Methadone for Opioid Addiction: Uses, Risks, and What to Expect

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More than 550,000 people in the U.S. receive methadone to treat opioid addiction. It is one of several FDA-approved medications for opioid use disorder (MOUD).

But how does this medication work? Who is eligible? And what are the benefits and drawbacks? Find answers here. 

In this article:

• What is Methadone?
• Benefits & Risks of Methadone
• Getting Methadone in 2025
• What to Expect
• Cost & Insurance
• Comparison to Other Medications
• Safety & Harm Reduction
• FAQs

What Is Methadone?

Methadone is a schedule II drug. This classification means it has a high potential for abuse, therefore its distribution is controlled (scheduled). 

In other words, it’s not something that anyone can get over-the-counter, and it’s not a medication that every clinician can freely prescribe.

However, approved opioid treatment programs (OTPs) can offer this medication to treat opioid use disorder (OUD).

How Methadone Works

Methadone is a long-acting full opioid agonist. This means it interacts with certain receptors in the brain to lessen pain (similar to morphine or oxycodone).

Taken as an MOUD, methadone can effectively bind with these receptors to prevent cravings for other opioids. By stabilizing the receptors, the medication can lessen the pain of withdrawal and block euphoric effects of other drugs such as heroin.

The medication is taken daily, typically in liquid form.

Who Methadone Helps

Methadone is prescribed to individuals who have been diagnosed with an opioid use disorder. Because it is long-acting, it stays in the body longer than other opioids, and it does not produce the same euphoric effects. Instead, it reduces withdrawal symptoms and cravings.

Receiving daily doses of methadone for opioid use disorder can help individuals manage their addiction and reduce the risk of using other opioids. It can allow those with an OUD to function in day-to-day life.

For women who are pregnant, methadone is considered a first-line treatment for OUD. It is important to work closely with clinicians to monitor this treatment, which should involve both prenatal caregivers and addiction specialists.

Exposure to MOUD can result in neonatal abstinence syndrome (NAS) in the infant. However, this can be treated, and it should not deter women from receiving MOUD while pregnant.

Benefits & Risks

As with any medication, methadone for opioid use disorder offers benefits, but it can have side effects. Taken under careful medical supervision, the potential risks can be mitigated, allowing patients to safely benefit from methadone treatment.

Methadone Benefits

Research has shown that methadone can reduce the risk of overdose, death, and other health hazards. It also improves treatment retention compared to non-medication pathways: 

• Those who have an OUD and are treated with methadone are less likely to die or experience an overdose than those who don’t receive this treatment.
• Methadone reduces the likelihood of risky behaviors such as injecting drugs or having multiple sexual partners.
• Methadone treatment for inmates has shown to reduce recidivism and risk of overdose after release from prison.

Methadone Side Effects

The potential side effects of methadone range from common to severe. If an individual experiences serious side effects, they should stop taking the medication and contact medical services immediately.

Common Side Effects

• Vomiting/nausea
• Itchiness
• Headache
• Constipation
• Restlessness
• Slow breathing
• Sexual problems
• Heavy sweating

Serious Side Effects

• Chest pain
• Lightheadedness
• Rapid heart beat
• Hives, rash, or swelling
• Difficulty breathing
• Hallucinations or confusion

Heart Side Effects

Another potentially serious effect of methadone is QT prolongation. QT is a measurement of electrical activity in the heart that influences the heart rhythm.

Methadone can cause a change in this rhythm, which can lead to irregular heartbeats. Because these arrhythmias can be fatal, close medical monitoring of those taking methadone is essential. 

Drug Interactions

Methadone is a central nervous system depressant, so taking it in combination with benzodiazepines (also depressants) can cause serious issues with the nervous system. The combined effect can lead to breathing problems or even coma or death.

Alcohol, also a depressant, poses similar risks when consumed in combination with methadone. This makes it extremely important to avoid these other substances while taking methadone.

Getting Methadone in 2025

Methadone has been used to treat addiction for more than 50 years. However, regulations surrounding its use have evolved during that time. In recent years, take-home and telehealth options have played a significant role in the latest stage of this evolution.

OTPs vs. Office-Based Care

Federal regulations established in the 1970s limited methadone dispensing to OTPs. Only SAMHSA-certified OTPs may dispense methadone for OUD. This means patients who are prescribed methadone must receive the medication at an OTP rather than a doctor’s office or pharmacy.

These boundaries were designed to prevent methadone abuse and ensure patients received appropriate supportive care. And until the COVID pandemic, strict policies remained in place requiring in-person visits to an OTP for medication. However, in 2024, these regulations changed.

Telehealth & Take-Homes: What Changed in 2024

The COVID pandemic caused healthcare providers and policy makers to re-examine the rules regarding methadone dispensing.

