Is Methadone a good choice for opioid dependence treatment?

Before we answer this question, let’s highlight several important, antecedent decisions:

Decision #1:  Medication-assisted treatment (MAT) vs. Abstinence treatment?

This should be a personal choice made in collaboration with your support team/network. If you have a record of multiple failed attempts at abstinence therapy or relapses then maybe you should now consider medication-assisted treatment as a bridge to eventual abstinence. 

Decision #2:  Choice of treatment drug: Opioid Agonist vs. Antagonist therapy vs. Withdrawal (“detox”) treatment/symptom management.

If you’ve decided to use medications in your recovery therapy then there are three categories of medications to choose from, depending on the type of MAT that you prefer. These categories are:   

1) Opioid agonist medications

2) Opioid antagonist medications

3) Symptomatic treatment medications

Approved Opioid agonist medications include only Buprenorphine (mono-product or combined with naloxone) and Methadone.

Approved Opioid antagonist medications include Naltrexone.

Symptomatic medications are palliative medications, primarily used to treat opioid withdrawal symptoms. For most, this is an unapproved use. This list frequently includes Clonidine, Lofexidine, and many others not specific to this purpose only, such as sleep meds, anti-nausea meds, etc.

Why Methadone? / What makes methadone a good choice?

• A long duration of action, allowing convenient once-daily dosing. 

• There is no dose maximum (but it may have cardiac effects that could limit dose).

• It can be titrated (dose adjusted) individually to your satisfaction/optimal effect.

• Methadone is a complete opioid, not a partial one, like buprenorphine.

• These qualities may allow it to have a more satisfactory/complete effect on the user.

• Methadone treatment is predictably phased: induction + stabilization >> maintenance >> MSW (medically-supervised withdrawal/tapering off).

• The duration of therapy is variable/customizable. It can be predetermined or indeterminate. Detox only, short-term vs long-term vs indefinite/open-ended treatment duration.

• Clinic setting: provides close supervision/monitoring, provides in-house counseling.

• Slow, gradual detox (medically-supervised tapering off of the medication).

• Treatment is flexible and adapts to special situations: 
  • Pregnancy
  • Incarceration ( in some jurisdictions)
  • travel/ relocation

My Opinion:

Methadone maintenance treatment is a good choice for medication-assisted treatment. The two biggest hurdles to overcome are mental – the lingering stigma/stereotyping surrounding methadone treatment and secondly, the clinic atmosphere may not be to some’s liking.

The effectiveness of the treatment, however, in terms of saving and rehabilitating lives is undisputed.