Methadone Addiction

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What Is Methadone?

Methadone is a synthetic (lab-made) drug that was developed by German scientists during World War II as an alternative to morphine. It belongs to a class of drugs called opiate (narcotic) analgesics. ^[1] Methadone is a powerful pain reliever and is used to treat moderate to severe pain that cannot be controlled with other (non-opioid) pain medications. In the United States, methadone is also used to treat opiate dependence in people with an addiction to other opioid drugs, including the illegal drug heroin and prescription opioid painkillers such as Vicodin, Percocet, and OxyContin. ^[2] Methadone is available under various brand names, such as Dolophine, Methadose, and Methadose Oral Concentrate.

Methadone has been classified as a Schedule II controlled substance by the U.S. Drug Enforcement Administration (DEA). ^[3] This means that while methadone has legitimate legal uses, it also has a high potential for abuse and addiction. Schedule II drugs are considered dangerous because their use can lead to severe physical and psychological dependence. Other prescription opioid pain medications, such as oxycodone (OxyContin), hydrocodone (Vicodin), and morphine are also Schedule II drugs. It is illegal to use methadone without a prescription.

Methadone is available in various dosage formulations including tablets, dispersible tablets, an oral solution, and a concentrated solution. It is usually prescribed to be taken every 8–12 hours to treat severe pain. As part of an opiate addiction treatment program, the dosage schedule of methadone varies from patient to patient.

Some people obtain illegal methadone from street dealers to control opioid withdrawal symptoms. Street names of methadone include tootsie roll, fizzies, dolls, amidone, and mud. This practice can be dangerous and can put users at a high risk of a methadone overdose which can be fatal.

Why Is Methadone Prescribed?

Methadone was introduced into the United States in the mid-1940s as a painkiller. At the current time, it is prescribed to provide around-the-clock pain relief to people with long-lasting severe pain that cannot be treated with other non-opioid medications.

By the mid-1960s, methadone began to be used as a maintenance treatment for heroin addiction. A heroin epidemic was sweeping New York City after World War II ended. Methadone was found to reduce or eliminate heroin use, decrease death rates, and help minimize criminal behavior associated with heroin use. ^[4]

Over the past few decades, methadone has continued to be used during medication assisted treatment for opioid use disorders, including addiction to prescription painkillers and the street drug heroin. In patients who are recovering from opiate addiction, methadone helps prevent drug cravings and withdrawal symptoms. It allows recovering opiate addicts to remain abstinent or decrease their intake.

Studies have shown that methadone treatment not only relieves cravings and suppresses withdrawal symptoms, but also leads to improved health and social productivity. Additionally, methadone maintenance in opiate addicts has been found to reduce transmission of infectious diseases like HIV/AIDS associated with injection drug use (heroin).

How Does Methadone Work?

Methadone provides pain relief by changing the way the brain responds to pain. It acts on the same opioid receptors as other opioid medications such as oxycodone, hydrocodone, and morphine, and also heroin. But even though methadone attaches to the same opioid receptors, its action is slower than other opioids. In other words, methadone takes longer to leave the body, and its effects last longer. For this reason, it can be used to help people come off other, more dangerous opiates.

In people who are dependent on opioids such as heroin or prescription pain pills, methadone is prescribed as part of medication assisted treatment to relieve cravings and withdrawal symptoms without producing the euphoria caused by the abused drugs. However, methadone can still cause cognitive and mood changes in treated individuals. ^[5] One can think of it as a replacement therapy, where methadone is used to taper addicts off heroin or others opiates.

Some people think of methadone treatment as replacing one addiction with another. However, the truth is that methadone has been used successfully for over four decades now to treat opioid use disorders. Nonetheless, since methadone itself is an opiate with a high risk of abuse and addiction, it is dispensed through specialized, tightly controlled opioid treatment programs.

