When most people hear the word methadone, they usually associate it with heroin addicts and those suffering from opiate withdrawal.  What most people don’t know is that in recent years methadone use in managing chronic pain has increased substantially.  As a painkiller, it is very effective, and it is also very inexpensive compared to other opiate alternatives, making it affordable even for the uninsured. 

Why It Is Used:

Methadone is used in the pain management arena to treat severe chronic pain that has not resolved through use of other therapies.  It is very rarely used as a first- or even second-line drug, and is sometimes viewed as the drug of last resort for patients whose pain has not resolved despite other treatment modalities.  It is also becoming an increasingly popular medication for those whose condition has reached the palliative stage, often end-stage cancer patients, where morphine has traditionally been the medication of choice.  Methadone is to be used only for chronic pain, and should never be used for acute conditions, such as a broken arm, tooth pain, or sudden-onset back pain. 

Why It Is So Effective:

Methadone is a very strong opiate that binds to the opiate receptors in the brain that send pain signals to the body.  As a result, once a patient is stabilized on a therapeutic dose of methadone, it is very likely that they will be nearly pain-free, regardless of how high their pain-scale levels were before -- although some patients may require low doses of short-acting opiates for breakthrough pain even when taking methadone.  It often takes up to a week for a patient’s methadone levels to stabilize in the bloodstream; once that occurs, though, they are provided with even, around-the-clock pain relief, without consistent periods of breakthrough pain often found when using short-acting opiates alone. 

What You Should Know Before Considering Methadone:

Methadone is a very strong pain medication.  It has the ability to cause dependency in a very short amount of time -- often within a matter of weeks.  It is also a very unique drug in that it is metabolized differently from patient to patient, thus making it difficult to know how you will react to the medication until you take it.  For this reason, methadone is typically not used in opiate-naïve patients, and the mantra in the medical profession is to start low and go slow -- starting at the lowest possible loading dose, and increasing slowly until the therapeutic dose is reached.  If you are a chronic pain patient who is considering discussing methadone with your physician, be sure to also consider whether your condition requires long-term pain management, or if it may require a shorter duration of treatment.  Methadone withdrawal can be very serious if not done under a proper tapering regimen under the care of your prescribing physician -- and even then can be a long-lasting and difficult process depending on your dose and length of time using the drug.    

Methadone toxicity is a very serious concern and can be fatal.  Methadone itself causes respiratory depression, and should not be mixed with other drugs unless approved by the prescribing physician.  Most importantly, you should not mix methadone and benzodiazepines -- Xanax, Valium, Klonopin -- unless approved by your physician.  There is a black-box warning regarding this combination from the FDA as most -- but not all -- deaths involving methadone occur when the patient mixes methadone with other prescription medications or illicit substances.  You also should not drink alcohol while on methadone, as alcohol is also a central nervous system depressant and death may occur if breathing becomes too weak. 

Methadone Side Effects:

As with all medications, there are side effects to taking methadone, and some of them can be serious.

  • Weight gain -- this should not be taken lightly, because significant weight gain can lead to other health problems/conditions.  It is not uncommon for people on methadone to gain significant amounts of weight in a relatively short amount of time.  Discuss this with your doctor before starting methadone therapy.
  • Constipation
  • Increased urination as a result of increased fluid intake.
  • Increased sweating
  • Dizziness/light-headedness

More serious side effects include difficulty breathing/shallow breathing, fainting, throat closing/swelling shut.  If these side effects occur, seek immediate medical attention. 

Other Considerations:

You must use methadone responsibly.  It does not cause the euphoric effect of most other opiates, and it is easy to believe that the medication is not working, leading to overdose.  Compared to other opiates used to fight chronic pain, methadone is very subtle.  It builds up slowly in the body and its full analgesic effect may not be realized right away.  However, once it has reached therapeutic levels, it simply eliminates feeling even the worst of pain.    

Before deciding on methadone therapy, you should also know and be prepared to deal with the stigma that is attached to the drug.  You will encounter people who are ignorant to its use as an analgesic, both among family and friends, and even sometimes those in the medical profession.  It is often advisable to tell as few people as possible that you are using methadone to treat chronic pain, to avoid having to deal with this unfortunate situation. 

Although methadone is an unpredictable drug that has serious risks, when used responsibly, under the care and direction of a competent pain management physician, it is an excellent drug for those who suffer daily with severe chronic pain, allowing them to achieve a better quality of life regardless of their condition. 

*This article is not to be used as a substitute for medical advice.  Please consult your physician to discuss whether methadone is appropriate for your condition.