Methadone

How is it used?

In Australia, methadone maintenance treatment usually involves methadone syrup taken orally: 

• Methadone Syrup / Biodone Forte: The main ingredient is methadone hydrochloride 5 mg/mL. Other ingredients include sodium benzoate, ethanol (4.4%), sorbitol solution, glycerol, red or yellow colour, anise flavour, and purified water.^{8, 9}
• Physeptone (only available for travel): the main ingredient is methadone hydrochloride 10mg.^{10, 11}

Methadone for opioid dependence

Generally, there are two types of methadone programs:

• Maintenance (long-term programs): May last for months or years and aim to improve quality of life and reduce the harms associated with drug use. Most commonly given when someone is actively going through opioid withdrawal.^{2, 12}
• Withdrawal (short-term detoxification programs): Short term programs focus on easing the discomfort of stopping opioid use.¹²

How effective is it?

Methadone pharmacotherapy has consistently shown positive results for the treatment of opioid dependence.²

However, methadone treatment is more likely to be successful if it’s part of a comprehensive treatment program, which addresses the body, mind, and environment in which opioids are being used.¹³

For example, treatment may include a combination of methadone, counselling, alternative therapies, and a positive support network of peers and friends.^{13, 14}

Program characteristics play a key role in successful outcomes, with the most important factor being the length of time in treatment. Other factors that support patients include adequate dosing, and trust and confidentiality between patients and staff.²

Methadone maintenance may not work for everyone, so it’s important to consult a doctor or drug counsellor to find the best approach.

Advantages of methadone maintenance over heroin use:

• Methadone maintenance helps to keep a person stable while they make positive changes in their life.⁴
• Health problems, particularly those related to injecting drugs, such as HIV, hepatitis B and C, skin infections, and vein issues, are reduced or avoided.²
• Methadone withdrawals are more easily managed than withdrawals from heroin.¹
• Methadone’s long-lasting effect (24 to 36 hours) of preventing withdrawal allows most patients to take a dose and remain stable. This avoids the four-hour cycles of high and withdrawal seen with heroin use.¹⁵

Effects of methadone

The use of any drug can have risks. It’s important to be careful when taking any type of drug.

Methadone can affect everyone differently, based on:

• size, weight and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the environment (where the drug is taken).

Onset and duration of effects

How fast a drug takes effect and how long it lasts can vary depending on how it's taken.¹⁶

When swallowed, the effects of methadone syrup can be felt within 20 to 90 minutes.¹⁷

A single dose of methadone syrup lasts about 24 to 36 hours.¹⁵

Side effects

The main side effects of methadone typically happen during the early stages of maintenance treatment.²

Side effects include:

• sweating (drink at least two litres of water each day to prevent dehydration)
• difficulty passing urine
• loss of appetite, nausea and vomiting
• abdominal cramps
• constipation
• aching muscles and joints
• irregular periods
• low sex drive in males
• rashes and itching
• lethargy, mental clouding and confusion.¹

For methadone maintenance treatment, your doctor will determine your methadone dose. If the dosage is too low, you may still experience opioid withdrawal symptoms along with methadone’s negative side effects.¹

Impact of mood and environment

Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’): 

• Set: a person’s state of mind, previous encounters with the drug, and expectations of what’s going to happen. For example, feelings of stress or anxiety before using methadone may result in an unpleasant experience and make those feelings worse.
• Setting: the physical and social environment where you take methadone – whether it’s known and familiar, who you're with, if you're indoors or outdoors, the type of music or sounds, and lighting. The ideal setting to take methadone will vary based on the individual and drug they’re using.¹⁸

Being in a good state of mind, with trusted friends and a safe environment before taking methadone reduces the risk of having a bad experience.¹⁸

Overdose

If you take a large amount of methadone you could overdose.¹²

Your risk of overdose increases significantly if you mix methadone with alcohol or other drugs, including medications such as benzodiazepines.^{12, 17}

Methadone pharmacotherapy greatly reduces the risk of opioid-related overdose.¹²

But, methadone overdose can still cause death.¹⁷

Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide more instructions).

Signs of methadone overdose can include:

• unconscious or non-responsive
• slow breathing, abnormal breathing, or not breathing at all
• slow or no heartbeat and pulse
• choking or gurgling sounds
• skin colour changes, especially lips and fingernails
• bluish-purple skin for people with lighter complexions
• greyish or ashen skin for people with darker complexions
• vomiting
• cool or clammy (wet and sweaty) skin
• small ‘pinpoint’ pupils.^{1, 19, 20}

There is an increased risk of overdose within the first two weeks of methadone treatment or when switching from another opioid pain medication.^{1, 21}

The pain relief from methadone happens before its effects on breathing, this means taking more doses can dangerously affect a person’s ability to breathe.¹

Learn more on overdose and drug-related emergencies.

