How Methadone Treatment Works

You are holding someone else's methadone, or you are about to take a second dose because the first one feels weak, or you are ready to stop it to prove you are serious. For opioid use disorder, this medicine comes only from a certified clinic. Do not take an extra dose. Do not share it. Do not stop it tonight.

If breathing is slow, the person will not wake, or you think too much was taken, call 911. For a mental health crisis, call or text 988. What to do with naloxone is in opioid overdose signs. Naloxone does not replace the daily clinic medicine.

What it does when a clinic prescribes it

Methadone is a Schedule II, long-acting full opioid agonist. For a confirmed opioid use disorder, it is dispensed only through a SAMHSA-certified opioid treatment program. The same medicine is also approved for pain. Those are different uses. A corner pharmacy does not start this treatment, and pain tablets from a friend are not a substitute for the clinic.

Taken daily as prescribed, it reduces opioid craving and withdrawal and blunts the effects of other opioids. The forms are liquid, powder, and diskettes. It is safe and effective as one part of a plan that also includes counseling. These medicines are not a swap of one drug for another.

It binds the same mu-opioid receptors as heroin and fentanyl, more slowly, and it stays in the body longer. In people with opioid use disorder it produces less intense pleasure while reducing withdrawal and craving. People treated with methadone or buprenorphine are less likely to die or to overdose than people who do not receive those treatments. That is a finding about groups, not a promise about one person. Keep naloxone.

It does cause dependence. Stopping abruptly can bring withdrawal, and that withdrawal is milder than withdrawal from other opioids. If the dose comes down at all, a clinician does it slowly. Do not design that change yourself. Office-based buprenorphine is a different medicine, in Suboxone treatment. How methadone, buprenorphine, and naltrexone differ is in medication for opioid use disorder.

The clinic, not a self-start

You enroll in an opioid treatment program. New patients usually go every day or almost every day. After a period of stability, and when the prescribed dose has been consistent, some people may take methadone at home between visits. Since 2020, regulations let many people who have already been in treatment receive up to 28 take-home doses. The program decides. A bottle at home is not permission to change the amount.

Patients in these programs must be able to receive counseling, along with medical, vocational, educational, and other services. A dosing window with no path to those services is not the program that rule describes.

Twelve months is the minimum described for methadone maintenance, and some people keep benefiting for many years. There is no length that fits everyone. If treatment is ending, the practitioner reduces the dose gradually, to prevent withdrawal. A court date, a relative, or a house rule that demands you stop this week is not that plan. Tell the prescriber. Do not flush the medicine to satisfy the demand.

If heroin is the drug you were using, the treatment path is in heroin treatment. The wider class of drugs is on opioids. How methadone compares with the office medicine is in methadone and buprenorphine.

The moves that get people hurt

If a dose feels weak, do not take another. Never use more than the amount prescribed, and do not add a dose because you missed one. The active drug remains in the body after the effects seem to wear off. Other medicines can interact with it and affect the heart. Tell every clinician the full list, including benzodiazepines and anything bought without a prescription.

Do not drink alcohol with methadone. That mix is a breathing risk.

Never share a dose, including take-homes. The amount is adjusted for one person. Someone who is not already on the medicine, and a child, can be badly hurt by a dose that is ordinary in treatment. Store it out of reach of children and pets. Be careful driving or using machinery until you know how you respond.

Leaving because a month felt long enough raises the chance of withdrawal. If you then return to illicit opioids, an old amount can be too much, because tolerance changes. Call the clinic before you restart anything on your own. The first hours after a return to use are in what to do after a relapse.

Pregnancy

Pregnant and breastfeeding patients can safely take methadone, and maintenance during pregnancy does not cause birth defects. Withdrawal in pregnancy may raise the risk of miscarriage or premature birth, because the uterus can contract. Some newborns have neonatal abstinence syndrome. Symptoms can appear as late as two weeks after birth. On breastfeeding, the benefits outweigh the small amount of methadone that enters the milk. Care during pregnancy is in rehab during pregnancy. The newborn's course is in neonatal opioid withdrawal. A positive test is a reason to call the prescriber, not a reason to stop in secret.

Restlessness, nausea or vomiting, slow breathing, itchy skin, heavy sweating, constipation, and sexual problems should be reported if they do not fade. Do not answer nausea by inventing a new dose.

Search FindTreatment.gov for an opioid treatment program. Call or text (800) 653-9376 if you need a clinic that keeps you on methadone instead of stopping it at the door.

Additional Resources

Sources cited on this page:

• SAMHSA: Methadone
• NIDA: Medications for Opioid Use Disorder
• NIDA: Principles of Drug Addiction Treatment, third edition
• SAMHSA: Treatment options for substance use disorder
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions