What Is Methadone? | What Does Methadone Do?

Methadone serves two distinct purposes in medicine, treating severe chronic pain and, more commonly, supporting recovery from opioid use disorder. Unlike opioids people misuse to get high, methadone is designed to reduce cravings and prevent withdrawal without producing the intense euphoria associated with drugs like heroin or fentanyl.

Despite decades of use in medication-assisted treatment and a strong evidence base, methadone remains widely misunderstood. Many people wonder whether it’s truly safe, how it differs from the addiction it treats, and whether relying on it simply substitutes one dependency for another. This guide covers how methadone works, what to expect from treatment, and potential risks.

How Methadone Works

Methadone is a long-acting, full opioid agonist that binds to opioid receptors in the brain. Taken daily, it can effectively treat opioid withdrawal symptoms and reduce cravings for other opioid drugs, such as heroin and oxycodone (OxyContin). When taken as directed, it can be safe and effective for short-term or long-term use as part of a comprehensive treatment plan for opioid use disorder.

When Should You Start Taking Methadone?

The decision to start methadone treatment is an important one that should be made with guidance from addiction specialists and medical professionals. Most people begin methadone when they’ve tried to quit opioids on their own and failed, or when their opioid use has become so severe that it’s destroying their health, relationships, and daily life. Methadone is specifically designed for people who have developed physical dependence on opioids like heroin, fentanyl, oxycodone, or other prescription painkillers.

One of the benefits of methadone maintenance therapy (MMT) is that you don’t have to go through the painful process of withdrawal before starting treatment. Unlike some other addiction medications that require you to be in withdrawal before taking your first dose, methadone can be started while you still have opioids in your system.

Doctors will carefully assess your current opioid use and start you on an appropriate dose that prevents withdrawal symptoms while reducing cravings. The dose is then gradually adjusted over time until you reach a stable level that keeps you comfortable without getting you high. This approach, called methadone maintenance therapy, allows people to continue going to work, caring for their families, and focusing on recovery without constant cravings and withdrawal symptoms.

Methadone Dosing

The prescribed dose of methadone for any given person will depend on personal needs and attributes, including opioid dependence severity and other health-related factors. Clinical guidelines for methadone maintenance programs suggest that methadone doses of 60 mg or greater are most effective for treating opiate addiction. However, clinical guidelines also advise that doctors first begin patients on a lower, initial dose of 20 to 30 mg, and adjust this dosage as needed over time.

Average Dose Of Methadone

The average effective dose of methadone for opioid use disorder is between 60 to 120 mg per day. Dosing may be different for people who are prescribed methadone for pain relief.

Read more about the average dose of methadone

How Often Methadone Is Taken

Methadone is taken for opioid dependence once a day. Generally, it is administered in a closed setting—an inpatient treatment facility or methadone clinic — for close medical supervision.

Types Of Methadone

Methadone comes in tablets, liquid solutions, and dispersible diskettes, all containing the same active ingredient. Liquid methadone is typically used in addiction treatment clinics since it’s easier to measure precisely and harder to divert, while tablets are more commonly prescribed for pain management.

Methadone is sold under both generic and brand names, with some brands marketed specifically for addiction treatment and others reserved for pain management.

Common brand name methadone products include:

• Methadose: Available as liquid concentrate or dispersible tablets, this brand is specifically designed for opioid addiction treatment programs. The liquid form is cherry-flavored and comes in carefully measured doses that patients take at treatment clinics under supervision.
• Dolophine: Primarily used for pain management, Dolophine comes in tablet form. While it’s the same medication as methadone used for addiction treatment, Dolophine is typically prescribed by pain specialists rather than addiction treatment providers.

Regardless of the form or brand name, all methadone products work the same way in the body. The choice of which type to use depends on whether the medication is being prescribed for pain management or addiction treatment, the treatment setting, and what the prescribing doctor determines is safest and most appropriate for each individual.

Side Effects Of Methadone

Methadone is a powerful opioid agonist and central nervous system depressant. When taken, methadone may cause acute side effects such as drowsiness, dry mouth, nausea, and euphoria.

Read more about the side effects of methadone

Methadone And Itching

Severe itching after methadone can occur, but this is generally considered a serious side effect or adverse drug reaction.

Read more about methadone and itching

Methadone And Depression

Major depression and other mental health disorders are common among people who seek drug addiction treatment, including those who take medications like methadone for addiction. Depression is not a common side effect of methadone. People who take methadone may feel depressed as a result of co-occurring mental illness, environmental factors, or other personal factors.

