Stigma And The Impact Of Misinformation
Many people accessing pharmacotherapy experience stigma in several different ways, including from:
- family and friends
- employees in pharmacies or clinics where methadone is dispensed
- the community particularly if the person lives in a small community where there is less anonymity.5
Experiencing any kind of stigma can turn people away from treatment which means they are unable to get the help they need.
People on methadone programs are the same as anyone else who needs medication to manage a long-term health condition and they shouldnt be treated any differently.8
Further information and support
What If I Miss My Dose
If you take methadone at home
Take it as soon as you remember, unless it’s nearly time for your next dose. In this case, skip the missed dose and take your next one at the usual time. Do not take a double dose to make up for a forgotten dose.
Tell your key worker or your doctor that you missed a dose. They may ask you to return the leftover liquid.
If you have supervised doses
Go to your pharmacy or drug treatment centre as soon as you remember, as long as its during opening hours.
If you cannot get to your pharmacy or drug treatment centre until the next day, they may not be able to give you any methadone. They may need to speak to your prescriber first.
Its important to take your methadone or collect your doses on the right day. Always check your treatment plan.
Is Methadone Safe What About People Selling Their Doses
Methadone treatment has always been tough to get, with access limited by strict federal guidelines since the 1970s.
“Now, our research has found exactly how difficult it can be for patients to get methadone and stay in treatment, and patients have been saying that for years,” McGaffey said.
But the medication is safe and effective when used as prescribed for opioid use disorder, research shows. It fills opioid receptors in the brain, which helps prevent painful withdrawal symptoms from stopping opioid use, and curbs cravings for drugs such as heroin and fentanyl. It does basically what other opioids do, but it acts slowly, and it doesn’t provide the euphoria that other opioids do, experts say. It can help patients get to and stay in recovery.
As for diversion people taking their doses out of the clinic and selling them to others the National Institute on Drug Abuse says that most data suggest that most of the time, methadone that’s misused is taken to control withdrawal symptoms, not to get high.
“Many of states current regulations are based on an approach developed during the war on drugs in the 1970s, which focused on reducing crime and diversion rather than treating addiction like a public health problem,” said Pew’s McGaffey. “Thats why we tend to see tight restrictions rather than a patient-centered, evidence-based approach.
‘First do no harm’ goes hand-in-hand with ‘allowing no harm,’ which is my approach to treating my patients,” Soria said.
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Screening For Other Mental Health Conditions
People with OUD may also have other mental health conditions, including depression and anxiety. They should receive recommended screening and treatment.
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Help For Oxycontin Withdrawal
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AddictionBlog.org is a subsidiary of American Addiction Centers . We are here 24/7 to help you understand your addiction treatment options.
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Frequently Asked Methadone Treatment Questions
Despite being one of the most popular treatment methods for opioid dependence, there are still a couple of questions surrounding the use of methadone. It is understandable considering that not everyone agrees with the implementation of methadone treatment. To give you a better understanding, lets take a look at some methadone treatment questions.
What is Methadone?
This is the most basic question that anyone should ask about the treatment. Basically, it is a type of drug used not only for the treatment of opiate addiction, but also for relieving pain. It is important to point out that methadone is strictly used for opioid related addiction and not applicable for other types like cocaine, marijuana, or alcohol among others.What does it do?
Methadone works by blocking the receptors of the brain that is affected by the use of heroin and other opiates. This allows addicts to achieve gradual detoxification without the violent withdrawal symptoms. This means that methadone will occupy the receptors to block high opiates and achieve a more stable feeling. The addict will have reduced cravings and tempered withdrawal symptoms that lowers the risk of relapse. This is done by simulating the same sense of euphoria that opiates deliver but with longer lasting effects so that a single dose a day would be sufficient for most addicts.Is the Treatment Safe?
Is the Treatment Effective?
Are there Side Effects?
What are the Benefits?
Will it Show on Drug Tests?
Understanding What Methadone Is And How It Works
As a class of drugs, opioids include hydrocodone, oxycodone, fentanyl, heroin and morphine. All opioids are chemically similar, interacting with the nerve cells opioid receptors throughout the body and brain. Generally, opioid pain relievers can be safe when taken for an appropriate amount of time with a doctors prescription and supervision, but they can lead to a dependency if misused.
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When Should I See My Doctor
Always check with your doctor before adjusting your dosage either up or down.
If you stop taking methadone suddenly, you may experience withdrawal symptoms. Your doctor can advise you on the best way to reduce your dosage of methadone to minimise the impact of withdrawal effects.
If you feel you need to increase your dosage, or you experience any unexpected side effects, see your doctor.
