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Each year, hundreds of thousands of people take methadone to aid in recovery from opioid addiction. The prescription drug has been used alongside counseling and therapy for decades. Studies show that it increases the chances of staying in treatment and reduces the likelihood of relapse.

What Is Methadone?

Methadone is one of the oldest medications used to treat opioid addiction. It’s sometimes used as a standalone therapy, but it’s much more effective as a complement to counseling and therapy. Brand-name drugs containing methadone include Dolophine and Methadose. Brand names that are no longer available include Diskets and Westadone.

The medication usually comes in liquid form at methadone clinics or addiction treatment facilities, but it’s also available in powder and tablet forms. It is usually consumed under the supervision of a physician because of its potential for abuse.

Methadone is a man-made opioid that weakens cravings and withdrawal symptoms caused by dependency to other opioids, such as heroin. The term opiate usually refers to naturally occurring drugs derived from opium, such as codeine and morphine. Methadone is made in a lab, so it is not an opiate.

The numbers of clients receiving methadone from certified opioid treatment programs increased from 258,000 in 2006 to 345,000 in 2016, according to the National Survey of Substance Abuse Treatment Services. More than 1,200 drug rehab facilities provided methadone in 2016.

If abused, methadone can cause euphoria and relaxation. Frequent abuse can lead to dependency and prescription drug addiction. However, methadone is a long-acting opioid. It takes several hours for the full effects of the drug to kick in, and the effects can last for up to 36 hours.

Most people who misuse opioids to get high prefer drugs that act quickly, such as oxycodone. Getting high on methadone is different from getting high off of other opioids. Methadone doesn’t cause the “rush” that other opioids cause.

It’s possible for individuals to become addicted to methadone. Some individuals with opioid use disorders seek methadone from a doctor only when they’re unable to find an illicit opioid, such as heroin. When methadone is taken irregularly and the person isn’t committed to a comprehensive treatment plan, recovery from opioid addiction is unlikely.

Methadone must be taken as prescribed by a doctor to be effective. Some people plan on temporarily taking methadone to avoid withdrawal. Once they take the medication, they may realize the drug can help them recover from addiction. With long-term methadone treatment and therapy, people can slowly taper off of opioids and return to regular life.

Methadone Maintenance Therapy

Most people who are addicted to opioids continue to take the drugs because they fear the withdrawal symptoms caused by dependency. Opioid withdrawal lasts for several days and can cause intense sweating, nausea, diarrhea, muscle aches and insomnia.

To overcome dependency, individuals have to stop taking opioids. The quickest way to overcome withdrawal is to quit cold turkey. However, quitting cold turkey is risky and can cause a number of health complications. Withdrawal is so intense that very few people successfully quit opioids cold turkey.

Recovery from opioid addiction is more realistic when individuals slowly decrease the amount of opioids that they take. Methadone maintenance therapy replaces heroin or prescription opioids with methadone. The medication is less prone to abuse and lasts longer than other prescription opioids, which usually last for between four and 12 hours.

People undergoing methadone maintenance therapy receive methadone once a day at a clinic for at least a year. Some people receive the medication for multiple years.

A 2005 review of 52 studies that was published in the Journal of Substance Abuse Treatment found that methadone maintenance therapy was more effective than several other forms of treatment at retaining patients in treatment and reducing heroin use.

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Initial Dosing

The initial dose of methadone depends on a person’s history of opioid use and his or her tolerance to opioids. Individuals with an unclear history of opioid use or those with a low tolerance to opioids usually begin with a low dose of methadone.

If patients experience cravings or withdrawal symptoms while on methadone, health providers will adjust the methadone dose gradually. The dose is usually adjusted based on how a person feels within two to four hours of receiving methadone. It isn’t adjusted based on when the effects of methadone wear off. Over time, methadone will accumulate in the body and the effects of the drug will last longer.

Steady State

After multiple days of methadone maintenance therapy, levels of methadone in the body reach a steady state. That means methadone leaves the body at a rate similar to the rate at which it enters the body. Individuals may experience some withdrawal symptoms when methadone wears off during the first days of initial dosing. Once the drug reaches steady state in their bodies, they should not feel withdrawal symptoms.

Stabilization

The stabilization phase of methadone therapy refers to the phase of treatment during which patients no longer exhibit drug-seeking behavior. To reach stabilization, methadone levels have to reach a steady state in the blood, and doctors have to determine a dosage of methadone that prevents withdrawal symptoms for 24 hours.

Once patients are stabilized, they usually begin intensive counseling and therapy to treat the psychological causes of addiction. They learn healthy stress-relief techniques, coping skills and strategies to avoid relapse.

