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All About Methadone: Uses, Side effects, Work


Methadone first saw widespread use as a painkiller during World War II when morphine supplies ran low. Methadone could replace medical morphine at a much lower cost, and eventually, the Food and Drug Administration (FDA) recognized its value not only as a pain reliever but as a treatment for opioid addiction. Methadone is a common treatment measure for patients struggling with certain types of chronic pain or undergoing surgery.

Deaths have occurred with methadone use and physicians are cautioned about the possibility of overdose leading to respiratory failure and other consequences. The drug is long-acting, which presents the risk of building up (re-dosing) too quickly, to toxic levels.

The most common use of methadone is as an opioid replacement. An individual addicted to heroin or prescription opioid painkillers is at risk of a wide range of unpleasant and even dangerous side effects. Methadone offers an easier transition away from more harmful opioids; however, it does carry a risk of abuse and addiction. There are alternative approaches to using medication to treat addiction to opiates.

What Is Methadone?

Methadone is a synthetic opioid that acts as an agonist. An opioid agonist essentially blocks the opioid receptors in the brain without causing the typical euphoria and psychoactive effects as does heroin or other opioids. It is a long-acting drug that functions as an opioid replacement without significant intoxicating effects. It comes in a drinkable liquid form, dissolvable tablet form, (Diskettes), and an injectable form.

Methadone in Addiction Treatment and Medicine

When an individual with an opioid addiction stops taking opioids like heroin or fentanyl, the withdrawal symptoms can be unbearable or even life-threatening. Methadone helps these individuals more easily manage their withdrawal symptoms and maintain sobriety more easily. It also functions as a treatment for some types of chronic pain but does not carry the same risk of addiction as other opioids.

Use in Tapering Opiates

When a doctor recognizes that a patient needs opioid replacement therapy, he or she may prescribe methadone as a form of maintenance therapy until the patient is ready for a full detox. Methadone generally exists in liquid, pill, or dissolvable tablet forms. A patient follows a methadone prescription’s instructions in an effort to gradually wean off the drug. Many community assistance programs and substance abuse clinics offer methadone free of charge as a harm reduction measure. These programs also aim to reduce crime related to procuring drugs. Unfortunately, many people will simply take the free methadone and sell it on the street to procure their preferred drugs.

Opioid Withdrawal Symptoms

Opioid addiction escalates very rapidly because the drug causes a user to develop a tolerance in a short amount of time. After abusing opioids for a while, the user will eventually need larger and larger doses to achieve the desired effects. This inevitably increases the risk of an overdose, as an individual in need of a stronger dose of opioids may use more than usual, and there is no way to tell the strength of opioids purchased on the street or identify what other substances a dealer may have added to them. Once tolerance develops, the individual will feel withdrawal symptoms more acutely.

Symptoms of Opiate Withdrawals:

  • Intense cravings for more opioids
  • Irregular heart rate
  • Fever and sweating
  • Nausea, vomiting, and stomach cramps
  • Irritability, confusion, and unpredictable mood swings
  • Symptoms of depression and anxiety
  • Seizures

Without immediate treatment, opioid withdrawal can sometimes turn fatal. Methadone functions as a maintenance treatment that prevents the onset of withdrawal symptoms without causing the euphoric effects that amplify addiction. Methadone is used to stop the harsh reactions of stopping opiates, which helps overcome the compulsion to continue addictive behaviors.

How Does Opiate Replacement Therapy Work?

Methadone effectively alters the way the brain responds to pain. It blocks opioid receptors in the brain, preventing the individual from feeling the euphoric effects of other opioids like heroin while offering relief from opioid withdrawal symptoms. It is important to note that methadone is not a self-contained opioid addiction treatment; it should be part of a comprehensive system of treatment that addresses an individual’s unique needs. Methadone can reduce the physical drive of opiate addiction, especially at the beginning of addiction treatment where the cravings can be hard to overcome.

Since methadone carries the potential for abuse, patients may only receive a prescription for methadone maintenance therapy from a prescribing doctor and generally receive their doses under supervision. Once a patient has proven consistently responsible use of the drug, the prescribing doctor may allow the patient to take the medication at home between office visits. In the U.S., the law requires any methadone prescription to come through an officially recognized opioid treatment program certified by the Substance Abuse and Mental Health Services Administration.

Methadone Withdrawal Symptoms and Side Effects

While methadone can be an effective initial treatment for opioid addiction, it does carry its own risk of addiction dependence as it is also an opioid. Methadone generally does not cause extreme levels of euphoria as do other opioids. But individuals who abuse methadone by snorting crushed pills or melting and injecting it directly, are doing so to experience more intense effects. Methadone is a generally reliable form of opioid replacement therapy, but it demands responsible use.

Methadone maintenance therapy is not without side effects, either. In addition to a risk of addiction or replacing one addiction with another, those who take methadone also commonly report several side effects.

Common Side Effects of Methadone:

  • Changes in appetite, cravings for sweets
  • Sexual dysfunction
  • Constipation
  • Nausea, vomiting
  • Abdominal pains
  • Sleepiness
  • Edema in various parts of the body, swelling, gastric issues
  • Urinary retention, dark urine
  • Potential impairment of memory, learning capacity.

Participants in an addiction treatment study reported over half of the male clients experienced moderate to severe erectile dysfunction.1

A Norwegian study done on rats found a 70% decrease in brain function after being given daily Methadone for 3 weeks.

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