Related: Under New Rules Methadone Clinics Can Offer More Take
Because of its potential for misuse, federal regulations require methadone for opioid use disorder to be prescribed and dispensed in highly structured OTPs. These regulations help protect patients on their recovery journeys, ensure appropriate provider oversight, and prevent the selling, sharing, or misuse of the powerful narcotic in communities.
Some organizations and members of Congress believe the overdose crisis can be solved by reducing opioid addiction treatment to just prescribing methadone without any of the consumer or community protections built into the OTP regulations.
In early 2022, Senators Ed Markey and Rand Paul introduced the Opioid Treatment Access Act of 2022, a bill aimed at expanding access to opioid treatment. While the legislation contains some provisions to do just that like removing duplicative registration requirements for mobile clinics and codifying methadone take-home flexibilities for patients Section 4 of the bill is a step backward. It would allow methadone to be dispensed at neighborhood pharmacies with no oversight or diversion control mechanisms, putting patients and communities at risk for even greater overdose and misuse.
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How Methadone Works As An Opiate Addiction Treatment
The use of methadone for opiate addiction treatment falls under a category of MAT called substitution therapy. This type of therapy involves prescribing another opiate to help a person struggling with addiction manage many of the physical effects of withdrawing from the use of the original opiate.
Methadone works by binding to the same brain receptors as other opioids, such as heroin and morphine. This means that an individual undergoing methadone treatment wont experience overwhelming withdrawal symptoms or cravings after stopping the drug they are addicted to. Without facing a constant battle against urges that could result in relapse, they are able to build a stronger foundation for their recovery.
Methadone is taken orally, typically once a day, but it can also be injected. Because it is a long-acting opioid, it can remain in the body for up to 56 hours. However, the standard single dose of methadone typically lasts between 24 and 36 hours. Methadone can be an effective treatment for opioid addiction, but it is important to note that it is a potent medication and should be used with caution under the close supervision of a medical professional.
Medication For Opioid Use Disorder During Pregnancy
Medication for Opioid Use Disorder refers to the use of medication to treat opioid use disorder. This type of treatment can lead to more favorable outcomes.
Methadone and buprenorphine are first-line therapy options for pregnant people with OUD. ACOG and SAMHSA recommend treatment with methadone or buprenorphine for pregnant people with OUD, in conjunction with behavioral therapy and medical services. While some treatment centers use naltrexone to treat OUD in pregnant people, current information on its safety during pregnancy is limited. ACOG recommends that if a woman is stable on naltrexone prior to pregnancy, the decision regarding whether to continue naltrexone treatment during pregnancy should involve a careful discussion between the provider and the patient, weighing the limited safety data on naltrexone with the potential risk of relapse with discontinuation of treatment.
Pregnant people with OUD should be encouraged to start treatment with methadone or buprenorphine. Like many medications taken during pregnancy, MOUD has unique benefits and risks to pregnant women and their babies. It is important for healthcare providers to and people who are pregnant with OUD to work together to manage medical care during pregnancy and after delivery. Coordination of care between a prenatal care provider and a specialist with expertise in opioid use is important for pregnant people with OUD.
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Why Searching For New Treatments For Opioid Addiction
It is undeniable that the actual OST, methadone and buprenorphine, have brought a substantial benefit in the opioid addiction treatments. Indeed, when associated with a risk reduction policy they substantially reduced death by overdoses and the transmission of blood-borne diseases. They help addicts to follow their recovery program and contribute to their social reintegration. OST were also shown to preserve immune and memory functions, have positive effects on psychopathology and reduce polyabuse .
Many side effects have been reported with these OST such as a decrease of cognitive performance or sexual dysfunction in men . Finally, as they remain MOPr agonists, they will contribute to maintainvery likely to a lesser extentthe allostasis generated by previously abused opioids. In rodents, a short treatment with buprenorphine or methadone is able to induce behavioral and neurochemical modifications until 35 days after withdrawal . It therefore appears necessary to find new MOPr agonists, or new combinations of MOPr agonists and other ligands, that would not induce the neuroadaptations responsible for the harmful effects of opioids , and would therefore gradually restore homeostasis, thus allowing for instance a complete escape from addiction.
Are There Alternative Treatments For Fentanyl Addiction
If you are not a good candidate for methadone treatment for fentanyl addiction, other medications are available. Health providers will also recommend these alternatives if you:8
- Have a history of another substance use disorder
- Have experienced a drug overdose before
- Use fentanyl in high quantities
- Have an occupation that does not allow treatment with opioid agonists or partial agonists
Buprenorphine is another medication for opioid use disorder and it is safer than methadone in terms of overdose risk. It also does not depress the respiratory system as much as methadone does.8
Naltrexone is another medication for fentanyl addiction that has no misuse potential. Some experts recommend naltrexone for mild opioid addiction and for patients who are highly motivated for treatment.8
Recovery is possible. For help with finding treatment providers for fentanyl addiction, please call Who Answers? 24/7 to speak with one of our treatment specialists.