Cost of Methadone Treatment

Methadone treatment, including the medication and psychosocial support services, costs approximately $126 per week or $6,552 per year. ^[6]

What Is Methadone Abuse and Addiction?

Some people obtain methadone illegally from street dealers to manage opioid withdrawal symptoms caused by withdrawal from other drugs such as heroin or prescription pain pills. In addition, some people abuse methadone as the drug of choice. Although it is slower acting than other opioid drugs, when injected directly into a vein, methadone can produce the same euphoric effects as heroin and morphine. Studies show that the effects and potency of methadone administered intravenously are indistinguishable from other opiates like morphine. ^[7]

As mentioned, although methadone is used to help people quit using other opioid drugs, it is itself an opiate with a potential for addiction. While methadone reduces cravings for opiates, it can still leave a person dependent. People struggling to quit illegal opiates can get addicted to methadone, so much so that methadone addiction has become a problem itself. Nonetheless, methadone is deemed safer than heroin and prescription opioid painkillers.

When a person uses larger or more frequent doses of methadone, they are said to be misusing the medication. This can put such individuals at risk of methadone addiction. When someone uses methadone without a prescription to get high, they are said to be abusing methadone. Like other opioids, methadone is habit-forming. Its misuse and abuse puts people at risk of developing a physical and psychological dependence on the drug. The risk of methadone addiction is higher in those who are receiving it for addiction treatment because such individuals have already developed opioid dependence.

To reduce the risk of methadone addiction, it is heavily regulated. People who take methadone for opioid use disorders are required to enrol in a special program approved by state and federal governments. Patients who are prescribed methadone must go to a methadone clinic every day to get their dose. Under federal laws, these programs are required to provide methadone under the supervision of qualified healthcare providers. Take-home methadone doses may be permitted for some people who have been on an established methadone maintenance program for an extended time.

Methadone can be prescribed by any physician for pain relief. However, it is currently illegal for a physician in the United States to prescribe methadone to treat an opioid use disorder outside of a licensed opioid treatment program. ^[8]

Trends in Methadone Use

Data from surveys, prescriptions, emergency room visits, and substance abuse treatment clinics reveals some interesting trends in methadone use in the United States over the past several decades.

Statistics (pre-2010)

• The number of methadone prescriptions filled at pharmacies increased from about 860,000 in 2000 to 4,440,000 in 2008.
• The most popular formulation of methadone is the 10-mg tablet, which comprised 85% of all methadone doses in 2008.
• Between 2000 and 2008, the U.S. Poison Control Centers reported roughly 4,700 methadone exposures and about 100 methadone deaths. The death rate from methadone exposures increased from around 25 in the year 2000 to more than 100 in 2008. ^[9]
• Between 2004 and 2007, the number of emergency room visits that involved methadone increased from around 48,000 to 69,000. There was also a roughly 80% increase in visits involving methadone use in combination with alcohol, street drugs, and other prescription drugs.
• In 2007, more than 70% of methadone visits were by Caucasians, with the highest rate for those in the 21–24 age group.
• Roughly 80% of emergency room visits for methadone use involve non-medical use, including misuse and abuse.
• The number of people admitted to addiction treatment centers for illegal or street methadone increased from around 1,200 in the early 1990s to more than 5,000 in 2007.
• The rate of methadone overdose deaths increased by 600% from 1999 to 2006. ^[10]

Statistics (post-2010)

• In 2010, roughly 10% of all treatment facilities were certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide medication-assisted therapy with methadone or buprenorphine.
• Approximately 80% of OTPs (opioid treatment programs) provided outpatient treatment in the decade leading up to 2018. Only 24% provided residential treatment, and about 5% provided hospital inpatient treatment. This indicates that most people with opioid use disorders receive outpatient addiction treatment with methadone. ^[11]
• In 2014, methadone accounted for nearly one-fourth of all prescription opioid deaths. ^[12]
• Methadone continues to be used extensively to treat opioid addiction. Various studies have shown that methadone maintenance in opioid addicts leads to a significant decline in illicit drug use as well as criminal activity. It has also shown improvement in health benefits, including reduced risk of HIV/AIDS. ^[13]

