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Methadone Maintenance Programs Pros and Cons

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 26, 2019

Methadone is a synthetic opioid that is often used in the treatment of addiction to other opioids by reducing cravings and decreasing the effects of withdrawal symptoms. If taken improperly, however, methadone can be addicting and lead to serious health problems if abused. It is important to understand all risks before beginning a methadone maintenance program.

Methadone is a long-acting synthetic opioid agonist medication frequently used within opioid treatment programs (OTPs) or methadone maintenance programs. Methadone reduces cravings, decreases withdrawal symptoms, and blocks the pleasurable effects of opioid drugs, should a person relapse

When combined with behavioral therapies and social supports methadone can help individuals to live more fully-functioning, healthy lives. However, if abused, methadone can be addictive. The highly-structured, daily requirements of these programs make treatment difficult for some individuals.

What Is Methadone?

As an opioid, Methadone targets the same areas of your brain that abused opioids like heroin and prescription painkillers work on. From this mechanism of action, it’s able to lesson intolerable symptoms of withdrawal, especially cravings.

It also prevents users from experiencing the feel-good effects or euphoria that they seek when abusing opioid drugs, which is the primary reason it’s used within maintenance programs. Combined, these characteristics make methadone a valuable part of treatment for many individuals in recovery.

When used properly, and as directed, methadone can be a safe and effective part of treatment for an opioid use disorder. To ensure its success within treatment, and to decrease instances of abuse and diversion, methadone is most effective when used as part of medication-assisted treatment (MAT).

What Is Medication-Assisted Treatment?

Medication-assisted treatment is an essential component of the most effective drug treatment programs. This approach blends medications, or pharmacotherapies, with behavioral therapies and social support so that the physical, mental, emotional, and social ramifications of addiction are addressed.

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As explained by the National Institute on Drug Abuse (NIDA) “MAT DECREASES opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.” For individuals living under the physical and mental strain of opioid addiction, these are all critical elements of a healthy, balanced recovery.

What Is A Methadone Maintenance Program?

Methadone maintenance programs may be public or private. Not every doctor or treatment program can dispense methadone. By law, only programs which have been certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) can do so. In order to receive their medication a person must travel to these clinics where their dosage is monitored and dispensed by a trained, authorized physician.

Once here, a person receives their dose of methadone, which, as SAMHSA writes, is offered in a liquid, pill, or wafer form. In the beginning of treatment a person’s dose is administered on site, but as time progresses and, as explained by SAMHSA, “After a period of stability (based on progress and proven, consistent compliance with the medication dosage), patients may be allowed to take methadone at home between program visits.”

Treatment is adjusted based on each individual’s unique health and medical needs, in addition to the presence and efficacy of their support network. But, as NIDA writes, in the least individuals should undergo methadone maintenance for one year, though some individuals may require treatment for years. Duration of treatment, including when to stop treatment, should only be made under the guidance of a doctor trained in these areas.

What Are The Pros Of A Methadone Maintenance Program?

Access To Other Treatment Modalities: Some programs offer counseling sessions, relapse prevention training, treatment for co-occurring disorders, social support, medical intervention (with a focus on reducing transmissible diseases), and the implementation of protective factors against criminal activity.

Detox Is More Comfortable: When a person is first trying to get clean, methadone may be used during a medical detox. When used this way it reduces or eliminates painful or uncomfortable symptoms of withdrawal which may otherwise lead a person to relapse.

Cravings Are Reduced: Cravings are one of the biggest triggers of relapse. And cravings from opioids can be some of the most severe. Methadone reduces opioid cravings (and subsequently relapse), allowing a person to focus more fully on their treatment and the betterment of their life.

Enhanced Social Functioning: Many individuals develop more meaningful and balanced lives as they’re no longer ruled by cravings or the ups and downs of opioid abuse. Again, when used as part of MAT, methadone reduces many individual’s participation in crime.

Fights Relapse: Should a person relapse, or become fearful they will, a methadone clinic may offer them the medication-based support they need to get or stay clean.

Fulfills Legal Requirements: Having proof that you’re involved in a methadone maintenance program may help to reduce sentencing by fulfilling certain legal requirements.

