Methadone: Uses, Side Effects & Interactions

Methadone is a versatile drug for pain and opioid use disorder, but it can carry risks for addiction, withdrawal and side effects such as dry mouth and lethargy.

If you struggle with opioid use, you may have heard of a medication called methadone. Although methadone is itself an opioid and carries a risk of dependence and addiction, it is also a valuable tool in helping people overcome a struggle with more potent, dangerous opioids. Learning about methadone can help you in your journey to becoming opioid-free.

What Is Methadone?

Methadone is a long-acting opioid. Although many people consider methadone to be synonymous with treating opioid dependence in adults struggling with narcotics, the drug has been FDA-approved for treating three different conditions:

• Pain
• Opioid dependence in adults
• Opioid withdrawal symptoms in newborns

Methadone Drug Class

Methadone is a synthetic opioid, meaning it is created in a lab, but it works similarly to other opioids. Also like other opioids, methadone is a Schedule II controlled substance.

Methadone Brand Names

Methadone is most often available as a generic drug but is sometimes sold under brand names as well. However, the brand name dependson the dosage form of methadone:

Methadone dosage form	Brand name
Oral liquid	Available as generic only
Oral tablets	Available as generic as well as the under the brand names Methadose and Dolophine
Dissolvable oral tablets	Available as generic as well as under the brand name Methadose

What Does Methadone Look Like?

Methadone comes as both a generic and a brand-name drug and can look and taste vastly different depending on the manufacturer and formulation. Further, the way the drug looks and tastes can change every time the manufacturer changes.

For example, methadone tablets can come in various shapes and imprints, including but not limited to:

• Methadone 10 mg tablets:
  • White, round, scored tablets with 54 142 imprinted
  • White, rectangular, unscored tablets with M on one side and 57 71 on the other
  • White, round, scored tablets with ASC 116 imprinted
• Methadone 5 mg tablets:
  • White, round, scored tablets with 54 210 imprinted
  • White, round, scored tablets with U 41 imprinted
  • White, rectangular, scored tablets with M on one side and 57 55 on the other
• Methadone dissolvable tablets
  • White, round, scored tablets with Methadose 40 imprinted

Methadone oral liquid, which is generally restricted to methadone clinics, can also come in a variety of colors and flavors. This includes:

• Orange colored and raspberry flavored
• Orange colored and citrus flavored
• Clear colored and citrus flavored
• Clear colored and unflavored

How Does Methadone Work?

Like other opioids, methadone binds to the mu opioid receptors in the central nervous system. The mu opioid receptors play a major role in both pain perception and the reward pathway, which is closely linked to addiction. 

Methadone is a full opioid agonist, meaning that it binds tightly to the mu opioid receptor. The higher the dose of a full agonist, the more likely it is to produce effects like analgesia or relief from opioid withdrawal symptoms.

What Is Methadone Used For?

Although many people think methadone is only used for treating opioid addiction, this is not true. Methadone is FDA-approved to treat pain, opioid dependence and opioid withdrawal symptoms in newborns. It is commonly prescribed for pain relief in hospice and in people with kidney or liver problems because it is less likely to accumulate in the body than other opioids in people with those conditions.

How Is Methadone Dispensed?

Most prescriptions are dispensed by regular pharmacies. However, methadone is a little different. When prescribed for pain, methadone can be dispensed from regular pharmacies. However, methadone prescribed for opioid use disorder must be dispensed from special methadone clinics. 

What Is a Methadone Clinic?

A methadone clinic is a special outpatient clinic for opioid use disorder that is strictly regulated at both the federal and state levels. At the federal level, methadone clinics are part of Outpatient Treatment Programs (OTPs) that must be certified by the Substance Abuse and Mental Health Services Administration (SAMHSA), licensed by the state where they are located and registered with the Drug Enforcement Administration (DEA). A methadone clinic should use a whole-health approach to treatment, offering not only methadone but also counseling and behavioral therapies to help a person overcome addiction, like what you can find at The Recovery Village Cherry Hill at Cooper.

How Do Methadone Clinics Work?

A person must sign up for a methadone clinic and agree to its terms and conditions.

