Methadone Treatment: An Overview
For many years I worked at a methadone clinic. Although I learned many important things about being a clinician in graduate school, I consider my years at the clinic to be my “true” education about drugs and the people who struggle with them. During my job interview, I was asked how I felt about urine. I should have known then that I was about to have a remarkably interesting job.
Other than what I am doing now, it was my favorite job and truthfully, I still miss it. I have nothing but gratitude and admiration for all the patients I encountered who shared their successes, their stories, their struggles with me.
I frequently meet people in the mental health field who have no idea what methadone is, or they believe that it is not a real treatment. The cost of this lack of knowledge or refusal to accept it as a valid treatment choice is lives. People who are struggling with opioid dependence need to know their options and should be given the freedom to make their own choice about treatment.
Before continuing, I must make a key clarification. I am not a medical professional. I do not have a license to practice medicine. The information here is general and NOT a substitute for consultation with a medical doctor. Only you and your doctor can determine if methadone is appropriate for you.
How methadone came to be
Methadone was originally developed as a pain killer by German scientists to assist Nazi Germany in becoming medically self-reliant during the war. After the war, the Allies obtained the patent to methadone. In 1947 the drug was introduced into the US. In 1970, Dr. Vincent Dole opened the first methadone clinic in New York City. By the late 70’s many federally regulated clinics opened around the country to support the returning Vietnam vets who were needing treatment.
What is methadone?
Methadone is a synthetic opioid agonist (need help with terminology?) that binds to the opioid receptors in our brain. It is an evidenced based treatment for those struggling with opioid use disorders (i.e. heroin, OxyContin, etc.). When someone with a tolerance to opioids is given a stable, adequate dose of methadone, two important things happen. 1) Methadone will prevent the person from going into withdrawal 2) If someone uses more opioids, it will block the effect of the high.
What happens when you begin methadone treatment?
You will probably not feel so great when you show up for your intake. Most clinics do not require that you be in severe withdrawal but going in high may be a barrier to beginning treatment. If the clinic permits it, bring something to drink with you! 1) You will probably be there for a while 2) You will almost certainly be required to give a urine sample. (Go ahead and get used to that—there is a lot of urine involved with methadone treatment, thus my interview question. If it makes you feel better, the staff gets drug tested too).
You will have to answer a lot of questions about yourself and your drug use. With any luck, the people asking the questions genuinely care about you and try to make the intake process as easy as possible. A nurse will probably take your vitals and look at your pupils. At some point, you will see a doctor—all of this will have to happen before you dose.
Your initial dose will probably be low, and they will titrate you to a stable dose. This will vary across states and clinics, but generally doses are increased in small increments at a time, so a little patience will be required on your end when you are stabilizing.
How do you take methadone?
Methadone is an oral medication measured in milligrams. Most often it comes in liquid or diskettes. The place I worked offered clients the choice of which they wanted. Officially, there is no difference, but people tended to prefer one versus the other. Liquid does give more options to move doses up or down in smaller increments.
Most clinics will provide you with water and/or some juice like Kool-Aid or Tang. FYI, if you want to get people to stare at you, go to Wal-Mart and buy 25 canisters of Tang. “Are you on your way to astronaut camp?”...I got that one more than once. I also once angered almost our entire patient roster by buying grape Kool-Aid—apparently the grape flavor does not complement methadone well. Lesson learned.
The nurse will watch you take your dose and ensure that you swallowed it all to prevent diversion.
Do you have to go to the clinic every day?
Usually, especially at the beginning. Most clinics will give you a take-home dose for Sundays and holidays. This can vary by state and clinic, but in general more take-home doses can be given based on time in treatment and favorable drug screens, but it is a process to get there.
If you need to travel, guest dosing at other clinics can usually be arranged. (Insider tip: this can be an arduous process for the staff, so give them a heads up if possible.)
Why are methadone clinics so strict?
Methadone clinics are highly regulated. They must report to the state frequently and are subject to inspections/audits by the state and the DEA. Often, these are “surprise” visits. Additionally, if your clinic is accredited by CARF or the Joint Commission (which it should be), they will be visiting as well. Failing these inspections/audits can result in clinic closure.
Although methadone is safe when prescribed to you by a doctor and taken as prescribed (and not combined with drugs/medications that don't mix well with methadone), methadone is extremely dangerous when taken in excess or taken by people who do not have a tolerance to opioids. Therefore, diversion (drugs from a legal source being channeled onto the street) remains a real concern.
If you have a methadone in your home, it is a good idea to get naloxone/Narcan.
How long will I be on methadone?
There is no easy answer to this. Some people choose to continue to take it for a very long time because their life is stable. They worry that discontinuing it could lead to relapse. For people who do decide to stop taking it, a slower taper is generally preferable—it is less disruptive, produces significantly fewer withdrawal symptoms and provides ongoing support. However, ideally this is a decision made between you and your clinic staff (including the doctor) that reflects your individual situation and needs.
Still have questions?
No problem—I got you covered. There will be a part 2 that further explores many of the myths (and stigma) surrounding methadone treatment.
Support if you need it
If you or someone you care about struggles with opioid dependence, Substance Use Therapy is available. You may want to examine your use, make changes, learn about treatment options, or maintain positive changes you have already made. Whatever you are facing, you do not have to face it alone.
Quinones, S. (2016). Dream Land, The True Tale of America’s Opiate Epidemic. Bloomsbury Press, NY.
About the Author:
Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples and families whose lives have been affected by substance use. By utilizing a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation. *Note: telephone and telehealth sessions are currently available.