Less Expenses: Inpatient treatment can become expensive, so the outpatient nature of many programs can be a more cost-efficient option for those on a budget.

Life Support: Drug addiction can be caused by, and even lead to, issues within a person’s family, career, and health. Clinics may provide support addressing these concerns as well as any legal ones which arose from situations of abuse and addiction.

Increased Treatment Retention Rates: The structure of a methadone clinic can hold people accountable within their treatment. Further, “Patients treated with medication were more likely to remain in therapy compared to patients receiving treatment that did not include medication,” as explained by NIDA.

Methadone Can Be Used As Treatment For Pregnant Women: According to NIDA, “Treatment of opioid-dependent pregnant women with methadone…IMPROVES OUTCOMES for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay.” Breastfeeding women can also safely take methadone.

Reduction Of The Spread Of Infectious Diseases: As methadone-based MAT reduces or eliminates abuse, a person is better protected from certain transmissible diseases linked to opioid abuse, including HIV/AIDS and Hepatitis B and C.

Stay Involved In Your Life: Since many programs allow individuals to remain at home, some individuals may continue to work part-time. The increased involvement with treatment-supportive family and friends can also be beneficial to your morale and recovery. These programs also allow people to remain involved as spouses, partners, or parents, giving individuals positive goals to fight for.

What Are The Cons Of A Methadone Maintenance Program?

One of the most negative aspects of MMT is that methadone is extremely addictive. This is a concern that anyone considering methadone maintenance should consider. Outpatient maintenance programs don’t protect you from the triggers and temptations of the outside world, which may increase the odds of relapse. Because of this, you may still be able to access and take opioid drugs. Inpatient drug rehab programs protect you far more from these risks.

Methadone does interact with other medications, which can be potentially dangerous (especially to the heart) if an individual doesn’t inform their provider of any existing or new medications. Should complications arise they may be more difficult to identify in an outpatient setting.

Methadone’s chemical makeup causes it to stay in a person’s body for a prolonged period of time. So should a person be able to take their doses at home and be abusing it (or abused illicitly purchased methadone prior to arriving at the clinic), they could overdose if they take too much too close together. This could also happen unintentionally to those who administer at home if they overlap after forgetting about a previous dose.

Though methadone clinics offer flexibility for some, others find the strict dosing schedule inconvenient and detrimental to their work or family-related responsibilities. While some individuals are able to adapt their work schedules to these demands, other’s find it conflicts too heavily, impeding their ability to carry out their work responsibilities.

Since you have to travel to the clinic on a daily basis it can make work trips or those for pleasure difficult. Other individuals who don’t have reliable transportation or live a distance away from the clinic may be deterred from continuing treatment for these reasons.

While methadone clinics do offer counseling and other supportive services in outpatient settings, these supports may not be intensive enough for many seeking recovery, versus those offered in inpatient drug rehab programs. This is especially true for individuals who require comprehensive dual diagnosis treatment.

How Do I Find A Methadone Maintenance Program?

Before you decide on a methadone-based treatment program, make sure to consider your alternatives. Buprenorphine (Suboxone, Subutex, and Zubsolv) is another pharmacotherapy used to treat opioid addictions for both detox and maintenance. Some individuals experience more favorable outcomes with this medication.

But as each individual, their health history, and life circumstances are different, we strongly urge you not to make this decision lightly. When considering treatment, there are certain medical and health concerns that only a trained addictions specialist or doctor should evaluate.

Once you’ve had this assessment, in combination with your concerns and preferences, a treatment plan can be designed. Integrating all this information and these perspectives helps to ensure you have the most favorable and long-lasting treatment outcomes.

Find The Best Treatment For Your Needs Today

Our staff at can assist you with these needs, beginning with our confidential assessment. We can help you to identify areas of your life and health which should inform and direct your treatment decisions. We can also reach out to various programs on your behalf to ensure you have the best options for yourself or a loved one. Contact us today.

National Institute on Drug Abuse - Effective Treatments for Opioid Addiction, Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

Substance Abuse and Mental Health Services Administration - Methadone

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