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Methadone Maintenance Treatment: What to Expect

Since the 1950s, methadone maintenance treatment (MMT) has been a helpful medical treatment for opioid use disorders.1 Methadone is a long-acting opioid taken daily in a pill or in liquid form. It is used to reduce opioid cravings and withdrawal symptoms, and prevent relapse.

In this article:

Who Needs Methadone Maintenance Treatment?

Methadone maintenance treatment is an appropriate form of treatment for persons who are physically or psychologically dependent on opioids.1

Several types of individuals should begin MMT without delay. Such persons include those who have an opioid use disorder and:1

  • Are HIV positive
  • Receive treatment for HIV or hepatitis C
  • Have been on MMT in a community program or risk interrupted treatment episodes
  • Historically have overdosed on drugs
  • Have a history of self-harming behaviors while dependent on opioids
  • Are pregnant

Pregnancy and MMT

There exist no FDA-approved medications to treat opioid dependence in pregnant persons. However, methadone maintenance with prenatal care can improve outcomes associated with untreated opioid use disorders.2

Pregnant and nonpregnant persons alike, if dependent on opioids, should be assessed and placed on methadone. Notably, the dose of methadone should be adjusted to control cravings and withdrawal symptoms adequately. This is done to protect the growing fetus.

Newborn babies exposed to methadone in utero may experience withdrawal symptoms. This is called neonatal abstinence syndrome (NAS) and can cause complications for the child. A postnatal care specialist should manage their care.1, 2

Special Considerations

Methadone should not be used to treat anyone who has severe liver disease or those who are allergic to or intolerant of methadone. Additionally, methadone should be prescribed with caution in those individuals with:1

  • Adrenocortical insufficiency (impaired adrenal glands)
  • Asthma or other respiratory conditions
  • Diabetes mellitus
  • Hypopituitarism (insufficient hormone production)
  • Hypothyroidism (insufficient hormone production)
  • Prostatic hypertrophy (prostate enlargement)
  • Urethral stricture (narrow urethra)

An Overview of Methadone Maintenance

Methadone maintenance treatment can be a key factor in your recovery from opioid use disorder. Research has shown that treatment with methadone may increase participation in therapy and may help decrease drug use, criminal behavior, and chances of engaging in high-risk behaviors.2

Your methadone maintenance also includes efforts to ensure you take your medication as prescribed and do not use additional substances. Medical staff will supervise your methadone use to confirm you take the correct amount. The program may employ random urine drug tests as well.

Methadone should be taken at the same time every day. Many state governments outline specific guidelines for facilities to follow while providing this form of treatment. Your state may require you to attend the facility daily to pick up and take your methadone dose.

As you progress in treatment (i.e., length of time in treatment, negative urine drug screens, engagement in other services), you may be awarded take-home doses. While you still have to attend your facility regularly, take-home doses can allow you to attend less often (e.g., every other day or once a week).

Risks

Methadone maintenance treatment is not without its risks. As an example, one common risk is dangerous interactions between methadone and other medications. Taking methadone with other opioids, alcohol, or benzodiazepines can be life-threatening. Opioids, alcohol, and benzodiazepines are all considered central nervous system depressants and can slow your respiratory system and increase the depressant effects of methadone.

Several medications can decrease the effects of methadone and potentially put your body into a state of withdrawal.

Unfortunately, even methadone can be misused, placing you at an increased risk for overdose.3

Overdose

There are specific signs and symptoms of an overdose on methadone. If you suspect you are in the process of an overdose, notify your provider immediately. If you have already left the facility, contact 911 immediately. Signs and symptoms of an overdose include:3, 4

  • Face appearing paler than normal
  • Clammy skin or face
  • Your body goes limp
  • Fingernails or lips turn a purple or bluish color
  • Vomiting or making gurgling sounds
  • Inability to speak
  • You are difficult to wake up
  • Your breathing or heart rate slows

You may experience several side effects, especially during the induction phase. These include:1, 5

  • Constipation
  • Disturbed sleep
  • Dry mouth
  • Hives or rash
  • Lightheadedness
  • Increased sweating
  • Itchy skin
  • Menstrual irregularities in women
  • Nausea and vomiting
  • Restlessness
  • Sexual dysfunction
  • Swelling of the face, lips, tongue, or throat
  • Weight gain

Clinical Settings for Methadone Maintenance Treatment

Methadone maintenance usually is provided at a medical clinic.1 These facilities are equipped specifically to provide methadone. At present, only three states do not offer methadone maintenance treatment.2

In states that offer treatment, methadone treatment is provided by specially licensed facilities. Many of these facilities include individual and group counseling. When combined, medication-assisted treatment (MAT) and therapeutic behavioral services improve your outcomes.2

Facilities that offer methadone maintenance will likely include a wide variety of specialists, which can include:

  • Physicians
  • Nurses
  • Medical assistants
  • Psychologists
  • Social workers
  • Case managers
  • Recovery coaches
  • Other support staff

These individuals will work closely as a team to ensure you receive the best and most effective treatment available. The medical team continually monitors you for any signs of withdrawal, whereas psychologists and social workers address your psychological health. Finally, case managers and recovery coaches will assist you with the day-to-day activities of treatment, as well as specific needs such as housing or employment.

