The opioid crisis has cost the health and lives of millions of people around the world. In 2019 alone, there were 150,000 opioid overdose deaths (WHO). Psychologists observe these alarming trends and ask – “how can we prevent this?” Ironically, the most common treatment for opioid abuse is…taking different opioids. In this post, we’ll look at methadone as one treatment for substance abuse.
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Methadone is a synthetic opioid commonly used to treat heroin addiction.
What is methadone?
Methadone is a synthetic (man-made) opioid used in the treatment of opioid abuse. It’s most commonly used to help people recover from heroin addiction. It can be taken as a pill or liquid and is taken once a day. The technical name for using methadone as a treatment is methadone maintenance treatment. It has been used to treat opioid addiction since the 1950s. While methadone itself is addictive, it’s arguably more safe for people to take prescribed and measured amounts of methadone than illegal heroin which is more dangerous. It’s also safer because it’s a pill or liquid, whereas heroin is often injected. Using needles increases risks of illnesses from infected needles, like HIV and hepatitis. It also means the dosage is harder to control so there’s a bigger risk of overdose. Another benefit of methadone is it can be acquired legally, unlike heroin. When people have a heroin addiction they may break the law trying to get more heroin (e.g. stealing) (NIH).
How does it work?
Methadone works the same as other opioids – it binds to opioid receptors, which triggers a release of dopamine. This creates the pleasurable and pain-relieving effects. This effect last about 24 hours and helps reduce a patient’s cravings for other, potentially more dangerous opioids. Methadone is still addictive, however. This is why it’s carefully administered by clinicians in regulated settings. This also means the dosage can be monitored.
Methadone binds to opioid receptors and has a similar effect as other opioid drugs. (Image ChatGPT)
Is methadone effective?
Understandably, methadone is a controversial treatment. It is replacing one opioid with another. Is it more effective than simply going cold turkey and suffering through the withdrawal side-effects? Numerous researchers have posed this question. In 2003 Richard Mattick and colleagues conducted a meta-analysis to study the effectiveness of methadone.
Key Study: Methadone Maintenance vs Cold Turkey (Mattick et al., 2003)
The aim of this meta-analysis was to see how effective methadone maintenance treatment was for treating heroin addiction, compared to other therapies that didn’t use opioid medications (e.g. placebos, drug-free treatments, or detox programmes). The researchers gathered data from 6 studies. Participants in these studies were mostly male patients who “ tended to be approximately 30 to 40 years of age, often unemployed and unmarried, with previous treatment histories and prevalence of use of other drugs…” The results showed that methadone was more effective than non-drug therapies in reducing heroin use and keeping patients in therapy. Fewer participants committed crimes or died during methadone maintenance compared with other therapies (although these results were not statistically significant).
Overall, the researchers concluded that “Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy.” An earlier study on methadone treatment drew a similar conclusion. They found methadone reduced illegal opioid use and reduced “…criminality, HIV risks and mortality.” (Bertschy, 1995).
Methadone can be used as a “treatment for one health problem” (substance abuse) in IB Psychology exams.
The research shows methadone is an effective treatment. People who stay in methadone therapy also have lower rates of relapse than those who stop. I still wonder, though, is this a valuable treatment, or just another way for Big Pharma to profit from opioid addiction? It seems convenient that the treatment for opioid addiction is to consume more synthetic opioids. But people can wean themselves off methadone to become completely drug free. This happens by slowly reducing the dosage of methadone over a long period of time. Perhaps it’s also just a case of the lesser of two evils. Moreover, we’re perhaps better off focusing on prevention rather than cure.
References
Bertschy, G. Methadone maintenance treatment: An update. Eur Arch Psychiatry Clin Nuerosci 245, 114–124 (1995). https://doi.org/10.1007/BF02190738
Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2003). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. The Cochrane database of systematic reviews, (2), CD002209. https://doi.org/10.1002/14651858.CD002209
World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. World Health Organization.
World Health Organization. (2025, August 29). Opioid overdose [Fact sheet]. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
Travis Dixon has been teaching for over 20 years and is an experienced IB Psychology, History and English teacher, author, workshop leader and examiner