Dosing Methadone for Pain versus Addiction

Using methadone for pain is different from using methadone for addiction.

It’s illegal in the United States for a doctor to prescribe methadone for the purposes of treating addiction, unless she is working at an appropriately licensed Opioid Treatment Center. Some doctors don’t know this, and have had grumpy DEA agents pay them a visit. However, it is legal for a doctor to prescribe methadone for pain, as long as she has an appropriate DEA license.

Methadone is prescribed differently when treating pain than when treating addiction. This is because each dose of methadone has an analgesic (anti-pain) effect of about six hours. However, methadone’s opioid blocking effect lasts for twenty-four hours or more. This is why methadone for pain should be dosed multiple times per day, but methadone for addiction can be given once per day.

The dose of methadone often varies, too, depending on the disease being treated. Doses of methadone 10 to 20mg, dosed three to four times per day, are adequate to treat pain for many patients. When treating addiction, studies have shown that patients do better when the doses are high enough to block other opioids. Usually, this occurs at doses 80 – 120mg per day, given as one dose. The patient doesn’t become sleepy or sedated at this dose because the dose is raised gradually, allowing time for tolerance to build to the sedating effect.

Some patients prefer to stay at a low methadone dose, so they can still feel intoxication from illicit opioids like heroin or oxycodone. For example, one patient told me he liked keeping his dose around 60mg, which was high enough to stave off the worst of his withdrawal symptoms. But it was also low enough to allow him to feel high from an injection of heroin in the evenings. He resisted going up on his dose as recommended by his treatment team.

Doctors have to be very careful prescribing methadone for pain. The very characteristic of the drug that makes it effective to treat addiction, its long duration of action, also makes it dangerous to prescribe. Too many patients, experimenting with methadone for the purpose of getting high, die of a drug overdose. Tolerance to the euphoric effect of methadone develops more quickly than the tolerance to the sedative effects. People consume a fatal dose before feeling high.

Over the last decade, the incidence of overdose deaths from methadone rose sharply. Most of these deaths were from people taking methadone pills, dispensed from local pharmacies, and prescribed by doctors who were treating patients for pain. Along the way, many milligrams were diverted to the black market, with disastrous results. Some methadone was diverted from opioid treatment centers, but appears to be a fraction of the total.

Given the overdose potential of methadone, it should be used cautiously when prescribed by physicians for pain. Soon, doctors may be required to take a training course before they can prescribe the long-acting opioids. This training will educate doctors on how to recognize if a patient is developing the complication of addiction, and to identify evidence of drug diversion.

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12 responses to this post.

  1. Hey There Janaburson,
    I take your point, Since pain is a normal every day occurrence, most often people who experience pain do not find a need to consult a doctor at all. This is understandable especially when the pain is infrequent can be attributed to an identifiable cause such as pain from a wound, a toothache, a stomach ache due to hyperacidity, joint ache caused by arthritis, or muscle ache from overdoing a gym workout. These types of pain are common and are usually tolerable. And if it tends to get somewhat annoying or unbearable, people just take popular over-the-counter pain killers and everything is fine again. Everyone does this and there is no harm in doing it a few times but everyone should know that pain killers have side effects. They should not be taken for granted and even the over-the-counter ones are not meant to be taken indiscriminately. As with all other types of medication, caution should be observed when taking pain remedies. It should also be emphasized that these pain killers are not to be used for long periods of time or for pain management by persons with chronic pain without consulting a pain management doctor first.
    Keep up the good work

    Reply

  2. Posted by connie on March 11, 2013 at 3:42 am

    I am a 60 yr old w who was talked into going on methadone for savere arthrytis. I liked it it worked and didn’t make me foggy like some of the other drugs I was on. But one day my doc just dissaperred. I have never been so sick and nobody will help me. The hospital thinks I just want drugs anb i cant find a doctor who will help me. My only other option is suiside. I really don’t want to but I can’t take it.

    Reply

    • Your doctor should have someone to whom he’s referred patients. If not, contact your state’s medical board to see if they can help you with information about his location. If that doesn’t work, sounds like you need to get to a family doctor as soon as possible, if you’ve already gone to the ER. Even if you’ve gone to the ER and they won’t prescribe anything, if you are suicidal, go back and please let them know.
      If you believe you have addiction to pain pills, go to your county’s mental health agency ASAP for appropriate referral

      Reply

    • I’m so sorry you’re getting f-ed over and it’s happened to me & many of us. Please don’t kill yourself! Here’s the # Nationwide Suicide Hotline 1-800-273-8255. It’s better than dying talking to a probably very caring & kind person. Please keep fighting! ;
      -Holly (fellow warrior)

      Reply

  3. Hello 60 year old going through methadone withdrawal. I went through about the same thing you went through with methadone withdrawal at age 63 and I know it was pure hell. It seems like no one has any sympathy for people who suffer from withdrawal. Hope you are doing better and if you need to talk send me an email. .

