Opioid Rehabilitation: How Does a Methadone Clinic Work?
What Is a Methadone Clinic?
Methadone is a synthetic, long-acting opioid agonist, meaning that it binds to and activates opioid receptors in the brain, which helps to reduce opioid cravings and minimize opioid withdrawal symptoms. Additionally, when taken as part of an OUD treatment regimen, methadone may blunt or block the effects of other opioids, including illicit opioids like heroin.1
It is a Schedule II controlled substance, which means it requires a prescription and qualified medical practitioner supervision. It may be prescribed to individuals undergoing detoxification as well as to those who are in the maintenance phase of treatment for opioid use disorder (OUD) in conjunction with appropriate social and medical services.2
Methadone is dispensed through specialized methadone clinics, designed as opioid treatment programs (OTPs), which operate under federal OTP regulations.3 Federal regulations require these OTPs to have a current and valid accreditation status, certification from the Substance Abuse and Mental Health Services Administration (SAMHSA), and registration from the Drug Enforcement Administration (DEA).4 Additionally, OTPs must provide adequate medical assessments and treatment; counseling; drug testing; and vocational, educational, and other services—either by offering these services onsite or by referring patients to an outside agency or practitioner through a formal agreement.1
Currently, individuals who prefer to receive medication via their physician’s office, cannot get methadone but may be able to get prescriptions for buprenorphine or naltrexone—both of which are also approved medications to treat OUD. But this relatively limited access may change in the future. The Modernizing Opioid Treatment Access Act, or M-OTAA, a bill currently on the legislative calendar, proposes to allow qualified addiction specialist physicians to prescribe take-home methadone doses that retail pharmacies can then dispense.5 Right now, a patient in an OTP, who meets certain criteria, can get a single take-home dose of methadone to be taken when the clinic is closed, which is usually Sundays and federal holidays.4
How Does Methadone Work?
Methadone is among the few medications used during medically supervised detox and withdrawal management as well as for maintenance treatment for people who are addicted to heroin, fentanyl, or other opioid drugs.2
Methadone is a full opioid agonist, which means it can eliminate or relieve symptoms of opioid withdrawal as it attaches to and fully activates mu-opioid receptors in the brain—similar to how other opioids work. However, because methadone is a long-acting opioid agonist, it acts on and stimulates these receptors in the brain more slowly than other opioids, such as oxycodone and other prescription opioids, as well as illicit opioids like heroin. When taken at the appropriate therapeutic dose, methadone should not elicit powerfully reinforcing or rewarding effects on its own in someone who is physiologically dependent on opioids, and it may blunt or block the euphoria-producing effects of other opioids, should other opioids be used while on a methadone treatment plan.1,6
How Is Methadone Administered?
Methadone is available in oral form as a liquid concentrate, tablet, or as an oral solution from a dispersible powder or tablet administered by a team of qualified medical professionals at certified OTPs, who determine an appropriate dose for each patient.1,2
Possible Side Effects of Methadone
Methadone maintenance treatment is generally associated with a low incidence of side effects and with significant health improvements. Studies indicate that around 75% of individuals who receive methadone maintenance treatment respond well.7
That being said, methadone is still a medication, and as with any medication, side effects are possible. Some of the potential side effects associated with methadone use include:1
- Drowsiness or sedation.
- Lightheadedness or dizziness.
- Nausea and vomiting.
- Constipation.
- Sweating.
The supervising healthcare professional may titrate or adjust the dose of methadone for each individual; the appropriate dose may depend on several factors, including the individual’s history, health, and previous substance use. Strict supervision by a physician ensures that dosing adjustments can be made based on factors such as an individual’s opioid tolerance as well as any treatment side effects that may arise.8
People who experience side effects from methadone, especially if they experience distressing or persistent effects, may benefit from adjustments in their treatment plans.8
Methadone Safety
When used as directed, methadone is a safe and effective medication for the treatment of OUD.1 However, as previously mentioned, methadone is a Schedule II controlled substance under the Controlled Substances Act, which means that—like other opioids—there is the potential for diversion and misuse.2 But the risk of misuse or addiction should not discourage individuals from receiving methadone as part of an OUD treatment plan.
