Methadone is one of the oldest and most extensively studied medications for opioid use disorder — and, despite persistent stigma, one of the most effective.
How it works
Methadone is a full opioid agonist with a very long half-life, which allows once-daily dosing to maintain steady levels that prevent withdrawal and reduce cravings without the intense highs and lows of shorter-acting opioids. "how opioids work in the brain"
Where you get it
Unlike buprenorphine, methadone for opioid use disorder can only be dispensed through federally certified Opioid Treatment Programs (OTPs) — not a regular doctor’s office. "why methadone is still restricted to clinics" article
What starting treatment looks like
Initial dosing starts conservatively (the federal cap was raised from 30mg to 50mg for the first dose under 2024 rule changes, giving providers more flexibility for people with high tolerance) and is adjusted upward over days to weeks based on response. "what to expect at an OTP" article
Daily visits — and how that’s changed
Daily visits are still the starting point for most patients, but take-home dose rules changed substantially in 2024 — patients can now receive up to 7 days of take-home medication within their first 14 days of treatment in many cases, a significant change from older, more restrictive rules. [full take-home rules article]
How methadone compares to other options
See our full comparison: methadone vs. buprenorphine article and [MAT comparison tool].
Common concerns, addressed directly
- Side effects — see our dedicated article [link]
- QT prolongation (heart rhythm risk) — a real, dose-related risk worth understanding, not avoiding information about [link]
- Stigma — methadone carries more public misunderstanding than buprenorphine despite comparable evidence of effectiveness [link to stigma article]
- Cost — roughly $400–650/month without insurance; [link to cost estimator tool]
How long treatment typically lasts
As with buprenorphine, there’s no required end date — long-term maintenance is a legitimate, evidence-based choice, not a stopgap.
Medically reviewed by [pending]. Sources: SAMHSA TIP 63, 42 CFR Part 8, SAMHSA 2024 Final Rule on OTP regulations.