During World War II, methadone was developed and prescribed for soldiers in extreme pain when morphine was scarce. This long-acting opioid was helpful in relieving pain during transport from the battlefield and after surgeries. It was used for pain relief in the U.S. in the 1940s, but it wasn’t until the 1970s that doctors recognized its potential for treating opioid use disorder as well. But how does methadone work for pain and addiction? Here are some common questions people have about methadone treatment. If you suffer from chronic pain and substance use disorder, these answers can help you decide if this might be a good option to explore with your doctor.
What Is Methadone Treatment?
Methadone was introduced as a slow-onset, long-acting medication for pain but has been increasingly utilized as part of medication-assisted treatment (MAT) for substance use disorder. It can be especially helpful for people suffering from severe withdrawal symptoms. When combined with therapy and other types of treatment (e.g., community support and job assistance), methadone treatment can be a positive step on the winding path to recovery.
For people struggling with the dual issue of chronic pain and opioid use disorder, methadone offers a way through for both conditions. As a synthetic opioid agonist, methadone blocks pain receptors in the brain while reducing withdrawal symptoms and cravings. In addition, methadone blocks the euphoric feeling produced by other opioids like heroin, oxycodone, and codeine. These effects last up to 56 hours and can provide relief from both pain and the symptoms of dependence.
Methadone itself does not produce the euphoric feeling of other short-acting opioids. For those who have developed an opioid use disorder, the combination of long-lasting pain relief and the lack of a euphoric “high” (and no subsequent “low”) can help them gradually reduce or eliminate their dependence.
So, why would a person be prescribed methadone for pain, addiction, or a dual-diagnosis of both?
- For the slow onset and long duration: It provides relief from pain and cravings gradually and lasts for a long time.
- When opioids for chronic pain don’t work: This can be a safer long-term pain therapy.
- When flexible dosing is important: Methadone can be taken at home or in a clinical setting.
- If Suboxone is not appropriate or doesn’t work for the patient: Certain health conditions are contraindicated for Suboxone, making methadone a better choice.
How Does Methadone Work? Dosage Information
As with all medications, your doctor will determine which methadone dosage is safest and most effective for you. Your dose may also change as you move through a medication-assisted treatment program.
Methadone is available as a pill, liquid, or powder. Tablets may be taken as a pill, or they might be dispersible — you’ll have to dissolve them completely in water or juice and drink all of the liquid for the full dose.
The actual methadone dosage varies, but it’s generally not suggested to take more than 40 milligrams in 24 hours. Most patients will typically start at 20 milligrams or lower. Methadone maintenance doses can be higher, but it’s best to start at the lowest dose that provides relief.
The effects of methadone are gradual. Most people feel the effects of their dose 30 to 45 minutes after they take it. The peak effect occurs two to four hours after dosing. After a week, methadone deposited in the body’s tissues maintains a steadier level in the body.
A prescription is required for methadone, and the form and dose may change as your therapy progresses. It is important to follow the dosage instructions exactly. Overuse can lead to dependence, but underuse can lead to relapse and may not provide pain relief.
It is also critical that you do not stop taking methadone without talking to your doctor. It is possible to have withdrawal symptoms if you are not being properly supervised, and this can lead to relapse in addiction. When your pain and opioid use disorder are well-managed, your doctor will develop a plan to slowly wean you or to move to a maintenance dose if that is best for you.
Are There Any Methadone Side Effects?
As with any type of medication, it is important to be aware of potential methadone side effects. Even if the treatment duration is relatively short, patients may experience:
- Dry mouth
- Sexual impotence or lack of interest
- Gastrointestinal effects (e.g., constipation)
- Weight gain
- Difficulty urinating
- Swelling in the extremities
- Changes to mood, including depression
- Dental issues
For some, these side effects are mild and transitory, but for others they can be debilitating as a person adjusts to the medication.
Any of the following side effects are serious. If you experience them, seek immediate medical attention.
- Difficulty breathing
- Shallow breathing
- Drop in blood pressure that causes lightheadedness or fainting
- Hives or a rash
- Swelling in the face, lips, tongue, or throat
- Chest pain
- Accelerated heart rate
- Changes to your menstrual cycle
Although methadone does have negative side effects, it is critical to understand that the benefits of methadone typically far outweigh the potential for side effects. Addiction to opioids and living in chronic pain that is unrelieved by other treatments leads to a greater incidence of mood disorders, early morbidity, and suicide.
