Methadone Side Effects - Separating Fact from Fiction

Millions of people have used and continue to use methadone as a treatment medication for opiate addiction. Methadone will sometimes cause side effects. The overwhelming majority of people who are involved in methadone maintenance treatment find the side effects to be mild and bearable, and the hundreds of thousands that continue to use methadone on a daily basis are a testament to how well most people tolerate the medication.

Although methadone has been administered on a wide scale and quite safely for decades within the United States, it remains a polarizing and controversial treatment for opiate addiction – but much that is widely believed about methadone side effects is not true.

Read below to find:

  1. A list of the common side effects caused by methadone treatment
  2. A list of side effects experienced during the first week of methadone maintenance treatment only
  3. A list of methadone myths – side effects falsely attributed to the use of methadone.

The Side Effects of Methadone

Few medications have been studied as intensively or for as long as methadone. When used as directed, methadone does not damage the heart, kidney, lungs, brain, liver or any other major organ or system. It won't affect your intelligence, it won't get you high, and it won't interrupt or impair your ability to work, drive a car, feel pleasure and pain, and generally live a normal life.

Some people tolerate the medication very well and feel no appreciable side effects. Some people experience mild side effects, and a very small percentage of people in methadone maintenance treatment experience intolerable side effects. Although methadone is dangerous if abused, it is quite safe when taken as directed as part of a medically supervised addiction treatment program.

People that experience side effects during methadone maintenance treatment tend to feel them worst during the first weeks and months of treatment. Over time, dosage adjustments and the development of a tolerance to the medication tend to reduce the severity of experienced side effects.

Common side effects of methadone use include the following:

  • Constipation
  • Drowsiness
  • Skin Rash
  • Sweating
  • Water retention
  • Flushing
  • Changes in sex drive or erectile dysfunction
  • Dizziness (especially in the beginning of treatment and especially as a person in methadone maintenance treatment rises from a lying position)
  • Dry mouth

Constipation and Sweating

Constipation and sweating are two of the most commonly experienced side effects of methadone maintenance treatment. Methadone users can reduce the severity of constipation by eating a high-fiber diet, getting regular exercise, and making a concerted effort to avoid dehydration. Those who experience excessive sweating while on methadone seem to sweat heavily regardless of the dose taken, and do not develop a tolerance to the effect.

Sexual Dysfunction

Methadone has been associated with the following types of sexual dysfunction in some men:

  • Impotence
  • Loss of libido
  • Delayed ejaculation

A recent study showed that 40 percent of men over the age of 40 will experience moderate to severe erectile dysfunction (ED) while on methadone. For men under the age of 40, the percentage that experience ED falls to only 12 percent. The use of heroin and the illicit use of prescription opiates are also associated with erectile dysfunction.

Methadone is associated with the loss of menstruation in a very small percentage of women. More women seem to regain regular menstruation than lose it after beginning methadone maintenance treatment.

Sedation (drowsiness)

People tend to experience drowsiness most severely during the first weeks of methadone maintenance treatment, and most people will develop a tolerance to the sedating effects of methadone a few weeks after dose stabilization. Sedation can be a sign of an overly high dosage, and methadone maintenance treatment patients who feel drowsy after the first couple of months may want to discuss a dose reduction.

Itchiness, Hives, and Seizures

Itchiness, hives, and seizures are indications of a dangerous allergic response to methadone. These are not normal side effects, and the presence of any one of these reactions should prompt an immediate call to a doctor.

First Week Side Effects?

Methadone works very well, and an appropriate dosage of methadone will eliminate all feelings of opiate withdrawal, but it takes about a week of methadone maintenance treatment before the medication will provide sufficient 24-hour relief of withdrawal symptoms.

During their first week of treatment, most methadone maintenance treatment patients will experience some mild side effects.

Why Does it Take a Week?

Methadone works in the bloodstream, but it also gets stored in the liver and in certain tissues. The stored methadone gets secreted out into the body very gradually, which creates a very stable level of methadone activation over a 24-hour period, but it takes between five and seven days of methadone use for the body to store a sufficient level of the medication.

Until your body has stored enough methadone to provide for steady methadone activation (called a "methadone steady state"), you will feel some mild symptoms of withdrawal during times during the day when the level of methadone in your body is low.

Mild withdrawal symptoms that you may experience during methadone maintenance treatment include the following:

  • Anxiety or depression
  • Fatigue
  • Insomnia
  • Hot flashes
  • Muscle pains
  • Nausea
  • Restlessness
  • Cravings for drugs

If these symptoms of withdrawal continue beyond the first seven days of treatment, your methadone dosage may be too low.

Methadone Side Effect Myths

Because methadone maintenance treatment has long been a controversial and polarizing process, a lot of untruths pervade popular beliefs about methadone.

Myth #1 - Methadone Causes Weight Gain

This is a tricky one. A lot of people gain weight while on methadone, but it's not the methadone that's causing the weight gain. People on methadone feel normal levels of hunger and experience a normal enjoyment of food -- healthy appetites that had previously been suppressed by their abuse of heroin or other opiates. People on methadone often begin methadone maintenance treatment at a low weight and gain weight as they eat with a normal and healthy appetite and enjoyment of food.

Myth #2 – Methadone Rots Your Teeth

Methadone does not, in itself, have any affect on the teeth or bones

Methadone sometimes causes a dry mouth, and since saliva protects the teeth from decay, methadone users may be more vulnerable to dental problems. Additionally, methadone users tend to begin methadone maintenance treatment after a long period of dental neglect.

Methadone users can avoid dental problems by visiting their dentist regularly, avoiding sugary foods and drinks, and brushing and flossing regularly. Also, sugar-free gum increases the amount of saliva in the mouth and can counteract the dryness that is sometimes caused by methadone.

Myth #3 Methadone Rots the Bones

Methadone does nothing to the bones.

People sometimes feel "bone ache" during the first week of methadone maintenance treatment -- but what they are actually feeling is some level of opiate withdrawal symptoms, which they are misattributing to the methadone.

Dealing with Side Effects

Most people find the side effects of methadone quite manageable. People who are unable to tolerate certain side effects, but who want to continue with medication management of an opiate addiction, have the option to switch from methadone to Suboxone. Suboxone is also a very well tolerated medication, although people on high doses of methadone will need to taper down to a low daily dose before making the switch to Suboxone.

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