Naloxone

Naloxone (also known as Nyxoid®/Narcan®) temporarily reverses the effects of opioid overdose (including methadone). It’s available for free over the counter from most local pharmacies and can be administered by anyone, including family or friends and bystanders.²²

If a person does not respond to the first dose after 3 minutes, give them a second dose. This can be repeated until the ambulance arrives.^{23, 24}

Find naloxone near you

Mixing with other drugs

Mixing methadone with other drugs can have unpredictable effects and increase the risk of harm.

Mixing includes using more than one drug (including alcohol or medications) at the same time, or one after another. You should also consider what drugs you’ve taken in the last 24 hours.

• Methadone and alcohol / benzodiazepines : Risk of increased drowsiness. This includes slowed breathing. Potential to cause coma and death.¹
• Methadone and MAOI antidepressants: Can cause delirium, convulsions, breathing difficulties and death.¹
• Methadone and fluoxetine (antidepressant): Can increase concentration of methadone in the blood. Check with your doctor about dosages for methadone and fluoxetine.²
• Methadone and GHB/GBL: Can quickly lead to unconsciousness. While unconscious, there is a risk of choking on vomit if the person is not placed in the recovery position. Can cause death.¹⁷
• Methadone and Ketamine: Both substances carry a risk of vomiting and unconsciousness. While unconscious, there is a risk of choking on vomit if the person is not placed in the recovery position. Can cause death.¹⁷
• Methadone and stimulants: Stimulants raise the breathing rate, allowing for a higher dose of methadone than usual. However, if the stimulant wears off first, methadone may dangerously slow the person’s breathing^.17

Using more than one drug or type of drug at the same time is called polydrug use.²⁰

Reducing harm

There are ways you can reduce the risk of harm when using methadone.

• Follow your doctors’ instructions on how and when to take methadone. Do not stop taking methadone or change the dose without talking to your doctor.
• When starting methadone treatment or making significant dose adjustments, a person should avoid driving or operating heavy machinery.
• Talk to your doctor if you experience any unexpected side effects or discomfort.²⁵

Coming down

Methadone is not known to cause comedown effects.

Long-term effects

Long-term effects can vary depending on how much, how often and how methadone is consumed.

Regular use may eventually contribute to physical and psychological dependence.¹

Methadone and mental health

Opioid pharmacotherapy, such as methadone, can improve mental health by reducing withdrawal symptoms, cravings, and suicide risk.^{12, 26}

It can also provide greater life stability, supporting improved wellbeing, relationships, and social functioning.^{12, 26}

This is especially important as people experiencing mental health concerns such as depression, anxiety, PTSD, psychosis, or bipolar disorder are also at higher risk of an opioid overdose compared to those without these conditions.²⁷

Tolerance

A person’s tolerance to methadone usually stays stable, allowing those on methadone maintenance treatment to remain on the same dose for many years.^{2, 4, 15}

Although tolerance to methadone’s pain-relieving effects may develop, the drug still reduces opioid cravings and prevents withdrawal, even after 30 years of use.^{2, 4, 15}

Dependence

A person who enters a pharmacotherapy program for opioid dependence remains dependent on opioids. However, the program helps them stop or reduce their use of shorter-acting opioids and, as a result, reduces their risk of related harms.¹¹

Withdrawal

Withdrawal refers to the symptoms that can occur when someone who is dependent on a drug, or who has been using it regularly over time, stops or reduces their use.²⁸

Withdrawal can include physical symptoms (such as headaches, or nausea) and psychological symptoms (such as anxiety, or depressed mood).²⁸

Symptoms - including how strong they are and how long they last - will vary depending on the type of drug and a person’s history of use.²⁸

If you, or someone you care about, is planning to stop taking methadone after using it for a long time, it’s important to speak with a medical professional for guidance and supervision. 

Withdrawal symptoms

Reducing, or stopping using methadone after a period of regular use can lead to withdrawal symptoms, including:

• Runny nose
• Yawning
• Sweating
• Restlessness
• Irritability
• Fever
• Chills
• Abdominal cramps
• Diarrhea
• Nausea
• Itching 
• Agitation and anxiety
• Cravings for methadone.¹

Withdrawal symptoms typically start 24-36 hours after the last dose. They peak around 3 days, then gradually subside.¹

Reduced tolerance and overdose risk

After withdrawing from methadone, your body is no longer used to opioids and your tolerance drops.¹⁷

This means if you use the same amount as before, it can be too much for your body and cause an overdose.¹⁷

Always start with a lower dose when taking any opioids after a break from methadone.¹⁷

Pregnancy and breastfeeding

Methadone is not known to cause birth defects.^{1, 29}

For people receiving methadone treatment for heroin dependence, methadone is a safer option than injecting heroin during pregnancy, as the baby's withdrawal symptoms are likely to be milder and easier to manage.^{1, 29}

Methadone treatment also reduces the risk of bloodborne viruses such as HIV and hepatitis C.²⁹

Small amounts of the drug are present in breastmilk. However, negative effects on the baby are unlikely.¹

Getting help

If your use of methadone is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about someone, there is help and support. 

• Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs.
• Call Pharmacotherapy Advocacy Mediation Support (PAMS) on 1800 443 844 for a free and confidential service that assists with pharmacotherapy issues between clients, prescribers and dispensers.