Long-term effects of methadone
While the benefits outweigh the risks in general, it is important to understand the long-term effects of methadone. These may influence how long you can take methadone.
- Addiction: This risk is highest when methadone is taken improperly or without a prescription. This includes snorting or injecting the powdered form.
- Sleep disorders: This includes not getting enough sleep or not getting restful sleep.
- Hallucinations: Hallucinations are rare but can occur with long-term methadone use.
- Liver damage: This is more common in patients with pre-existing liver damage due to hepatitis C or HIV infection.
- Brain damage: Brain function may be changed or impaired with long-term use.
Many of these can be avoided by remaining under a physician’s care and taking the medication only as prescribed.
How Is Methadone Different From Other Opioids?
The biggest and arguably most important difference is the time frame of methadone versus other opioids. Methadone’s effects come on gradually and last for a long time. This contrasts with opioids such as oxycodone, fentanyl, and heroin with their lightning-fast but short-lived high that results in a crash and the sudden onset of cravings and other withdrawal symptoms.
Although there is a chance of misuse, methadone treatment for addiction under a doctor’s supervision is correlated with fewer relapses and a greater chance of recovery. Methadone also provides pain relief that is superior to morphine and can work better long-term for cancer pain.
Another commonly used medication for substance use disorder is Suboxone, a combination of buprenorphine and naloxone. The first reduces cravings for other opioids, and the second one blocks the high of opioids. These are not opioids, but work on the same opioid receptors in the body. This medication is virtually impossible to abuse or overuse, as there is a plateau at which the person taking it will not feel any effect at all.
But unlike methadone, Suboxone is not FDA-approved to treat both substance use disorder and chronic pain. Buprenorphine on its own can be prescribed for chronic pain, but Suboxone for pain is considered an off-label use. Suboxone can only be administered by a physician who is specially licensed for treating substance use disorders, but methadone can generally be prescribed by any licensed doctor.
Will Methadone Treatment Work For Me?
When it comes to methadone treatment, only you and your doctor can decide if it’s the best option for your chronic pain or substance use disorder.
Good candidates for methadone treatment include:
- People 18 years or older who are addicted to opioids
- Those undergoing surgery who are at risk for opioid dependence
- Chronic cancer pain patients
- Chronic pain patients with pain unrelieved by other medications
- People with chronic pain and substance use disorders
- People with high dependence on opioids who require long-term medication-assisted maintenance
Methadone is a safe treatment for people who are pregnant or breastfeeding, but consistent pre- and post-natal care is critical. Some babies experience withdrawal symptoms after they are born, but others have no evidence of effects from methadone.
There are some people who should not take methadone. These may include people who have:
- Heart disease or a heart rhythm disorder (e.g., arrhythmia)
- Electrolyte imbalance
- Respiratory disease or breathing problems
- Previous head injury, brains tumors, or seizures
- Liver of kidney disease
- Difficulty urinating
- Issues with the gallbladder, pancreas, or thyroid
- Gastrointestinal obstruction
Additionally, methadone should not be taken if you are also taking:
- Sedatives (especially benzodiazepines)
- Certain antibiotics
- Antifungal drugs
- HIV drugs
- Certain allergy drugs
- Urinary incontinence drugs
- Heart rhythm drugs
- Benztropine and amitriptyline
In some cases, these medications amplify the effects of the methadone. In others, the interaction between methadone and the other medication increases the risk of side effects for both.
This list of medications to avoid is not exhaustive. Talk to your doctor about any medication you are taking, including over-the-counter drugs and herbal or natural remedies. They can help assess the potential risk of interactions.
Your Journey Towards Recovery
As part of a wraparound medication-assisted treatment program, methadone is associated with positive outcomes, lower relapse rates, and decreased rates of criminality and mortality. But the journey towards recovery takes time and is challenging. Long-term support is critical.
If you are struggling with substance use disorder and chronic pain in the Phoenix area, we can help. Our Arizona Pain’s Mercy Care Center of Excellence outpatient program utilizes a variety of medications and concurrent therapies to help you get your life back and your pain under control. We are with you every step of the way.
When you’re ready to learn more about methadone treatment for pain and addiction, get in touch.