Maintenance Phase

Once a patient is stabilized and health providers don’t have to adjust doses of methadone to prevent withdrawal, the patient enters the maintenance phase. This phase is associated with abstinence from illicit drugs and a return to productive life. Most patients in the maintenance phase have completed some form of therapy and are regularly attending support groups or outpatient counseling.

Some individuals remain in the maintenance phase of methadone therapy for the rest of their lives. Others choose to slowly taper off the medication. Tapering usually begins after a person has been on a regular dosage of methadone for several months.

Tapering off of Methadone

Tapering is recommended only for patients who have a history of abstinence, a strong support system and a motivation to discontinue methadone therapy. Relapse is likely when patients taper before they’re ready. The decision to taper should always be discussed with a health provider.

The rate of tapering varies. One tapering technique is to reduce the daily dose of methadone by 5 to 10 percent every one to two weeks. At this rate, tapering takes many months. If relapse seems likely, health providers adjust the dose and patients return to the maintenance phase.

Once the dose drops below 40 milligrams per day, many individuals can no longer maintain a steady state of methadone in the blood. At this point, most people experience withdrawal symptoms. Some may choose to discontinue tapering and return to maintenance therapy. Others may choose to enter supervised detox and get through withdrawal.

Side Effects, Interactions and Complications of Methadone Treatment

Methadone therapy isn’t without risks. Like any medication, methadone can cause side effects. Many side effects of methadone fade once a person stabilizes and enters the maintenance phase of treatment, but some side effects can persist.

Side effects of methadone include:

If you experience difficulty breathing, chest pain, rapid heartbeat or confusion while taking methadone, call 911 immediately.

Other medications can reduce or intensify the effects of methadone. Drugs that are known to interact with methadone include:

Some medications cause severe withdrawal symptoms when they interact with methadone, so it’s important to give your doctor a list of all prescription and over-the-counter drugs you’re taking before you start methadone therapy.

Methadone should not be taken with illicit drugs or alcohol. Consuming alcohol or other drugs that affect the central nervous system, such as heroin or benzodiazepines, can cause life-threatening side effects. If the effects of methadone begin to wear off, patients should talk to their health provider about adjusting the dosage. Consuming additional opioids to prevent withdrawal can lead to overdose.

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Addiction Risk During Methadone Treatment

When taken as prescribed as a part of a comprehensive treatment plan, methadone therapy is considered safe and effective, according to the National Institute on Drug Abuse. However, misuse of methadone outside of treatment can lead to dependency and addiction.

Methadone is less addictive than other opioids, but it does have addictive qualities. The drug is long-acting and stays in the body longer than other opioids. Withdrawal from methadone may not begin until one to two days after the last dose, and symptoms may persist for 10 to 20 days.

Symptoms of methadone withdrawal include:

People who receive methadone maintenance therapy created a 12-step program called Methadone Anonymous that has slowly grown in popularity. Peer support and accountability can increase the effectiveness of treatment and the chances of long-term recovery.

Why the Controversy Involving Methadone Treatment Isn’t Justified

Methadone treatment has been stigmatized by individuals who don’t understand the science of substance use disorders. Some people say that giving methadone to people with heroin addiction is like replacing one addiction with another. However, many doctors refute that belief.

Most health providers prefer to help individuals addicted to opioids recover without the use of another addictive drug. However, treatment dropout rates and relapse rates are high among people in recovery from opioid use disorders. Numerous studies have shown that individuals who receive methadone have higher retention rates than individuals who don’t receive medication-assisted treatment.

Methadone has also drawn scrutiny because of its role in increasing rates of overdose deaths. An estimated 25 percent of prescription opioid deaths are caused by methadone, according to a 2017 report by the Centers for Disease Control and Prevention.

However, a 2014 report by the National Conference of State Legislatures cited CDC data suggesting that the rise in methadone overdose deaths stemmed from methadone that was used to treat pain. The data show that methadone used to treat opioid addiction was not causing the increase in overdose deaths.

In 2016, an estimated 1.4 million people used methadone for any purpose in the past year, according to the National Survey on Drug Use and Health. Only 346,000 people said they misused methadone in that period, meaning the vast majority of people took methadone responsibly.

In recent years, treatment specialists have introduced other medications for people with opioid use disorders. Buprenorphine, an opioid with less potential for abuse than methadone, and naltrexone, a medication that blocks the effects of opioids, are effective at treating opioid use disorders. More research involving direct comparisons of the medications is needed to determine whether one drug is more effective than the other. However, buprenorphine or naltrexone are effective alternatives for individuals who can’t take methadone.

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