Methadone is prescribed by healthcare professionals for the management of chronic pain and by DEA registered addiction professionals, as a part of substance use treatment. It has two primary purposes:
- to treat moderate to severe pain
- to treat narcotic drug addiction
Want to know more about the methadone prescribing process and options? Here, we explore how methadone is usually taken, how is it supplied, and what you need to do before getting on methadone. Then, we invite your questions. In fact, we’ll try to respond to all legitimate questions about methadone with a personal and prompt reply.
How is methadone supplied?
Methadone is a white-powdery substance, supplied as tablets, which are designed to be swallowed whole, while other methadone tablets are intended to be dissolved in liquid. Also, methadone is available as a ready-to-drink solution. There is a methadone concentrate, which must be mixed with water or fruit juice before administering. Another way methadone is supplied is as a liquid taken via injection.
1. Methadone hydrochloride tablets are available in 5 mg and 10 mg dosage strengths. The 5 mg tablets are white to off-white, modified rectangle shaped convex tablets, and the 10 mg tablets are white to off-white, modified rectangle shaped convex tablets.
2. Methadone Oral Concentrate (methadone hydrochloride USP) is supplied as a cherry flavored liquid concentrate. It contains 10 mg of methadone hydrochloride per mL.
3. Methadone Sugar-Free Oral Concentrate (methadone hydrochloride USP) is a dye-free, sugar-free, unflavored liquid concentrate of methadone hydrochloride. This liquid concentrate contains 10 mg of methadone hydrochloride per mL.
4. Methadone Diskets are supplied in 40 mg strength. A a single (40 mg) Diskets may be broken in half to yield two 20 mg doses or in quarters to yield four 10 mg doses. Diskets are intended for dispersion in approximately 120 mL of liquid. They should be taken immediately after dispersing into water, orange juice, or other acidic fruit beverage.
5. Oral liquid doses are different. Your prescription should include mg strength as there are multiple concentrations available.
6. Methadone Hydrochloride Injection is an opioid analgesic given by professional medical staff during inpatient care or during an emergency period of no longer than 3 days. Each milliliter of Methadone Hydrochloride Injection contains 10 mg (0.029 mmol) of methadone hydrochloride, equivalent to 8.95 mg of methadone free base.
Who prescribes methadone?
It’s a little confusing at the moment how methadone is prescribed. This is because the use of methadone to treat addiction has been heavily regulated and strictly controlled in the U.S.
Licensed physicians can write a prescription for methadone, if it’s prescribed for pain. Federal law and regulations do not restrict the prescribing, dispensing, or administering methadone, for the treatment of pain, if such treatment is deemed medically necessary by a registered practitioner acting in the usual course of professional practice.
Confusion often arises due to regulatory restrictions concerning the use of methadone for the maintenance or detoxification of opioid addicted individuals, in which case the practitioner is required to be registered with the DEA as a Narcotic Treatment Program (NTP). This is why most family doctors will refer you to an addiction specialist for diagnosis if you are ready to quit using drugs. Following assessment, methadone can be delivered only through specially licensed clinics, called Opioid Treatment Programs.
How do you usually take methadone?
As we listed above, there are several ways to administer methadone: orally, as tablets, oral concentrate, diskets, or liquid, and through injection. Some people take methadone and put it under the tongue for a sublingual administration, while there is also a rectal route of administration usually suggested as an alternative in cancer pain (but the bioavailability of the rectal route is not known).
For the management of CHRONIC PAIN, usual adult methadone doses are:
- Initial doses for the opiate-naive: 2.5 mg orally, administered every 8 to 12 hours.
- Initial doses for people switching from other oral opioids treatment: 20 mg per day (10 mg for the elderly or infirmed).
- For patients switching from injectable/IV methadone to oral: Use a conversion ratio of 2:1 for oral to parenteral (e.g., oral methadone 10 mg to parenteral methadone 5 mg).
For the management of OPIATE WITHDRAWAL, (according to treatment standards cited in 42 CFR (Code of Feral Regulations) Section 8.12) usual adult methadone doses are:
- Oral: initial doses are generally 20 to 30 mg. The maximum initial dose is 30 mg while the maximum initial daily dose should not go over 40 mg per day.
- Injection or IV: A patient’s oral dose is converted to the parenteral dose based on a 2:1 ratio (e.g., oral methadone 10 mg = parenteral methadone 5 mg).
For the management of PAIN, usual adult methadone doses for the opiate-naive are:
- Initial IV doses are 2.5 mg – 10 mg every 8 to 12 hours.
- Oral methadone is not indicated as an as-needed analgesic; due to increased risk of overdose and death with this long-acting opioid.
*NOTE: Initiation, dose adjustment, switching from one form of methadone to another, or switching from another opioid to methadone should be done according to your doctor’s suggestions, as prescribed and with the proper monitoring needed. The dosages listed here are the initial general prescribing doses, and you should also follow your doctor’s orders when increasing or decreasing methadone.
Before you get methadone: Doctor-Patient information
Before taking methadone, tell your doctor and pharmacist if you are allergic to methadone or any other medications. Further, be sure to also share the following information with your doctor:
- if you are breast-feeding
- if you are having surgery, including dental surgery
- if you experience seizures
- if you have an enlarged prostate (a male reproductive gland)
- if you have difficulty urinating
- if you have or have ever had a blockage in your intestine
- if you’ve been diagnosed with Addison’s disease
- if you’ve been diagnosed with thyroid, pancreas, gallbladder, liver, or kidney disease
- what herbal products you are taking, especially St. John’s wort
- what prescription and nonprescription medications you take,
- what vitamins and nutritional supplements you are taking or plan to take
You should also know that this medication may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. I can also cause dizziness, especially after lying down. Further, methadone is known to cause constipation. Talk to your doctor about changing your diet or using other medications to prevent or treat constipation while you are taking methadone.
Methadone v.s. Buprenorphine and Naloxone
On the market there is a combination of Buprenorphine and Naloxone (Suboxone) that helps for detox from prescription opioid addiction. Suboxone (buprenorphine) works in the brain by activating opioid receptors, reducing drug craving and preventing withdrawal. Naloxone helps prevent misuse of the medication.
Methadone, as a full opioid agonist, continues to produce effects on the brain’s opioid receptors until either all receptors are fully activated, or the maximum effect is reached. While buprenorphine, as a partial opioid agonist, does not activate receptors in the brain to the same extent as methadone. Buprenorphine reaches a ceiling effect at a moderate dose, which means that its effects do not increase after that point, even with increases in dosage. Methadone on the other hand, has no ceiling effect, so it’s more effective and useful in patients dependent on high doses of opioids.
Which one should you be prescribed? That is completely individual!
Suboxone is great, but it’s not for everybody. Some feel better on buprenorphine, some feel better on methadone. In general, if a person has been using opioids chronically, for a longer period of time, or has a higher tolerance, methadone would be more appropriate. But Suboxone has a pretty good safety profile and is appropriate for those who get the needed effects from it. The dependence and addiction potential for both medications are about the same.
Getting methadone questions
Do you have additional questions about getting or using methadone? Feel free to leave them in the comments section below and we will try to answer you personally and promptly.