    Reply

  4. Posted by Nicole on May 1, 2016 at 7:05 pm

    I have fractured my spine lower lumbar degenerative disc disease osteo arthritis and have been heroin. Free for three years.I have poor quality of life pain makes it hard to stand walk or play 28th my son dr will not give me anything but elevil amitriplene and say I had a drug history but heroin addicts recurve opioid for addiction .Wtf.the gabapentin made me gain 100 pounds and growing I cry everyday I nd pain relief do I go back to heroin because it is available then go to meth clinic so I can recurve meth and take a chance of bad heroin reaction.what is this conundrum.help.

    Reply

  5. Posted by Stephen on May 3, 2017 at 7:08 pm

    My brother and sisters I feel for every one of you .It brakes my heart to see people suffering so bad ,and they can’t get the help they need .if you need to get on a methadone clinic then do so ,please.never give up.I have arthritis and I was on a methadone clinic for 12 years .I use medical marijuana now and I have non narcotic pain relievers when it gets real bad.Oh yea when you detox off the methadone from say 120mgs a day you go down slow like 10mgs a month then at 50mgs you go down 5mgs a month until your off.I didn’t feel any bad symptoms doing it this way.God bless you all

    Reply

  6. Methadone works just fine for my pain. I’ve never seen any overdoses from methadone, heroine yes I’ve heard of a lot of overdoses from that but not methadone works great for pain it shouldn’t even be even used for abuse only for pain. Yeah suboxone I see should be used by addicts but not methadone.

    Reply

    • Actually, we have more scientific evidence supporting the use of methadone to treat opioid use disorder than we have for any other treatment of any other disease, so…your opinion is not backed by science. But thanks for reading my blog!

      Reply

  7. Posted by Leaf on May 11, 2017 at 11:37 pm

    Any opiate pain medication has inherent risks. Un/fortunately opiates are the best pain relievers, in my opinion, by far. “Medicine of the gods” is a Chinese description of opium. (They discovered it’s use) “scourge of a generation” is an American (1890’s) description of morphine. These descriptions are BOTH VERY accurate, in my opinion, as well. This dichotomy is unfortunate but, very realistic. I have heard it said that “anything that feels that good, you know, you have to pay for!” The wages of opiates are the pain of withdrawal. The most conscientious/frugal usage WILL, eventually in time, lead to dependence. If there was ever a way to separate the good from the bad the “perfect drug” would be born. In reality there’s already perfect drugs. We only need to perfect it’s accessibility. Dopamine, serotonin etc., the drugs our brains create on their own are incredibly effective. We just try to regulate them. If it is possible then, rest assured, that the pharmaceutical (and possibly medical as a whole) industries would lobby against its access until a way to tax it could be contrived. Some patients will be on opioid medicine until death. Some actually need it. Access for those people shouldn’t be impeded. No matter the avenue of that need. Prescription beats illicit, by far, in terms of safety. If people keep their habit from the streets their survival chances are increased greatly. Informed communities are a safer communities. Remove stigma and replace it with education and there will be less heartbreak all the way around. An attainable dream. With God’s help, and eachother’s. Together a reality.

    Reply

  8. Posted by Terri Persaini on May 24, 2017 at 1:20 am

    First time to your site. Great info. Weaning off methadone at clinic 2mgs a week. Started at 200 and down to 57mgs as of today. NEVER HELPED WITH MY HORRIBLE CHRONIC UNREAL WHOLE BODY PAIN EVER. Just turned 60 doubt I will see another Christmas. Five years ago, my internist helped me get off my pain meds I was scared that in a few years nothing would help, stout mistake of my life. Now with the and gov. Putting heroin in with every single opoid overdose, soon opposed will be gone. They work and yes after a few weeks your body already getting hooked, sad but true. So, at this point I can’t walk hardly, my fusions and rods etc in spinal cord scream constantly, add disease of brain, rather, ‘s I’m a gonner soon.
    All I pray for is a few hours a day with a pain level under 8 that’s all. Never gonna happen, I see that now, hoping a pain clinic will help, maybe a pump of strong stuff anything best luck to everyone out there and stay away from clinic methadone at all cost for pain…doesn’t work at all

    Reply

    • I’m sorry for your experience. But then, methadone clinics are set up to help people with opioid use disorders, and not chronic pain. Of course, there’s some overlap…but for opioid use disorder, we use it to quash opioid withdrawal. In some cases, it also help with chronic pain, particularly for the first 8 hours after dosing. But no medication works for everyone. I do hope you can find something that works.

      Reply

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