Last Updated: January 17, 2023

As the opioid epidemic makes headlines across the country, many people may think of methadone as a tool to help solve this problem. This is especially true in Ohio, which had the second-highest rate of opioid-related deaths in 2017.

Famous for being an opioid replacement drug, methadone has been used for years in people struggling with narcotic use. However, methadone itself can be abused. Further, as a potent, long-acting opioid, methadone poses risks of its own when misused, sometimes with deadly results. In 2017, 98 Ohioans died of a drug overdose linked to methadone. Therefore, it is important to understand how methadone works and why overdose is dangerous.

What Is Methadone?

Methadone is an opioid that was invented during World War II due to a morphine shortage. At first, it was only intended for pain relief. However, doctors soon noticed that it seemed to help people stop using heroin. Methadone was approved as an opioid replacement therapy in the 1970s. The drug has remained one of the main treatments for people trying to get or stay sober from opioid use.

Classification

Legally, methadone is classified as a Schedule II controlled substance. This means that it has both medical uses and a high potential for abuse and dependence. It is illegal to use methadone for non-medical uses.

Chemically, methadone is a synthetic opioid. This means that it is created in a lab.

What Is Methadone Used For?

Methadone can be used for many different medical reasons. Although the drug is most often linked to opioid replacement therapy, it can be used for pain as well. The drug is prescribed for reasons including:

• Opioid detox,
• Opioid replacement therapy (even while pregnant or breastfeeding),
• Neonatal abstinence syndrome, and
• Moderate to severe pain management.

Methadone Maintenance Treatment

Methadone has been a staple drug for opioid replacement therapy for decades. The drug was first approved for this use in 1972 and is still a cornerstone treatment to this day. Methadone is considered an optimal agent to help people recover from opioid use because it:

• Can stop opioid cravings and, therefore, reduce the risk of relapse;
• Stops opioid withdrawal symptoms for up to 36 hours;
• Blocks the high from heroin;
• Does not cause a high or sedation.

Dosage and Administration

The starting dosage of methadone depends on why you are taking it:

• If you are taking methadone for opioid replacement therapy, you will often start with a dose of 20 to 40mg once daily.
• However, if you are taking methadone for pain, you will start at much lower doses, often 2.5mg twice daily, as pain relief lasts for about 8 hours.
• Further, for pregnant patients, methadone may be prescribed twice daily since their body clears the drug faster than normal.

Doses may be increased every four to seven days.. Because methadone takes days to fully work, doses should not be increased more often than this.

Also, it is very important to not start with a higher dose than recommended. Because methadone releases very slowly into your system, it is possible to take a high dose and feel fine for the first couple of days after starting the drug, only to have an overdose days later.

Taking too much methadone too quickly can also cause heart and breathing problems. For this reason, you should only take as much methadone as prescribed by your doctor, and only take it as frequently as your doctor tells you. If you are taking methadone for pain, you should know that pain relief may not kick in until several days after you start it.

Prescribed Methods

When methadone is prescribed by a doctor, it is most often taken by mouth. If you are in the hospital, it can also be given intravenously. If you are enrolled in an opioid replacement program, the center will often require you to take the methadone while you are there, instead of bringing it home to take later.

Abusive Methods

When methadone is bought on the street, it is often used much the same as if it were prescribed. People may take the drug by mouth or they may inject it.

How Does Methadone Work?

When used for opioid replacement therapy, methadone blocks opioid withdrawal symptoms for 24 to 36 hours. People taking methadone for opioid replacement should stay on the drug for at least 12 months. However, some people may need to stay on the drug longer, or even indefinitely.

When used for pain, methadone works much like other opioids. The drug binds to mu opioid receptors in the brain, causing pain relief. However, a unique trait of methadone is that it blocks N-methyl-D-aspartate receptors, which reduces the development of drug tolerance. Another unique benefit of methadone use in pain is that unlike many other opioids, it can be safely used in people with kidney problems.

What Does Methadone Look Like?

Methadone comes in different forms, including:

• Tablet: Mainly for pain relief
• Wafer: Mainly for opioid replacement therapy
• Liquid: Mainly for opioid replacement therapy, or pain relief in people with trouble swallowing
• Injection: Mainly for pain relief; for hospital use only

Brand Names

Methadone is available both as a brand and a generic drug. Brand names for methadone are:

• Methadose and
• Dolophine.

Other Names & Street Names for Methadone

Street names for methadone include:

• Fizzies
• Amidone
• Chocolate Chip Cookies (when mixed with MDMA, or ecstasy)
• Maria
• Pastora
• Salvia
• Street Methadone
• Wafer

Side Effects of Methadone

Methadone side effects are like those of other opioids. You may experience:

• Sweating,
• Itchy skin,
• Drowsiness or
• Constipation.

Also, if you start taking methadone for opioid replacement therapy, other effects may occur. For example, if you are a woman struggling with heroin, you will often stop getting your period. Doctors have learned that once women who take heroin transition to methadone, they typically start getting their periods again. This can lead to a risk of pregnancy if you are sexually active.

Overdosing on Methadone & Withdrawal Symptoms

Just as with other opioids, it is possible to overdose on methadone. If you suspect an overdose, you should administer naloxone and call 911 right away. In 2016 alone, almost 3,400 people overdosed on the drug. Symptoms of overdose include:

• Breathing that is slow or shallow
• Blue fingernails or lips
• Stomach spasms
• Skin that feels clammy
• Seizures
• Weak pulse
• Coma
• Death

Stopping methadone cold-turkey can also lead to side effects. If you take methadone regularly and suddenly stop, you may get withdrawal symptoms such as:

• Anxiety
• Muscle tremors
• Nausea or vomiting
• Stomach cramps
• Diarrhea

How Long Does Methadone Stay in Your System?

Methadone is a very long-acting drug. For this reason, methadone will last in your system for much longer than other opioids.

Methadone Half-Life

The half-life of methadone is up to 48 hours. This means that 48 hours after taking a dose, about half of the drug will remain in your body.

• Blood: Methadone starts to get into the blood within 30 minutes. Your body stores methadone in the liver and fat cells, which continue to release the drug into your blood for hours. Because of the half-life of 48 hours, it is likely detectable in blood for about 10 days. If you are in an opioid replacement program in Ohio, you will likely have your blood checked at least three times a year.
• Urine: Methadone can stay in the urine for about 3 days.
• Hair: Methadone is present in the hair and may stay there for years. If a pregnant woman uses methadone, the baby’s hair may test positive for the drug as well.
• Breastmilk: Methadone appears in breast milk in very small amounts. Doctors believe that breastfed babies are not at risk from this.

Methadone Addiction

Although it is often used to treat opioid addiction, methadone is as addictive as other opioids. Luckily, when used as prescribed by a doctor, the risk of addiction is reduced.

Drug addiction is closely linked to tolerance and dependence. Many people can take methadone without becoming tolerant and needing higher doses. Although chronic methadone use means that a person may be dependent on the drug to function, withdrawal symptoms are less likely. This is thought to be because the drug is so long-acting that it wears off slowly, reducing withdrawal risk.

Methadone Laws in Ohio

Methadone can be prescribed by medical providers who are registered with the Drug Enforcement Agency (DEA) and who have a DEA number. If methadone is to be used for opioid replacement therapy, the prescriber must also be from an opioid treatment program certified by the government.

When used for opioid replacement therapy, Ohio law requires methadone to be given as an oral liquid. A single prescription for methadone is valid up to 90 days in the state. During the first 90 days of treatment, a patient may only take home a maximum of one dose weekly. The drug must be consumed in front of clinic staff on all other days.