At the height of the pandemic, more flexibility was needed to allow patients to access medications without risking exposure to COVID. Providers began exploring more options for take-home doses of methadone as well as telehealth opportunities.

In 2024, SAMHSA’s OTP Final Rule (42 CFR Part 8) made these flexible policies permanent. Methadone treatment may now take place via telehealth, and patients can receive take-home doses rather than visiting an OTP in person.

Stabilized patients may be eligible to take home up to 28 doses of the medication.

Criteria for admissions and qualifications for take-home doses were also expanded to be more inclusive. The Rule also broadened the scope of practitioners who can prescribe MOUD.

The Rule took effect April 2, 2024, with a compliance date of October 2, 2024.

The goal of these new regulations is to remove barriers to treatment that many individuals have faced in the past.

The availability of telehealth methadone and the opportunity to receive take-home doses has the potential to expand treatment to many who were previously unable to access the medication due to transportation issues or other obligations that made daily visits to an OTP unfeasible.

What to Expect: First Visit, Dosing, Monitoring

If you are prescribed methadone for opioid use disorder, your treatment is monitored closely by a healthcare provider. While flexibility with take-home doses and telehealth options have increased, this close supervision is necessary for optimal outcomes. 

During your first visit, the clinician completes an assessment that typically includes your overall health, history of substance abuse, goals for treatment, and any other factors that may influence your treatment.

They also conduct a urine tox screen, to determine what substances are currently in your system. Based on this assessment, they determine whether methadone for opioid use disorder is the best course of treatment for you.

Induction & Dose Adjustments

The first dose of methadone is a low dose. The prescribing healthcare provider will gradually increase this dose and monitor for side effects and effectiveness.

The dosing will be adjusted accordingly, until a maintenance dose is reached.

How long this dosing is maintained differs from patient to patient. If tapering off methadone is part of the treatment plan, dosing will eventually decrease over time to reduce reliance on the medication.

The end-goal may be to stop taking the medication once stability in sobriety is achieved.

Counseling

MOUD should always be prescribed in conjunction with counseling. While the medication manages the physical side of addiction, counseling addresses the emotional, mental, and relational aspects.

Common therapeutic methods applied during addiction counseling include cognitive behavioral therapy, motivational interviewing, and dialectical behavior therapy. These methods focus on changing thought and behavior patterns that lead to drug abuse and addiction.

Cost & Insurance

Methadone treatment costs an average of $4,700 per year, or around $13 a day. Fortunately, methadone for opioid use disorder is covered under most insurance plans, including Medicare.

Insurance Coverage

The Mental Health Parity and Addiction Equity Act of 2008 requires that insurance providers cover treatment for mental health and substance use disorders equal to the coverage provided for other medical care. This includes methadone for opioid use disorder. 

While exact coverage may vary by plan, at least some of the cost of this treatment must be covered by insurance.

How to Verify Benefits

To verify your coverage, it is best to contact your insurer directly. It is also important to verify with the treatment provider that they accept your insurance and find out how this will be billed to your insurance company.

If you have Medicare or Medicaid, you can call those programs directly or visit their websites for more information on coverage.

Methadone vs. Buprenorphine vs. Naltrexone

These three medications are widely prescribed to treat opioid use disorders. They are all FDA-approved, but each has unique benefits and drawbacks.

Clinicians determine, based on individual circumstances, which medication is best suited for each patient. 

Safety & Harm Reduction

The harm reduction approach to treating addiction aims at minimizing negative consequences rather than demanding abstinence from substances.

Methadone’s role in harm reduction includes: 

• Preventing the spread of infectious diseases
• Preventing overdoses
• Reducing stigma
• Improving treatment retention

For safe use of methadone, close medical supervision is required. Clinicians monitor and adjust dosing as needed to prevent adverse outcomes.

Naloxone 

Also known by the brand name Narcan, naloxone is an effective treatment for opioid overdose. To further improve the safety of methadone programs, many OTPs provide prescriptions or take-home doses of this medication.

Recent policy changes have also made this drug available over-the-counter (without a prescription) at pharmacies nationwide.

Methadone Addiction FAQs

Can I Start Methadone Via Telehealth?

Yes. The 2024 Final Rule allows OTPs to initiate methadone treatment via audio-visual telehealth. An in-person exam is not required if the healthcare provider determines that a telehealth visit can provide an adequate patient assessment.

How Fast Can I Get Take-Home Doses?

This can vary by state and clinic. In some cases, take-home doses may be available after the initial assessment.

Is Methadone Safe During Pregnancy?

Methadone is FDA-approved for use during pregnancy. SAMHSA recommends methadone in combination with medical treatment and counseling, for pregnant women who are experiencing OUD.

How Can I Find a Methadone Clinic Near Me?

Use the Rehab Center locator to search by area, treatment type, and other filter options. Or call  800-681-1058 (Sponsored)  to speak with someone about treatment options and insurance coverage.