What Is Methadone Maintenance Treatment?

Methadone is a manufactured opioid prescribed for pain management and treating an opioid use disorder. It is long-lasting and can take up to 36 hours to leave the system. This characteristic makes it an excellent substitute for prescription and illicit opioids.¹

Methadone maintenance reduces cravings and withdrawal symptoms, offering you a chance to benefit from behavioral therapies that can help you maintain long-term recovery.

What Is a Methadone Maintenance Treatment Program?

The Center for Disease Control reports two million Americans with an opioid use disorder and have labeled it a public health epidemic.²

Methadone maintenance treatment is considered an effective treatment for opioid addiction. Unfortunately, there are only 1,500 federally-certified opioid treatment facilities offering methadone maintenance currently.¹

Methadone maintenance treatment (MMT) is a program with structure and medical supervision in a federally certified opioid treatment center. In recent years, Americans have filled over 2.2 million prescriptions of methadone annually.³

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Who Will I See for Methadone Maintenance?

A methadone maintenance treatment program has varying levels of staffing. A typical MMT program staff includes the following:⁴

Physician or psychiatrist, someone with a medical degree and specialty licenses in substance use disorders and methadone maintenance treatment. They are the only ones who can prescribe methadone.
Nurses who support the doctors in administering the average dose of methadone and monitoring the vital signs, and taking care of the health needs of program participants
Counselors provide therapeutic activities to enhance the recovery skills of MMT participants. Counselors may be psychologists, social workers, licensed professional counselors, or certified addiction specialists
Support staff will vary for each MMT

Does Methadone Maintenance Work?

Methadone maintenance treatment has existed the 1940s. When compared with placebos and other therapies, methadone maintenance was superior. Out of all the participants, more than 33% had fewer drug tests and were 4 times more likely to remain in treatment longer. Treatment completion is associated with positive recovery outcomes.⁵

Numerous studies show methadone maintenance helps reduce cravings for opioids. MMT programs also address other issues associated with opioid addiction, such as the risk of HIV transmission related to reuse of needles and use of nonsterile needles. People in an MMT program had over a 50% reduction in the rate of contracting HIV.⁶

What Are the Strengths of Methadone Maintenance?

When compared to other opioid use disorder treatment programs, the methadone maintenance treatment program has many advantages, including:¹

Treatment retention is longer
Risk of overdose is lower
Opioid misuse is lower
The risk of medical complications such as respiratory depression is lower
Withdrawal symptoms and cravings are minimized or eliminated
Clinical supervision occurs during dosing

Who Can Benefit from Methadone Maintenance?

Methadone maintenance treatment is for someone with an opioid use disorder or who struggles with opioid misuse. They are typically physiologically dependent on opioids, have built a tolerance for opioids, and experience withdrawal symptoms when they try to discontinue the misuse of the drug.¹

They meet the criteria for opioid use disorder as provided in the Diagnostic and Statistical Manual of Mental Disorder (DSM5). The DSM-5 defines OUD as when a person experiences clinical impairment and distress due to their pattern of opioid misuse.¹

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How Is Someone Admitted into a Methadone Maintenance Treatment Program?

There are many factors to consider before admission to a methadone maintenance treatment program can happen.⁷ For instance, how far away you live from the MMT facilities. If you do not live within a reasonable distance, you may not be able to attend the program daily to receive your average dose of methadone. Because you cannot take home methadone maintenance prescriptions until being stable for a specified period, you may need to seek alternative medication-assisted treatment.

A full assessment will address issues like this and more. Below are additional factors to consider.⁷

Severity of opioid addiction
Medical history of you and your family
Psychological history of you and your family
Opioid and other substance use history
Treatment history
Current physical health
Transportation to and from programs
Stage of withdrawal, if applicable
Current medications taken for other conditions
Co-occurring disorders and treatment needs

How Is Methadone Administered?

Methadone maintenance doses are given to program participants daily under the close clinical care of medical staff. Each day you are expected to arrive at the opioid treatment center and consume your dose on site. You cannot leave with a dose or a prescription.

An average dose of methadone comes in several forms, including:¹

Liquid
Powder
Wafer or diskette
Injection
Tablet
Film

Your doctor will work with you to determine the best form for your treatment. They will also determine the dose you should receive each day.

Protocols exist to give doctors a starting point when prescribing methadone. Most start with the lowest dose, observe the effects, then increase the average dose of methadone if needed. The goal is for the peak effects to occur four or more hours after your dose. Your ideal dose allows you to function cognitively and physically without withdrawal symptoms.

What Are the Side Effects of Methadone Maintenance?

As with any medication, especially synthetic, there is a potential for adverse effects. Methadone side effects may include:⁸

Flushing
Itching and scratching
Nausea and vomiting
Constipation
Lethargy and slowed responses
Respiratory suppression
Heart rate increase
Sweating
Hallucinations
Hives or rashes

Adverse interactions can happen when taking methadone with other medications that treat physical or psychological disorders. Some medications, such as anti-anxiety prescription medications, may suppress the central nervous system. Some drugs will increase the effects of methadone, increasing the possibility of an overdose. Medicines that increase the effects of methadone are benzodiazepines, fluoxetine, and ciprofloxacin.⁸

Some medicines decrease the effects of methadone, leading to a return of withdrawal symptoms. Medicines that decrease the effects of methadone are phenobarbital, carbamazepine, and phenytoin.⁹

Because methadone is a synthetic medicine, it too can affect other medicines you may be taking, especially in the way the medicine metabolizes.

