FAQ

Methadone is a medication used to treat Opioid Use Disorder (OUD), a chronic disease of the brain, sometimes called an addiction, characterized by the persistent use of opioids despite harmful consequences caused by their use. Opiates are a class of highly addictive natural extracts from the poppy plant that include Opium, Morphine, Codeine and Heroin. Methadone is an opioid, a controlled drug synthetically derived from an opiate, prescribed by a doctor and dispensed in a Federally certified, SAMHSA Opioid Treatment Program (OTP). Methadone is used during the course of Medication Assisted Treatment (MAT) for OUD. MAT in conjunction with counseling by CASAC certified counselors are used together to guide the patient on the road to recovery.

Methadone is used to reduce the craving that OUD patients feel for an opiate such as heroin. To understand how methadone works we need a little background in how opiates affect the human brain. Opiates bind to opioid receptors in the brain and cause the release of large amounts of dopamine which, in turn, induces euphoria, a blissful state of mind, and physical numbness. Consistent use of heroin creates a perpetual need for that feeling of euphoria or “high” brought on by the dopamine. To interrupt this cycle, methadone, a full agonist administered daily, binds to those same opioid receptors, effectively taking the place of the heroin but with a much longer, less dramatic euphoria. Patients taking methadone feel less or even no “high” for a longer period of time between doses allowing them a safer, more balanced and productive life.

This is a common misconception. The difference between methadone and an opiate like heroin is that methadone is a controlled medication, prescribed by a doctor in a clinical setting thereby reducing the danger faced by patients satisfying their craving on the street. Furthermore, these patients are followed regularly by medical and behavioral health staff catering to their physical and mental health needs. In regular treatment, the prescribing physician finds the proper dose of methadone which reduces the craving for heroin without inducing the associated “high”. Once this “sweet spot” is found, the patient can live a more meaningful, productive, less-stressful, safer life. As treatment progresses and with the assistance of counseling, some patients can be tapered off methadone completely while others may remain on a negligible dose for the remainder of their lives. But both can be considered eventually as having achieved full recovery.

There is a common stigma associated with Methadone held usually by persons who have been misinformed. Many don’t understand how addiction and addiction treatment work for patients. Many believe that the opioid dependent are weak and lacking in moral character and somehow less worthy. They believe that using methadone is the same as using heroin therefore enabling that moral weakness. Nothing can be further from the truth, and these are stigmas which we combat every day with education and enlightenment. When discussing your treatment with others remember that opioid use disorder (OUD) is NOT a character flaw. OUD is a chronic illness, and methadone is an opioid prescription medication that has been used to treat that illness since the 1960’s. Over the years Methadone Medication-Assisted Treatment (MAT) has assisted millions of people recover from opioid addiction. Remember that methadone, taken daily as prescribed, treats an illness, Opioid Use Disorder, in much the same way as insulin treats diabetes and should therefore not be looked down upon in any way. Would you look down upon a diabetes patient for using insulin every day? Obviously not, and methadone use should be viewed the same way.

Outpatient MAT treatment begins with a patient’s diagnosis of OUD by a Medical Professional. This diagnosis can be given during a telehealth or in-person patient visit. Following the diagnosis the patient is started on an initial daily dose of methadone to block the effects of opiates. This dose is then adjusted by the medical professional, over time, to find the appropriate level that reduces and eliminates the craving for opiates. Initially, for patient safety, the dose of methadone is administered in-person, under the supervision of a medical practitioner such as a nurse. After a period of time, the patient is allowed take-home medication which allows the patient more flexibility and empowers them in their own treatment. The amount and timing of daily take-home medication is ultimately determined by the physician with the input of a multidisciplinary team including the counselor and other professionals. The decision for take-homes depends on a number of factors including the patient’s progress in treatment, abstinence from opiates and ability to safely store the medication which can be dangerous if mishandled. Counseling is also an important part of the treatment. To identify underlying causes for the opiate use disorder, patients meet regularly with a credentialed behavioral health counselor. These visits explore the patient’s background to identify triggers and to develop behavioral coping skills that will promote harm reduction and prevent relapse.

Outpatient MAT treatment is voluntary. The intention of the OTP is to provide patient-centered care which gives patients a say in their treatment, and which minimizes disruption to patient’s’ lives and eliminates barriers to treatment. The focus of treatment is to provide a flexible structure which isn’t onerous to the patient, and which finds the patient’s individual path to recovery. That path does, however, include certain guardrails which over our years of experience have proven to assist most patients in recovery. Those guardrails are thoughtfully imposed by our medical professionals with the patient’s individual needs and considerations in mind. We realize patients have private lives which shouldn’t be hampered by treatment and that the frequency of clinic visits directly impacts those lives. Our goal at LMA is to safely decrease frequency of clinic visits and increase take home medication availability in an ongoing evaluation which balances patients’ convenience with patient’s safety.

This is a common misunderstanding of the new regulations ratified by SAMHSA and supported by OASAS since the COVID pandemic. The “new regs” DO NOT guarantee a right to patients to immediate take home medications. At the discretion of the Medical Director, the “new regs” DO allow an Opiate Treatment Program greater flexibility to allow qualified patients, on a case-by-case basis, to carry out their daily doses of methadone, a controlled substance which can be dangerous if lost or abused. If the Medical Director finds that a patient qualifies, take homes can be and are awarded sooner than they used to be before the Pandemic and greater flexibility is now placed on attaining reduced pick-up schedules sooner. We at LMA enthusiastically endorse this more patient-centered approach but always with a thoughtful eye towards the individual patients’ needs and circumstances and their progress and attitude towards treatment.

This is also a misinterpretation of the spirit of the “new regs”. The “new regs” only say that failure to see your counselor cannot be used punitively in MAT. At LMA participating in counseling is NEVER used punitively but it does remain one of the fundamental “legs of the stool” in our approach to Medication Assisted Treatment (MAT). Counselors help patients reflect on certain behavioral patterns which may contribute to opioid dependence and relapse. During treatment counselors remind patients that accountability and responsibility are key elements to achieving better outcomes. A successful counselor-patient relationship is a bond which contributes to an enduring recovery which can last a lifetime.