Statistics 2022

• Over 6,100 facilities (constituting 41% of all substance use treatment facilities) offered methadone or buprenorphine maintenance or naltrexone treatment in 2022 in the United States.
• More than 618,000 clients received methadone or buprenorphine maintenance or naltrexone treatment in 2022. ^[14]
• Over 17 million people over the age of 12 years in the US reported any use of methadone in 2021. This number fell to about 14 million people in 2022.
• In 2022, about 200,000 people reported misusing methadone in the past year. ^[15]

Recognizing Methadone Addiction

Because methadone is an opioid drug, there are serious concerns about using it to treat heroin and prescription painkiller addiction. The use of methadone comes with a risk of becoming addicted to the drug treatment itself.

To reduce the risk of methadone addiction, it is dispensed through special methadone clinics in a regulated fashion. Nonetheless, friends and family members of people receiving methadone for pain relief or addiction treatment should know how to recognize the signs of methadone addiction. Some of the signs and symptoms of methadone addiction include:

• Tolerance, i.e., needing more methadone to obtain pain relief or reduce opiate cravings and withdrawal symptoms. This is usually the first sign of methadone addiction. The dosing schedule of methadone should always be changed by the prescribing physician. Increasing the dose or taking more frequent doses of methadone without medical authorization is a red flag for methadone addiction.
• Worsening withdrawal symptoms.
• Behavioral changes, such as prioritizing methadone use over everything else, trying to obtain methadone from illegal sources, failing to meet work or home responsibilities, or cutting back on social and recreational activities. These are are all worrisome signs that could indicate methadone addiction.

Side Effects of Methadone

Like most medications, methadone can cause a variety of side effects. People who are using methadone should be vigilant for the following adverse effects:

• Headache
• Stomach ache
• Dry mouth
• Sore throat
• Flushed skin
• Weight gain
• Difficulty urinating
• Vision problems
• Mood changes
• Sleep difficulties
• Irregular menstruation in women
• Erectile dysfunction (impotence) in men
• Decreased libido (sexual desire)

Occasionally, people using methadone can experience more serious adverse effects that require emergency medical help. Some of the serious side effects of methadone include itching; hives; skin rashes; swelling of the eyes, face, tongue, mouth, or throat; hoarseness; difficulty breathing or swallowing; extreme drowsiness; nausea, vomiting; weakness and dizziness. Other serious side effects include seizures, agitation, hallucinations, fever, chills, sweating, fast heartbeat, muscle twitching, stiffness, confusion, and loss of coordination. ^[16]

Deaths from Methadone

• Methadone has been shown to reduce the risk of death after an opioid overdose when used as part of medication assisted treatment for opioid use disorders. ^[17]
• In 2014, methadone was responsible for around 3,500 deaths. ^[18]

Risk Factors for Methadone Addiction

Anyone who uses methadone is at risk of abuse and addiction. For this reason, it is important to take methadone exactly as directed by the prescribing physician. People with a history of alcoholism, street drug use, or prescription drug abuse are at higher risk of developing methadone addiction. Also, people who currently have or previously had depression or other mental health conditions are at increased risk of developing an addiction to methadone. Those with family members who have struggled with alcohol or drug abuse are also at higher risk of methadone addiction.

People who abuse methadone or are addicted to it are at risk of life-threatening breathing problems and a fatal drug overdose. The risk is especially high in those with lung conditions, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, and bronchitis. Also, conditions that cause increased pressure in the head, such as a head injury, can put a person at a high risk of breathing problems with methadone abuse. The risks are also greater in older people and those who are malnourished or weak. In people who are taking methadone, symptoms such as slowed or shallow breathing, long gaps between breaths, or shortness of breath require immediate medical treatment.