Generally, this includes items like:

Not missing counseling sessions

Not missing methadone doses

Not sharing their methadone with other people

Not taking any illicit drugs

Consenting to random and scheduled drug checks

Agreeing to receive methadone strictly from the methadone clinic prescriber

Failure to meet these terms can cause a person to be discharged from the methadone clinic. A person enrolled in a clinic will start off by swallowing their methadone dose in front of the prescriber. Over time, the person may be able to earn some take-home methadone doses.

During the COVID-19 pandemic, SAMHSA loosened methadone clinic restrictions for additional flexibility, allowing people to take home methadone doses. It remains to be seen whether the changes to the restrictions will remain permanent.

How Effective Are Methadone Clinics?

Methadone clinics are very effective. Studies show that people taking methadone have 33% fewer opioid-positive drug tests and are more than four times as likely to stay in opioid treatment compared to those who do not participate in medication-assisted treatment for opioid use disorder.

Methadone Dosage

The methadone dose that a person takes is highly individualized. It depends not only on why the person is taking methadone but also on their opioid tolerance and physiology. That said, helpful information is available about how to find the correct methadone dose.

Methadone Dosage for Opiate Withdrawal

A person’s methadone dose for opioid withdrawal will vary widely based on their needs. Federal standards recommend against a target or max methadone doses for a person with opioid use disorder. Instead, the goal should be adjusting the methadone dose to prevent cravings and withdrawal symptoms. Since different people will have different opioid requirements, there is no one methadone dose for withdrawal that is recommended across the board. 

Methadone Dosage for Pain Management

The opioid dose a person takes for pain depends greatly on the person and their opioid tolerance. People who are brand new to opioids should take no more than 2.5 mg to 10 mg every 8 to 12 hours for pain. 

However, people who have built a tolerance to opioids may be able to take higher doses of methadone. Generally, their methadone dose is mathematically calculated based on the other opioids they take and their doses.

Can You Overdose on Methadone?

It is possible to overdose on methadone. The drug is very long-acting and can take several days to achieve full effect. This can tempt people to increase their methadone dose too quickly, leading the drug to build up in their bodies and potentially cause overdose, which can be fatal. 

Methadone overdose symptoms are similar to other opioid overdose symptoms and include:

• Extreme lethargy
• Sleepiness
• Pinpoint pupils
• Slow heartbeat 
• Low blood pressure
• Slowed breathing

Methadone Side Effects

Like all drugs, methadone has side effects. These are similar to other opioids and include:

• Sweating
• Flushing
• Itchy skin
• Nausea or vomiting
• Dry mouth
• Constipation
• Sedation
• Lethargy
• Slowed breathing

In addition, methadone has some side effects that are unique among other opioids. These include low blood sugar and a heart-related side effect called QTc prolongation. QTc prolongation can cause life-threatening abnormal heart rhythms.

Long-Term Effects of Methadone

As a Schedule II controlled substance, methadone must be prescribed and taken carefully because it carries a risk of addiction, abuse and dependence. This risk is not reduced with time. However, when taken as prescribed, methadone is a generally safe drug that can be taken for years. People who struggle with opioids may safely remain on methadone therapy indefinitely. 

Methadone and Pregnancy

Methadone is often prescribed during pregnancy to help women with opioid use disorder. It is the gold standard treatment of opioid addiction during pregnancy. Experts recommend that it be prescribed as early in the pregnancy as possible to help the mother and baby avoid risks of illicit opioid use. These can include stillbirth, miscarriage, neonatal abstinence syndrome and overdose. Further, women are able to safely breastfeed while taking methadone.

Methadone Interactions

Methadone has several drug interactions that can make the drug more or less potent than expected. Other substances that can intensify the side effects of methadone and may increase overdose risk include:

• Benzodiazepines
• Alcohol
• Ciprofloxacin
• Fluconazole
• Cimetidine
• Fluoxetine
• Phosphate supplements
• Medications to dissolve kidney stones

Conversely, substances that can decrease the amount of methadone in the body and may cause withdrawal symptoms include:

• Efavirenz
• Phenobarbital
• Phenytoin
• Rifampin
• Ritonavir
• Carbamazepine
• Potassium supplements

Methadone and Alcohol

As a central nervous system depressant, alcohol can intensify methadone’s effects. For this reason, you should avoid drinking if you take methadone. Mixing the two substances can lead to side effects like:

• Drowsiness
• Dizziness
• Lightheadedness
• Problems concentrating, thinking and judging
• Low blood pressure
• Slowed breathing
• Fainting
• Coma
• Death 

Is Methadone Addictive?