Read more about how methadone effects depression

Methadone And Effects On Blood Pressure

Methadone is a depressant that can lead to hypotension (low blood pressure) in some people. Increased blood pressure, or hypertension, is a sign of opioid withdrawal and may develop if someone tries to stop taking methadone too quickly or all at once.

Read more about the effects of methadone on blood pressure

Cardiac Effects From Methadone

Abnormal heart rhythm and other cardiac effects of methadone are uncommon. This can occur as a result of a drug interaction, opioid withdrawal, overdose, or an underlying cardiac condition.

Read more about how methadone affects the heart

Methadone And Effects On Weight

Changes in weight can occur while taking methadone. Methadone may cause bloating, swelling, and constipation, all of which can lead to minor weight gain.

Read more about how methadone affects weight

Other Effects Of Methadone On The Body

Methadone can cause a range of physical effects. The use of methadone may cause fatigue, leg swelling, skin problems, and hypotension, in addition to other effects on the body.

Methadone Treatment Duration

Methadone is a strong pain reliever and addiction treatment that can be taken for as long as a doctor sees therapeutic benefit in its use. People with opioid dependence or opioid use disorder may safely take methadone for weeks, months, or years as an ongoing treatment.

Read more about how long you can take methadone

Does Methadone Cause Withdrawal?

Methadone can result in withdrawal syndrome if it is stopped too abruptly. It is habit-forming and can lead to physical dependence with chronic use, like many prescription medications.

Read more about withdrawal from methadone

Methadone Detox

Beginning a detoxification program for methadone is highly recommended for those who wish to stop taking methadone. Methadone detoxification (detox) programs can offer treatment for withdrawal and help prevent potentially serious consequences such as dehydration, opioid cravings, and relapse.

Read more about how to safely detox from methadone

Can Methadone Lead To Addiction?

Yes, methadone can be addictive if it’s misused or taken in ways other than prescribed. Like all opioids, methadone has the potential for abuse, especially when people take higher doses than recommended, combine it with other substances, or use it without medical supervision. When methadone is obtained illegally or diverted from treatment programs, the risk of addiction and overdose increases.

People who misuse methadone by taking extra doses to chase a high or mixing it with alcohol or benzodiazepines put themselves in serious danger. This type of misuse can lead to respiratory depression, overdose, and death.

However, when methadone is used exactly as prescribed within a supervised treatment program, it’s not considered addiction, it’s medical treatment for opioid dependence. There’s an important distinction between physical dependence and addiction. Physical dependence means your body needs the medication to function normally and you’ll experience withdrawal if you stop suddenly. Addiction means compulsively seeking and using drugs despite harmful consequences.

Risks Of Using Methadone To Treat Opioid Use Disorder

Methadone is not a risk-free medication. Like any medication, there are risks to methadone drug use. Potential health risks of methadone may be communicated to patients prior to beginning methadone treatment for opioid use disorder.

Methadone Overdose

Taking a very high dose of methadone, or mixing it with other depressants (including alcohol), can lead to methadone overdose, which may cause serious breathing issues. Without treatment, severe overdose can be life-threatening. Overdose can be treated with the opioid overdose-reversal drug, naloxone, also known as Narcan.

Read more about a methadone overdose

Long-Term Risks Of Methadone

Taken chronically, methadone can have effects on sleep, sexual function, mood, cognition, and cause physical dependence.

Read more about the long-term effects of methadone

Drug Interactions With Methadone

Methadone can interact with certain prescription and illicit drugs. Before taking methadone, tell your doctor about any other substances you’re taking to discuss potential interactions.

Read more about drugs that interact with methadone

Methadone Interactions With Other Substances

Some non-pharmaceutical substances like grapefruit juice can interact with methadone. To prevent adverse effects, talk to your doctor about substances you should avoid while taking methadone.

Read more about how grapefruit juice can interact with methadone

Methadone And Pregnancy

Methadone maintenance treatment is often considered the standard of care for pregnant women with opioid use disorder, since untreated opioid dependence during pregnancy carries serious risks for both mother and baby. Staying on a stable, medically supervised dose of methadone throughout pregnancy is generally considered safer than either continuing illicit opioid use or attempting to quit abruptly, which can trigger withdrawal dangerous to the pregnancy.

Babies born to mothers on methadone may experience neonatal opioid withdrawal syndrome (NOWS), a treatable condition managed by medical staff after birth. Pregnant women considering or currently on methadone treatment should work closely with both an obstetric provider and an addiction specialist.