Beginning Methadone Maintenance

Before starting methadone maintenance treatment, your provider will conduct a biopsychosocial assessment. This assessment will examine your health history, psychological history, and social history.

This assessment gives providers a complete view of your life, struggles, and goals for treatment. It can include your:

  • Education history
  • Employment history
  • Legal history
  • History of relationships
  • Medical history
  • Psychiatric history
  • Religious or cultural background

Additionally, your provider will collect an in-depth history of your opioid use, including:

  • How long you have used
  • The amount you use
  • The frequency in which you use
  • Additional substances you use

Gathering this information will help your provider cater recommendations and treatment to your specific needs. It will also allow the provider to determine an appropriate methadone dose to begin your treatment.

The First Dose and Induction Period

As you begin treatment, your provider will discuss informed consent. This means your provider will outline the treatment plan with you and discuss:1

  • The rationale for treatment
  • The reason why this form of treatment is recommended for you
  • Side effects that can occur due to this treatment
  • Risks of this form of treatment
  • The expected length of time in treatment
  • Any other forms of treatment available

Given that methadone maintenance treatment is a specialized form of treatment and includes a prescribed narcotic, your provider will review policies and procedures. These policies can include the following:1

  • Taking the prescribed methadone in front of staff
  • Not buying or selling any part of your dose
  • Not engaging in violence or threats toward staff or other patients
  • Attending appointments with your physician and counselors
  • Informing you of the consequences should any of these policies be broken

Your provider will start at a low dose and raise your dose over the next few weeks. This increase typically occurs every three days, as it allows you to be monitored for signs and symptoms of withdrawal or intoxication.1

Your provider will observe you for approximately 3 to 4 hours after your first dose. This will help prevent an overdose and prevent serious complications should you begin to show signs of an overdose.1

Dose Management for Methadone Maintenance

After the induction phase, your provider will continually monitor you for signs and symptoms of withdrawal. The maintenance dose for methadone is typically between 60 mg and 120 mg, but your dose may be higher or lower given your history of use.1

While maintaining your methadone dose, you should:1

  • Take your prescribed methadone every day
  • Participate in treatment review sessions
  • Not sell or give your methadone dose to anyone
  • Follow guidelines, policies, and procedures of your treatment facility

Concluding MMT and Maintaining Your Continuum of Care

There is no set length of time for methadone maintenance treatment. Nonetheless, it is widely accepted that the longer the treatment, the better the outcome. On the other hand, some facilities will encourage individuals to stop methadone maintenance treatment after approximately 2 years. Many facilities indicate that 12 months is the minimum time to be in methadone maintenance treatment.2

During your treatment, you should engage in other forms of treatment, such as individual and group therapy. Depending on your facility, this may be required to continue receiving methadone.

You may want to stop your methadone maintenance treatment if:1

  • You or your treatment team believe methadone is no longer appropriate
  • Your treatment team or you believe you no longer need treatment
  • You experience problems associated with this form of treatment
  • You desire to live a drug-free lifestyle

When you decide to taper off of methadone and conclude your treatment, your provider will review their recommendations and treatment plan with you. This likely will include a relapse prevention plan.

An example of a recommended reduction is as follows:1

  • Reduce the dose by 10 mg per week until you reach 40 mg
  • Once at 40 mg, reduce by 5 mg per week until 0 mg is reached
  • Make no more than one reduction per week

Continuing Your Recovery from Opioid Misuse

Methadone maintenance treatment is just one of many forms of treatment for opioid use disorders. You may consider engaging in individual therapy or group therapy. You also might consider attending social support groups, such as Narcotics Anonymous or SMART Recovery.

If you are interested in hearing more about treatment options, call 800-891-9360(Who Answers?) to speak with a treatment specialist. They can direct you to the appropriate treatment program.

Resources

  1. World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings.
  2. National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition).
  3. Substance Abuse and Mental Health Services Administration. (2020). Opioid overdose.
  4. Substance Abuse and Mental Health Services Administration. (2018). Opioid overdose prevention toolkit: Opioid use disorder facts.
  5. Substance Abuse and Mental Health Services Administration. (2022). Methadone.

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