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What Are Typical Methadone Doses
Recently, providers have recommended higher doses of methadone when treating fentanyl addiction compared to addiction to other opioids.5 This might be because fentanyl is a much stronger opioid, being about 50 times stronger than heroin.
Experts are making this recommendation after seeing some research results showing that those with fentanyl addiction improved with higher doses of methadone.5,7
The starting dose of methadone for fentanyl addiction is 30 mg. Your provider will generally increase it by 10 to 15 mg about every five days until a dose of 100-120 mg is reached. You slowly take higher doses over time as a way to avoid methadone overdose. When you reach a dose that is stable, you enter methadone maintenance, where your dose may not be adjusted for a longer period of time.5
If you are at high risk for overdosing on fentanyl or are just starting your methadone treatment, your provider might also prescribe slow-release oral morphine at the same time. This supplements the methadone and reduces withdrawal symptoms and cravings while you are taking low doses of methadone.5
Scientists recommend SROM doses begin at 200 mg per day. Your prescriber may keep this dose throughout your treatment or slowly increase it while they increase your methadone dose.5
How Do People Take Methadone
Methadone is only available in liquid form, and there are two main versions used in Australia Methadone Syrup and Biodone Forte.3
In long-term methadone programs, the person has to attend a public clinic or pharmacy daily to receive their dose. The pharmacist will dilute the methadone liquid with water, and then the person will take their dose and pay a fee for it.
Some people are able to get takeaway doses if the pharmacist decides they are stable on the program and theres a low risk of the takeaway doses being used incorrectly.
How does methadone help people?
Methadone has the effect of:
- reducing the euphoric feelings of opioids
- reducing opioid withdrawal symptoms
- controlling or eliminating cravings for the opioid the person was dependent on.4
This can support people to focus on things like:
- improving their physical and mental health
- strengthening relationships with friends, family and partners
- finding and maintaining a job.4
It can also help reduce some of the health concerns and risk behaviours that come with opioid use, such as:
- injecting drug use, which increases the risk of blood- borne viruses and other health issues
- chances of overdose
- contact with the criminal justice system. 4, 5
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Advantages Of Opioid Use Disorder Treatment With Methadone
The benefits of methadone treatment for opioid addiction include:
- Methadone has a history of use in addiction medicine that goes back to 1947. According to the National Institute on Drug Abuse, research suggests that it can increase a patient’s chance of staying in treatment by 4.44 times.
- Effective for severe symptoms: The lack of a ceiling effect in methadone makes it very effective for patients who take large amounts of potent opioids. With medical supervision, methadone treatment can relieve the associated withdrawal symptoms during recovery.
- Safe during pregnancy and breastfeeding: Breastfeeding and pregnant patients can safely take methadone. It helps these patients manage their addiction as they go through these life changes.
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Are There Any Alternatives To Methadone For Treating Opioid Addiction
There are other medications that can be used to treat opioid addiction. Each option comes with its own set of advantages and risks.
Buprenorphine is another medication that is commonly used, and it works in a similar way to methadone. Naltrexone is another option that works by blocking the effects of opioids rather than mimicking them.
Dr John Elgin Wilkaitis
Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Childrens Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.
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Treatment For People With Opioid Use Disorder After Delivery
Support for people with OUD is important after the baby is born. People may be adjusting to many new factors in their lives. For example, they may experience a lack of sleep and anxiety about the demands of caring for a newborn.
According to ACOG and SAMHSA, people with OUD should continue MOUD as prescribed after the baby is born. Healthcare providers should monitor people during this time and adjust the dosage if needed. Discontinuation of MOUD for OUD should generally be avoided in the time immediately after the baby is born. At the very least, it should be avoided until the baby is consistently sleeping through the night and has completed breastfeeding. However, ending MOUD later may be considered if the mother is stable, if the mother and child are well-bonded, if the mother and child have a safe and stable home and social environment, and only with medical supervision and when it is in the best interest of the mother and child.
Plans to stop MOUD should be made together with the healthcare team. MOUD must be reduced slowly to prevent withdrawal. A safety plan for the mother and family needs to be in place before slowly stopping MOUD, so that plans are in place if opioid relapse occurs. People can safely continue MOUD for as long as they need it. For some, this may be months or years, and for others, it may be a lifetime.
