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Methadone Maintenance Treatment Pros and Cons

Recovering from opioid addiction or dependence can be difficult without professional rehab, which often includes medication-assisted treatment (MAT) or medication maintenance. Methadone is a safe and effective medication that can help you quit using opioids like heroin, fentanyl, or oxycodone. Before beginning this medication, it’s important to learn the methadone maintenance treatment pros and cons.1,2

In this article:

What is Methadone Treatment?

Methadone is a full opioid agonist medication prescribed to treat opioid addiction and dependence. It binds to the opioid receptors in the brain, alleviating cravings, reducing withdrawal symptoms, blocking the effects of other opioids, and decreasing the risk of relapse. Although it is an opioid, it is a safer opioid than those people misuse like heroin or prescription painkillers to feel euphoria.1,2,3,4

Many people take methadone over an extended period of time, months or even years, and this is known as methadone maintenance. It is taken on a daily basis in pill or liquid form.2

Methadone may also be part of a medication-assisted treatment program, which combines medication with counseling to provide comprehensive care that helps people change their behaviors and address underlying issues that motivated opioid misuse.1

Methadone Maintenance Treatment Pros and Cons

Methadone treatment can be life-saving.1,7 As with any medication, there are several methadone maintenance treatment pros and cons.

Benefits of Methadone Treatment

Methadone treatment has several benefits. The main benefit is that it decreases the risk of relapse.7 People in recovery from opioid misuse or addiction are less likely to return to opioid use while in methadone maintenance treatment (MMT) because they are less likely to experience withdrawal and cravings for opioids.1

This medication can also help ensure that withdrawal from opioids like prescription medication or heroin is done safely.1 Research also shows other benefits of methadone treatment, including:3,7

  • Significantly reduces drug injecting
  • Lower risk of contracting HIV or other infectious diseases due to decreased drug injecting
  • Lowers risk of death due to opioid overdose or use
  • Reduces criminal activity associated with opioid misuse
  • Blocks the pleasurable effects of opioids
  • Increases patient retention in treatment

Cons of Methadone Treatment

Because methadone is an opioid medication, chronic use can lead to physiological dependence, which means you’ll experience withdrawal symptoms if you suddenly quit. If you decide you want to discontinue methadone use, consult your doctor and they will create a tapering schedule to gradually wean you off methadone and avoid withdrawal.2

Additionally, because it’s an opioid, it has a high potential for misuse and addiction. People may misuse methadone by:

  • Taking higher doses than prescribed
  • Taking more frequent doses than prescribed
  • Mixing methadone with other substances
  • Taking it in a way other than prescribed (injecting or crushing and snorting)
  • Using it without a prescription

However, despite its addiction potential, methadone is still safer for people to use compared to other opioids like heroin. It’s safer because it’s used only under medical supervision and is dosed appropriately based on your individual needs—plus, it is taken orally instead of intravenously like many opioids of abuse.2

Another con is that methadone can cause side effects. Common methadone side effects include:2

  • Restlessness
  • Nausea or vomiting
  • Slow breathing
  • Itchy skin
  • Heavy sweating
  • Constipation
  • Sexual problems

You may experience serious side effects that require emergency medical attention. These include:2

  • Having difficulty breathing or shallow breathing
  • Feeling lightheaded or faint
  • Getting hives or a rash
  • Swelling of the face, lips, tongue, or throat
  • Chest pain
  • Fast or pounding heartbeat
  • Hallucinations
  • Confusion

If you experience any of these side effects from methadone, you should call 911 immediately.

