Methadone
Medication names: Methadose, Diskets, Dolophine
Administration: Oral liquid, tablet, tablet for suspension
How it works: Methadone fully activates opioid receptors in the brain.
What it does: Patients taking methadone have less craving and they use less heroin or prescription opioids, stay in treatment longer, and have fewer medical complications, lower risk of death, and improved social and work functioning.
Where to get it: Only available in licensed opioid treatment programs (OTPs). Methadone is a controlled substance (schedule II). It can only be used legally by a person enrolled in an OTP. Methadone tablets available by prescription from the pharmacy cannot be used for the treatment of opioid withdrawal and OUD maintenance.
Detoxification: Detoxification is not required before starting methadone. Methadone acts as an opioid and patients treated with it will remain physically dependent. If taken daily, methadone prevents withdrawal, but if abruptly stopped, opioid withdrawal will begin within 36–48 hours.
Wait time: No wait time or withdrawal symptoms required before first dose is given, but the patient cannot be intoxicated or sedated.
Dosing: Lower doses (20–40 mg/day) are sufficient to eliminate physical withdrawal; 50–60 mg doses eliminate subjective withdrawal and craving; higher doses (60–120 mg) are needed to block the effects of heroin and decrease the risk of opioid use.
Lag time to full effect: Methadone has to be started with a low dose and increased slowly; it may take 2 or more weeks before a fully therapeutic dose is reached.
Possible side effects: Sedation during treatment initiation, dizziness, constipation, nausea/vomiting, excessive sweating, low blood pressure
Serious adverse effects: Heart arrhythmia or deep somnolence with slowing of breathing, both of which may result in death
Contraindications: Acute asthma, severe breathing problems, obstruction of bowels
Blockade: High doses of methadone (above 100 mg) are more effective in blocking illicit opioids but may not be sufficient to block very high doses of heroin or fentanyl.
Overdose risk: If the daily dose is increased too fast at the beginning of treatment; if a high dose of methadone is taken in combination with high doses of other sedatives such as benzodiazepines, sleep medicines (especially if injected), or alcohol; after methadone is abruptly stopped and heroin use is resumed, especially after several days of no opioids.
Potential for abuse: Methadone can be abused if taken in higher doses, in combination with sedatives, or injected.
Limitations: Only available at specialty clinics with restrictive regulations; medications must be taken daily at the clinic during early stages of treatment.