacement therapy (ORT) and chronic pain management. In people with opioid use disorder (OUD), it can be taken to reduce cravings and withdrawal symptoms. ^[1] As methadone has a long half-life and stays in the body longer than many other opioids, it can be taken less frequently. ^[2]

Methadone is distributed mainly by specialized clinics under strict federal and state regulations. Although it has life-saving benefits, there is a potential for misuse, and therefore, signs of dependence should not be ignored.

Is Methadone Addictive?

Yes, methadone is addictive. The risk of addiction is high when it is taken in ways other than those directed by a medical professional. Like any other opioid, methadone works by acting on opioid receptors in the brain and creates a sense of relief and mild euphoria. ^[3] Over time, the brain tends to become reliant on this stimulation and leads to physical and psychological dependence. 

However, it is essential to differentiate between dependence and addiction. While dependence refers to physical adaptation to the drug, addiction refers to a compulsion to use the drug despite its harmful effects. Many patients who take methadone under clinical supervision develop a physiological dependence on the drug without actually becoming addicted to it in the behavioral sense.

How Addictive Is Methadone Compared to Other Opioids?

In comparison to other more addictive opioids, such as heroin or oxycodone, methadone has a much milder euphoria if taken as prescribed. This is why it is used in medication-assisted treatment (MAT). But the long duration of action of methadone can lead to the accumulation of the drug within the body and increase the risk of overdose. 

Furthermore, the onset of action of methadone is slower, and this makes it less likely to produce the intense euphoria that is often the driving factor for addiction. However, there is still a potential for addiction, especially among people with a history of substance abuse or those who take doses higher than prescribed. 

Why Is Methadone Addictive?

To properly understand why methadone is addictive, it is essential to know how it affects the reward system in the brain. Methadone stimulates the release of a neurotransmitter called dopamine, which is also known as the “feel-good” neurotransmitter. Taking methadone for long periods can cause the brain to adapt as it produces less dopamine naturally. 

With time, people taking methadone may feel like they are unable to function normally without the drug. This can lead to cravings, tolerance, and compulsive use.

There are several factors that can increase the risk of addiction to methadone, such as:

• Previous opioid addiction
• Mental health disorders
• Genetic predisposition
• Chronic pain conditions
• Polydrug use (mixing methadone with other substances)

Signs of Methadone Addiction

Signs that someone might be addicted to methadone include:

• Using methadone outside of prescribed guidelines
• Taking higher doses than directed
• Craving the drug or obsessing over the next dose
• “Doctor shopping” to obtain multiple prescriptions
• Isolating from family and friends
• Poor performance at work or school
• Physical symptoms of tolerance and withdrawal
  

What Does Methadone Withdrawal Look Like?

Withdrawal symptoms of methadone are usually less intense than heroin, but it can still be a difficult phase to endure due to its long half-life. ^[4] Symptoms begin to manifest 24 to 36 hours after the last dose and may continue to persist for several weeks. 

Common methadone withdrawal symptoms:

• Anxiety and irritability
• Muscle aches and joint pain
• Insomnia
• Nausea and vomiting
• Chills and sweating
• Runny nose and watery eyes
• Diarrhea
• Intense drug cravings

In some people going through withdrawal, the symptoms may persist as post-acute withdrawal syndrome (PAWS) for several months, affecting their mood, energy, and sleep.

Safe Use: Methadone in Medication-Assisted Treatment (MAT)

In spite of its potential to cause addiction, methadone is an important part of treatment for people with opioid use disorder. ^[5][6] In MAT programs, methadone is dispensed in controlled doses under medical supervision. Doing so can greatly reduce the risk of misuse and subsequent addiction.

Key benefits of MAT with methadone include:

• Reduced illicit opioid use
• Decreased risk of HIV and hepatitis C transmission
• Improved social and occupational functioning
• Lowered risk of overdose and death

Tapering Off Methadone Safely

For people who want to stop taking methadone, it is essential to taper the drug under medical supervision. Stopping the drug suddenly can lead to withdrawal symptoms, which may further increase the risk of relapse.

Therefore, a gradual dose reduction plan that takes into consideration the person’s health status, addiction history, and psychological readiness is the safest route. 

Medical detox programs may also include adjunct therapies such as:

• Clonidine to manage autonomic symptoms
• Anti-nausea medications
• Sleep aids
• Counseling and behavioral therapy

Methadone Alternatives

Patients who are concerned about methadone’s addictive potential can explore alternatives:

• Buprenorphine (Suboxone, Subutex): It is a partial opioid agonist with a lower risk of abuse.
• Naltrexone (Vivitrol): It is an opioid antagonist that blocks the euphoric effects of opioids.
• Non-opioid pain management: It is beneficial for chronic pain patients struggling with addiction.

Final Thoughts: Is Methadone Worth the Risk?

To conclude, the answer to the question, is methadone addictive is yes. But, even more dangerous is untreated opioid use disorder. If methadone is used appropriately in a clinical setting, it can be a life-saving medication. The key lies in structured use, ongoing counseling, and close medical supervision.