If you take medications for other medical or psychological reasons, make sure your MMT doctor is aware, so they can ensure they will not interact.

Are There Special Risks to Consider in Methadone Maintenance?

While methadone is generally considered safe, including during pregnancy and breastfeeding, your doctor may monitor your reaction and dosage more closely if you are:¹⁰

Pregnant
Breastfeeding
Over 65
Under 21

Risks are not a guarantee that an adverse reaction will occur. You may participate in a methadone maintenance program for the rest of your life and never experience adverse outcomes. Or you may take methadone for a few weeks and undergo potentially serious side effects.

Risks may include:¹⁰

Addiction and misuse for those who gain approval to take home a prescription
Serotonin syndrome
Severe hypotension
Adrenal insufficiency
Seizures
QT prolongation, or changes in time from when the heart contracts and relaxes

How Does Counseling Improve Methadone Maintenance?

Admission to a methadone maintenance treatment program is often a starting point in recovery. However, therapies that teach replacement skills promote long-term abstinence. You can process the contributing factors of your addiction and learn new coping skills through the counseling programs offered at a methadone maintenance treatment program.

Studies reveal that combining counseling with MMT decreases the number of positive urine tests, criminalized activities associated with opioid addiction, money spent on illicit drugs, and illegal income associated with opioid addiction.⁵

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Contingency Management

Receiving a reward each time you reach a treatment goal motivates you to continue working hard in recovery. That’s the idea behind contingency management, a strategy often used in MMT. Incentive-based treatments may use voucher programs.

Each time your urine tests are negative for anything but methadone, you receive a voucher to substitute for money at places in the community. Prize incentives are also effective, allowing participants to enter their names in a drawing or raffle for prizes each time they reach a milestone.¹¹

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a form of talk therapy that focuses on changing thought patterns that lead to negative behaviors. CBT also teaches you essential skills that prevent relapse, regulate emotions, build relationships, and improve the overall quality of your life in recovery.¹¹

Family Therapy

Family and friends are affected by loved ones’ addictions. Some may even contribute to it. For these reasons, it is crucial everyone learn how to support recovery. If they have mental health or substance use disorders, they need to enter recovery.

Working with a therapist, family and friends can help learn how to set healthy boundaries, stop enabling behaviors, improve communication skills, and discover their roles within the family system.

12-Step Facilitation Groups

Twelve-step groups, Narcotics Anonymous, and other groups provide peer support that enhances recovery. Sometimes peers can offer feedback in a way a therapist, physician, or family member cannot. Working with peers lets you know you are not alone in overcoming an opioid use disorder.

Family members can also attend support groups, including Al-Anon, specifically for loved ones.

How Do I Find a Methadone Maintenance Program?

The most common ways to find methadone maintenance treatment are:

Referral from a doctor or addiction treatment provider
Referral from your insurance provider
Enrollment directly through intake at a local facility
Assistance from a third-party

Some programs take insurance claims, and others take cash or both. You likely have many questions regarding scheduling, transportation, and the program’s benefits.

We can help you reach a methadone maintenance provider. Call 800-678-5931(Paid Advertiser) and we will connect you directly to the program that can offer you methadone maintenance.

Resources

Center for Substance Abuse Treatment. (2021). Medications for Opioid Use Disorder. Treatment Improvement Protocol (TIP) Series 63 Publication No. PEP21-02-01-002. Rockville, MD. Substance Abuse and Mental Health Services Administration.
Center for Disease Control and Prevention. (2020). Opioid Overdose Prevention Saves Lives.
Drug Enforcement Administration. (2019). Methadone.
US Bureau of Labor Statistics. (2021). Occupational Outlook Handbook: Substance Abuse, Behavioral Disorder, and Mental Health Counselors.
National Institute on Drug Abuse. (2021). How Effective Are Medications to Treat Opioid Use Disorder?
Fullerton, C.A., MD, M.P.H., Kim, M. M.A., Thomas, C.P. Ph.D., Lyman, R. Ph.D., Montejano, L.B., MA, CCRP, Dougherty, R.H. Ph.D., Daniels, A.S. Ed.D., Ghose, S.S. Ph.D., and Delphin-Rittmon, M.E. Ph.D. (2014). Medication-Assisted Treatment With Methadone: Assessing the Evidence. Psychiatric Services, 65: 146-157.
Center for Disease Control and Prevention. (2016). Module 5: Assessing and Addressing Opioid Use Disorder.
Substance Abuse and Mental Health Services Administration. (2022). Methadone.
Durrani M, Bansal K. (2022). Methadone. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
West-Ward Pharmaceutical Corporation. (2018). Dolophine.
National Institute on Drug Abuse. (2020). Behavioral Therapies.