As a Schedule II controlled substance, methadone carries a high risk for addiction, abuse and dependence, particularly if the drug is misused or is not taken as prescribed. In 2017, the most recent year for which data is available, the American Association for Poison Control Centers reports documented 2,611 methadone exposures and 16 deaths from methadone overdose.

Signs of Methadone Addiction

Signs of methadone addiction are similar to those of other opioids and include:

• Taking methadone in larger doses or over a longer period than intended
• Desire or unsuccessful previous efforts to cut down or quit methadone
• Spending a lot of time trying to obtain, use or recover from methadone
• Craving methadone
• Problems fulfilling major obligations at work, school or home due to methadone
• Social or interpersonal problems because of methadone
• Giving up other activities because of methadone
• Taking methadone even when it is dangerous to do so, like before driving a car
• Staying on methadone even though fully aware it is causing problems to do so
• Needing higher doses to achieve the same effects from methadone as before
• Withdrawal symptoms when methadone is stopped

Methadone Withdrawal

When you take methadone over the long term, there is a risk of becoming physically dependent on the drug. This means that your body comes to expect the drug’s presence and requires it to function normally. If you suddenly stop methadone, you can experience unpleasant withdrawal symptoms as your body gets used to being without the drug. Methadone withdrawal typically starts within around 30 hours of the last dose and can last up to 10 days.

Methadone Withdrawal Symptoms

Methadone withdrawal symptoms are similar to other opioids. These symptoms can include:

• Muscle aches 
• Trouble sleeping 
• Increased tear production
• Sweating 
• Runny nose 
• Yawning 
• Enlarged pupils 
• Stomach cramps
• Goosebumps
• Nausea or vomiting 
• Agitation 
• Anxiety 
• Diarrhea

Other FAQs About Methadone

Does methadone get you high?

It is extremely difficult to get high off methadone. This is because methadone has a very slow onset and can take up to three to five days to kick in. Generally, medications that cause a high have a much more rapid onset, typically seconds to minutes.

How long does methadone stay in your system?

Because methadone is an extremely long-acting drug, it can stay in your system for days, weeks or even months following the last dose. The half-life of a drug refers to how long half a dose will stay in your body. Generally, it takes five half-lives to remove a drug from your system. The half-life of methadone ranges from 8 to 120 hours, depending on the person, meaning a dose can stay in your system anywhere from 40 hours to 25 days.

How long does methadone stay in urine?

Methadone can be found in the urine for up to 14 days after the last dose. 

How long does methadone last?

Methadone’s effects can last for hours or days and depend on the condition the drug is treating. In people taking the drug for pain, the pain-relieving effects often last four to eight hours. However, for those who take methadone to treat opioid use disorder, the effects can last from 22 to 48 hours.

How long can you be on methadone?

You can be on methadone indefinitely if needed. Particularly when taken for opioid use disorder, methadone has a much lower risk of causing health problems than a relapse back into opioid use. For this reason, some people stay on methadone for years or even decades.

Why does methadone rot your teeth?

Methadone can rot your teeth because one of its side effects is dry mouth. Without adequate saliva in your mouth to wash away food and acids, you may suffer from dental conditions like tooth decay. Your doctor may be able to recommend a mouthwash that can help to protect your teeth if you have dry mouth.

Find a Methadone Clinic in New Jersey

If you struggle with opioids, you are not alone. Millions of Americans have faced opioid addiction, and many have been helped by methadone clinics and outpatient treatment programs like the one at The Recovery Village Cherry Hill at Cooper. Our opioid addiction treatment program offers methadone as medically appropriate in combination with therapy and support groups to help you live an opioid-free life. Don’t wait: contact us today to learn how we can help you overcome opioids.