Medication-assisted treatment or methadone maintenance treatment could be a good option for you if you are showing signs and symptoms of opioid use disorder (OUD) or opioid misuse. Symptoms of OUD include:8

  • Taking larger amounts of opioids or over longer periods than intended
  • Wanting to quit or control opioid use but failing to do so
  • Spending a lot of time obtaining and using opioids, as well as recovering from effects
  • Experiencing strong cravings for opioids
  • Failing to fulfill school, home, or work obligations due to opioid use
  • Continuing opioid use despite interpersonal or social problems caused or worsened by use
  • Giving up hobbies or previously enjoyed activities due to opioid use
  • Using opioids in dangerous situations, such as while driving
  • Continuing opioid use despite physical or psychological issues caused or worsened by use
  • Using higher doses of opioids to experience the same effects (tolerance)
  • Experiencing opioid withdrawal symptoms when you suddenly quit (dependence)

If you experience two or more of the above symptoms, you may have an opioid addiction and may benefit from methadone maintenance treatment. If you are concerned about a friend or loved one, you may notice the following signs of opioid misuse or addiction:9

  • Change in attitude or personality
  • Avoiding contact with family or friends
  • Change in friends or hobbies
  • Decreased performance in school or work
  • Isolating
  • Secretive behavior
  • Moodiness, such as irritability or nervousness
  • Small pupils
  • Drowsiness
  • Loss or increase in appetite
  • Weight loss or gain
  • Intense flu-like symptoms, such as nausea or vomiting
  • Missing medications
  • Burnt or missing spoons
  • Syringes
  • Small bags with powder residue
  • Missing shoelaces or belts

While methadone maintenance treatment is shown to reduce cravings and lessen withdrawal symptoms, research shows this is not enough for someone to recover from opioid use disorder (OUD).1 Medication is most beneficial when it’s combined with evidence-based addiction treatment methods, like therapy, in order to produce lasting changes.1

Treatment programs, on an inpatient or outpatient basis, typically offer methadone in addition to other treatment modalities, like family therapy, group counseling, and individual therapy. Some places, like a detox center, might only provide medical support and supervision for you to take the medication.

Contraindications and Priority Patients

Methadone is contraindicated in people with severe liver disease, as methadone maintenance treatment could lead to hepatic encephalopathy, which causes brain dysfunction. Additionally, those who are intolerant of methadone should not be given methadone.3

Conversely, individuals who meet any of the following criteria should begin methadone maintenance treatment right away:3

  • HIV positive
  • Receiving care for hepatitis C or HIV
  • History of overdose
  • History of suicidal or self-harming behavior related to opioid addiction
  • Pregnant, opioid addicted people

Can Pregnant People Get Methadone Treatment?

Methadone treatment is approved for pregnant people or individuals who are breastfeeding. Pregnant people who are in treatment for opioid misuse should continue with methadone throughout their pregnancy because it helps them avoid misusing opioids. Treatment for opioid misuse is important during pregnancy because it can reduce the risk of miscarriage, low birth weight, and birth defects.2

It might seem confusing that methadone is safe to use during pregnancy. However, methadone is not shown to cause birth defects. Some babies may experience withdrawal after birth, a syndrome known as neonatal abstinence syndrome. These symptoms can be treated at the hospital. If you are pregnant and in need of methadone treatment, always let your doctor know. This is important for your health and your baby’s.2,6

How Do I Find Methadone Treatment?

The law states that only centers and providers certified through the Substance Abuse and Mental Health Services Administration (SAMSHA) can provide methadone to treat OUD.2 SAMSHA has strict requirements for methadone treatment clinics. Different types of clinics offer these services, such as:

  • Inpatient or hospitals
  • Residential rehab facilities
  • Intensive outpatient programs
  • Outpatient methadone clinics

Always speak with a qualified mental health professional or doctor to determine which treatment option is right for you. It is possible to recover from opioid misuse.

If you think you could benefit from methadone treatment, call 800-891-9360(Who Answers?) to speak with a treatment specialist about recovery options.

Resources

  1. Substance Abuse and Mental Health Services Administration. (2021). MAT Medications, Counseling, and Related Conditions.
  2. Substance Abuse and Mental Health Services Administration. (2021). Methadone.
  3. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
  4. The United States Department of Justice. (2022). Opioid Facts.
  5. National Library of Medicine. (2021). Opioid Misuse and Addiction.
  6. National Institute on Drug Abuse. (2021). Prescription Opioids DrugFacts.
  7. Dydyk, A., Jain, N., & Gupta, M. (2021). Opioid Use Disorder. Treasure Island, FL: StatPearls Publishing.
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  9. New York State. (2017). Opioids: Recognizing the Signs.

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