CleanSlate Blog

MAT Facts: How Does Methadone Work?

by Tracey Cohen, M.D. | Mar 20, 2019

MAT Facts is a special CleanSlate blog series that answers questions, corrects misunderstandings, and combats stigma around addiction and medication-assisted treatment (MAT).

MAT Facts

Medication-assisted treatment involves the use of one of three medications approved by the U.S. Food and Drug Administration (FDA): buprenorphine, naltrexone, or methadone. The oldest of these medications is methadone, a safe and effective treatment which treats withdrawal, controls cravings, and blocks the effects of other opioids.  

Because methadone offers the strongest opioid dosage of the medications, it is highly regulated and only dispensed in licensed opioid treatment programs. Those who choose to pursue this treatment must adhere to strict limitations, such as visiting a clinic every day to receive the medication and following specific guidelines to receive behavioral counseling and support.  

Related blog: MAT Facts: What Is Medication-Assisted Treatment?

Methadone operates as a full opioid agonist medication. This is different than buprenorphine, which is a partial opioid agonist, and naltrexone, which is not a narcotic at all.  

Methadone is a longer-acting opioid which activates the opioid receptors in the brain, creating a small opioid effect that suppresses withdrawal symptoms and cravings. While itself an opioid, methadone doesn’t give patients a feeling of being high, and if patients relapse and use heroin or other opioids, such as codeine, hydrocodone, morphine, and oxycodone, methadone will block the effects of those drugs.

Methadone was developed during World War II by German scientists as an alternative to morphine. In the U.S., it was originally used as a morphine substitute for pain, but over the decades, it became a popular and effective treatment for heroin addiction. More recently, methadone has been used to treat addiction to other opiates as well.

Related blog: MAT Facts: How Does Buprenorphine Work?

Stigma surrounds addiction. Sadly, stigma also surrounds MAT, although this is changing. But the stigma around MAT is especially true with methadone. Because patients must visit methadone clinics daily, these programs create more foot traffic and visibility within their communities.

Depending upon the jurisdiction, methadone patients must report to the clinic first thing in the morning and receive their dosage, which is usually provided in liquid form.  Patients sometimes then stay to participate in support groups at their clinic.

Some patients who have achieved a period of proven stability and compliance may be permitted to take methadone at home in between program visits.

Some patients welcome the stability and structure of having to report to a clinic every day. For others, this requirement conflicts with other demands in their lives - whether it’s a job, family, geographical distance, or something else. The structure of methadone programs can then create barriers to entering or maintaining this type of treatment.

While methadone can be abused, its strict regulation makes diversion difficult. Because methadone can be addictive, patients must comply with the supervision of a doctor for their own safety.

Like buprenorphine, methadone is a safe treatment for women who are pregnant or breastfeeding.

Related blog: MAT Facts: How Does Naltrexone Work?

The Substance Abuse and Mental Health Administration (SAMHSA) advises patients to follow these guidelines:

  • Do not consume alcohol while taking methadone.

  • Be careful driving or operating machinery on methadone.

  • Call 911 if too much methadone is taken or if an overdose is suspected.

  • For those who have “take-home” methadone, it’s very important to store it very safely away from children.

  • Store methadone at room temperature and away from light.

  • Never use more than the amount prescribed, and always take at the times prescribed. If a dose is missed, or if it feels like it’s not working, do not take an extra dose of methadone.

  • Dispose of unused methadone by flushing it down the toilet.

SAMHSA also cautions patients to call a doctor or emergency services immediately if they experience these side effects:

  • Experience difficulty breathing or shallow breathing

  • Feel lightheaded or faint

  • Experience hives or a rash; swelling of the face, lips, tongue, or throat

  • Feel chest pain

  • Experience a fast or pounding heartbeat

  • Experience hallucinations or confusion

As with the other addiction medications, methadone alone isn’t a cure for addiction. Addiction is a chronic relapsing brain disease which may involve a lifetime of treatment, and should be ideally combined with a comprehensive treatment plan. This may involve behavioral therapy and other services, depending upon the unique needs of the individual.



CleanSlate treats patients suffering from opioid or alcohol addiction with medications (note that CleanSlate does not treat patients with methadone) and a continuum of care to support each individual's journey to recovery. If you or someone you love needs help, contact us at 833-505-HOPE, or visit our website at www.cleanslatecenters.com to find the center nearest you.


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Picture of Tracey Cohen, M.D.

Tracey Cohen, M.D.

Dr. Cohen, Chief Clinical Officer of CleanSlate, is responsible for the clinical and quality oversight of CleanSlate’s services as well as continuous improvement and development of CleanSlate’s model of care. A part-time clinical provider at CleanSlate since 2010, Dr. Cohen joined the CleanSlate leadership team full-time in the summer of 2018, bringing over seventeen years’ experience of leadership in direct care, managed care, and public policy. Board certified in Addiction Medicine and Family Medicine, Dr. Cohen is widely recognized as a leader in substance use disorder care, health care integration, primary care, and chronic pain management. In her previous roles as Medical Director of Neighborhood Health Plan of Rhode Island and as Medical Director of Behavioral Health and Quality at BCBS Rhode Island, Dr. Cohen led initiatives that expanded access to addiction treatment across the state and served as regional and national models. Dr. Cohen earned a Bachelor of Arts degree in psychology from Barnard College and a Doctorate in Medicine from University of Pennsylvania School of Medicine where she was one of the six inaugural Twenty-First Century Scholars.

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If you or someone you know suffers from the disease of addiction, please call 833-505-HOPE to speak with a professional.

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