Methadone addiction can lead to serious heart problems, such as fainting, irregular heartbeat, and sudden death. This is because methadone causes prolongation of the QT interval in some people. This is a rare condition in which the heart’s electrical system takes an abnormally long time to recharge between heartbeats. The risk is higher when methadone is used along with certain medications, including certain antidepressants, antifungals, water pills, laxatives, and medications used to treat an irregular heartbeat. Studies have shown that despite recommendations for cardiac risk monitoring, many patients who are prescribed methadone do not receive ECG assessment. ^[19] If a person who is addicted to methadone or is abusing methadone experiences symptoms such as fainting, lightheadedness, dizziness, or a pounding heartbeat, they should seek immediate medical attention.

Methadone and Other Drugs

Taking methadone with certain other medications increases the risk of serious, potentially life-threatening adverse effects, including slowed or stopped breathing, coma, and death. That’s why it’s important to tell your doctor about all the other prescription and over-the-counter medications and supplements you are taking. Methadone can interact with a range of medications, including benzodiazepines (Xanax, Valium, Ativan), muscle relaxants, sleeping pills, and cough or pain medications that contain opiates. Drinking alcohol or using other street drugs while on methadone also increase the risk of life-threatening health complications.

The use of methadone with other drugs can lead to symptoms such as lightheadedness, dizziness, drowsiness, slowed or difficult breathing, and loss of consciousness. These symptoms warrant emergency medical care. Family members of people who have methadone addiction should be aware of these symptoms so that they can contact a doctor and get emergency help.

Opioid Prescription Trends

In 2012, healthcare providers in the United States wrote nearly 260 million opioid prescriptions, enough for each American to get their own bottle of pills. The amount of opioids prescribed in the US peaked in 2010 and then decreased every year up to 2015. However, prescribing of opioids remained high and was still more than 3 times higher in 2015 compared to 1999. The amount of opioid prescriptions also varied greatly from county to county. Providers in the highest prescribing counties prescribed 6 times more opioids per person than the lowest prescribing counties in 2015. ^[20]

Methadone Use in Pregnancy

Opioid use in pregnant women has increased dramatically in recent years, mirroring the opioid epidemic in the general population. Methadone addiction in a pregnant woman can lead to many complications for the mother and baby. Regular use of methadone during pregnancy can cause life-threatening withdrawal symptoms and neonatal abstinence syndrome (NAS) in the baby after birth. Symptoms of NAS include hyperactivity, irritability, high-pitched crying, abnormal sleep patterns, diarrhea, vomiting, uncontrolled shaking, and failure to thrive or gain weight.

Breastfeeding is encouraged in women taking methadone, as it can decrease the severity of neonatal abstinence symptoms and reduce the length of hospital stay for the infant. ^[21]

Methadone Withdrawal

People who are abusing methadone or have developed an addiction to the drug can experience withdrawal symptoms if they suddenly stop using it. Withdrawal symptoms of methadone may include:

• Watery eyes
• Runny nose
• Restlessness
• Yawning
• Sweating
• Chills
• Enlarged pupils
• Muscle and joint pain
• Anxiety
• Irritability
• Backache
• Stomach cramps
• Weakness
• Sleep difficulties
• Nausea, vomiting, diarrhea
• Decreased appetite

To avoid these uncomfortable and potentially dangerous withdrawal symptoms, people with a methadone addiction should undergo a medically supervised detox from the drug.

Symptoms of Methadone Overdose

It is possible to overdose on methadone by taking a large dose in a short period. Symptoms of methadone overdose include:

• Slow or shallow breathing
• Pinpoint pupils (the small black circle in the center of the eye)
• Drowsiness
• Limp muscles
• Cool, clammy skin
• Loss of consciousness (unresponsiveness)

A methadone overdose can be treated with a medication called naloxone. Naloxone reverses the dangerous effects of a methadone overdose by blocking opioid receptors in the central nervous system. Family members, friends, and caregivers of people with a methadone addiction should keep naloxone on hand and should learn how to use it. This drug can be life-saving in the event of a methadone overdose until emergency help arrives. Sometimes, a second dose of naloxone is necessary if methadone overdose symptoms return. In 2023, the U.S. FDA approved an over-the-counter 4-mg naloxone nasal spray that can be purchased without a doctor’s prescription.