Risks of Interactions with Other Medications and Substances
Methadone can interact with over-the-counter medications as well as those prescribed to treat other health conditions—all of which can lead to adverse effects or overdose.2 This is also true when combining methadone with recreational or illicit drugs. Thus, it is essential that you speak to your doctor about any medications or drugs you may be taking before starting methadone.1,8
Methadone can cause heart rhythm issues on its own, and combining it with anti-arrhythmic medications, including antiarrhythmics (medications that prevent or treat arrhythmias), some antidepressants and antipsychotic medications, and certain over-the-counter products like laxatives or diuretics, may exacerbate these concerns.2
The risk of respiratory depression, profound sedation, coma, and death increases when methadone is taken with alcohol, benzodiazepines and other central nervous system (CNS) depressants (including sleeping pills and tranquilizers), other opioids (prescription or illicit), and any medications or substances that cause drowsiness.2,8
Additionally, antihistamines, blood pressure pills, HIV medications, MAO inhibitors, and certain antibiotics can interact with methadone, rendering one or both medications less effective and potentially causing other adverse health issues.2,8
Pregnant or Breastfeeding Women and Methadone
Research indicates that methadone use during pregnancy and while breastfeeding is safe for the mother and baby, but it should be used as a part of a more comprehensive prenatal care and OUD treatment plan to reduce the risk of potential complications during pregnancy and at birth.9
Who May Benefit from Visiting a Methadone Clinic?
People who may benefit from the services provided by methadone clinics essentially include anyone who is 18 and older and struggling with OUD—though not all patients meeting OUD criteria, particularly those with a confirmed diagnosis of mild OUD, make good candidates for methadone.1
Why Choose an Opioid Treatment Program That Uses Methadone
According to research, when taken as prescribed, methadone is safe and effective and can help individuals achieve and sustain recovery. It is, however, only one component of a comprehensive OUD treatment plan, which includes counseling and behavioral therapies to help individuals understand the thoughts, emotions, and behaviors that led to opioid use and teach them skills to avoid relapse.9
Current Viewpoints on Methadone
As previously mentioned, there is an increased acceptance of methadone use, and the potential for greater access to it with the removal of certain restrictions as stated in the Modernizing Opioid Treatment Access Act (M-OTAA).4,5
Critics of M-OTAA believe that its passage will increase the likelihood that physicians will prescribe methadone with little to no safeguards or oversight. But the American Society of Addiction Medicine (ASAM) disagrees, saying that these beliefs are false and misleading. According to ASAM, non-OTP clinicians and pharmacies would still be subject to federal and state laws and regulations to guard against the diversion and ensure that methadone (and other controlled medications) be issued only for legitimate medical purpose.10
Members of the American Society for the Treatment of Opioid Dependence, on the other hand, worry that M-OTAA only increases access to medication, not treatment.11 To this point, ASAM argues that M-OTAA does not prohibit non-OTP providers from offering other therapies and recovery supports.10
Research suggests that increasing the availability of methadone and other medications used to treat OUD may help address the epidemic of opioid overdose deaths as well as the treatment gap since only 20% of individuals with OUD currently take one of the FDA-approved medications for OUD.12
Additionally, allowing methadone to be prescribed and delivered in the current methadone treatment clinics, as well as primary care settings, can help to reduce the stigma associated with OUD, putting it more in line with other chronic medical conditions that are treated in primary care settings.12
Find Treatment and Methadone Clinics Near Me
Treatment for OUD is available at addiction rehabs throughout the United States. Many OTPs offer methadone as part of OUD treatment.9 That being said, there’s no one-size-fits-all treatment, so it’s important to consult your primary care physician or an addiction treatment specialist about the options that are right for your unique needs.
American Addiction Centers (AAC) offers customized treatment plans for OUD at our facilities located throughout the county. We offer medical detox and withdrawal management, counseling and evidence-based therapies, and treatment for co-occurring disorders in a variety of settings, including inpatient and outpatient rehab. Call our free, confidential helpline at to speak to a caring and knowledgeable admissions navigator about your treatment options or to find methadone clinics near you.
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