How Should Prescription Methadone Be Used?

Taking a few precautions can help you get the maximum benefit from methadone therapy while minimizing the risks.

Before taking methadone, give your doctor and pharmacist a full list of your current prescription and non-prescription medications, herbal products, and dietary supplements. Also, tell your healthcare providers about any allergies to medications, pre-existing medical conditions, or planned surgeries, including dental procedures. Keep all your medical appointments and complete all lab tests requested by the physician who prescribes methadone to you.

It is very important to take methadone exactly as instructed. If you are taking methadone for pain management and do not have adequate pain control, do not increase the dosage or dosing frequency without your doctor’s approval. Tell your doctor about your lack of pain control. They may change your methadone dose or prescribe additional medications to control your pain.

Never share your methadone with others or obtain the drug from other people or unauthorized sources. Also, do not stop taking methadone without talking to your prescribing physician. The dose of methadone needs to be reduced slowly. Suddenly stopping methadone use can lead to uncomfortable withdrawal symptoms. If you miss a dose, take it as soon as you remember and then continue your regular dosing schedule. If it is almost time for the next dose, skip the missed dose and go back to your schedule.

Dispersible methadone tablets should not be chewed or swallowed. If a part of the tablet is to be taken, it should be carefully broken along the scored line. The dispersible methadone tablet should be dissolved in half a glass (roughly 120 mL or 4 ounces) of water and ingested immediately. Any remaining tablet residue in the glass should be mixed with a little more water and swallowed immediately.

Methadone Storage and Disposal

Methadone should be stored in its original container with the lid tightly closed. Many containers are not child-resistant, so it’s important to keep methadone out of sight and out of reach of children to prevent accidental poisoning. It is recommended that you store methadone at room temperature and avoid exposure to excessive heat and moisture. Any expired or unneeded methadone should be taken to a drug take-back program or your local waste disposal.  Your pharmacist can advise you on the best way to dispose of methadone.

Treatment for Methadone Addiction

Methadone addiction can be somewhat challenging to diagnose and treat because it is a drug that is widely accepted in the medical community. But addiction to methadone is an all-too-common side effect of legitimate MAT treatments for opioid use disorders. Many people begin using methadone as part of an opioid addiction treatment program but go on to misuse methadone. Some people start abusing methadone recreationally to get high.

It can be challenging for a person to quit methadone. Drug rehab centers offer supervised detox and withdrawal for people with methadone addiction to safely come off the drug. During addiction treatment, the dose of methadone is gradually reduced. A person recovering from methadone addiction may be switched to other medications, such as buprenorphine, to make the withdrawal easier. In the long term, counseling and behavioral therapies are used to treat methadone addiction, similar to alcohol and other substance use disorders.

Methadone Addiction and Mental Health

Many people with methadone (opioid) addiction have co-occurring mental health disorders, such as anxiety, depression, PTSD (post-traumatic stress disorder), bipolar disorder, and schizophrenia. ^[22] People with mental health concerns are more likely to self-medicate for symptoms of opioid addiction. It is important to get comprehensive care for methadone addiction and mental health disorders at the same time. Counselors and other healthcare professionals can help people who are addicted to methadone overcome their dependence and manage mental health symptoms.

An opioid treatment program where methadone is dispensed daily is an ideal setting to initiate and monitor treatment for co-occurring psychiatric disorders. Patients attend the methadone clinic every day, and clinicians have the chance to monitor their response to psychiatric medications in conjunction with the methadone they are receiving in treatment.

Last updated: March 20, 2024