Addiction is extremely powerful. The opioid addiction epidemic has been sweeping our nation for years now, and throughout the epidemic of opioid addiction, medical experts have banded together to find better ways to treat patients.
Methadone has long been a tried-and-true staple in the substance abuse doctor’s trusty toolkit. But how does it work? In this article, Dr. Robert Sherrick, Chief Science Officer at Community Medical Services and pioneer of several opioid addiction treatment programs in the state of Montana, explains how methadone impacts the brain to treat OUD.
How Addiction Changes the Brain
To understand why methadone is so effective for treating opioid addiction, we must first look at how addiction changes the brain. People with an addiction have profoundly abnormal brain circuits – which is one reason why it is so hard to treat.
The first time someone takes an opioid, receptors in the brain are stimulated, increasing the level of dopamine and creating the “high” that many people with addiction are seeking. People may describe feeling like they have “a warm blanket” that takes away their anxiety, depression, and other worries – (at least until the drug wears off). The natural response is to want to repeat the experience.
With continued exposure to the drug, however, the brain starts to adapt, getting used to the presence of the drug. As your brain starts to expect the substance, it takes more of it to get the desired effect. The brain changes eventually become so extreme that people don’t feel normal unless the drug is present. This process (called neuroadaptation) can happen in as little as a few weeks, and once it has occurred, people will experience uncomfortable withdrawal symptoms whenever they don’t have the drug.
In those suffering from a severe opioid addiction, avoiding withdrawal often becomes the main focus of their daily lives, overtaking all other responsibilities like their jobs, family, and even children. The fear of withdrawal can drive people to do things they would never usually do just to avoid the suffering of opioid withdrawal symptoms.
What Happens to the Brain During Opioid Withdrawal?
When someone is going through opioid withdrawal, multiple brain circuits “overload.” The brain in withdrawal looks something like this:
Withdrawal symptoms can include sweating, chills, achiness, stomach cramps, nausea, vomiting, diarrhea, and extreme restlessness. While these symptoms are not usually life-threatening, they are extremely uncomfortable – often described as “the worst I have ever felt in my life.”
One of the biggest changes during withdrawal is a surge in stress signaling. This can make a person feel anxious, agitated, restless, and unable to relax. At the same time, the body’s automatic functions can become overactive, which is why withdrawal often causes sweating, chills, goosebumps, rapid heartbeat, and gastrointestinal distress such as cramping, nausea, vomiting, and diarrhea.
Withdrawal also affects the parts of the brain involved in motivation and reward. During active opioid use, the brain adapts to repeated opioid exposure. Without opioids, people often feel emotionally low, physically uncomfortable, and intensely driven to use again just to make the symptoms stop.
How Methadone Stops Withdrawal Symptoms
Understanding what is happening in the brain during withdrawal helps explain why medications like methadone can play such an important role in treatment. By helping stabilize these disrupted brain systems, methadone can reduce withdrawal symptoms and cravings so people can focus on healing and recovery.
Methadone uses the same brain receptors that have been damaged by severe opioid addiction to normalize brain function. By occupying the receptors, they prevent horrible withdrawal symptoms that drive people to desperation.
This matters because opioid withdrawal is not just painful; it is the result of the brain struggling to function without the opioids it has adapted to. When opioids are suddenly removed, the systems involved in stress, pain, reward, and physical regulation can become overactive all at once. That is what leads to the intense physical and emotional symptoms people experience during withdrawal.
Methadone works by attaching to those same opioid receptors in a controlled, long-acting way. Instead of causing the repeated cycle of intoxication and withdrawal that comes with short-acting opioids, methadone helps stabilize the brain. It gives the brain a chance to function more normally without the constant highs and crashes that keep addiction going.
When methadone is present, the brain looks more “relaxed” like this:
All the areas that were “overloaded” during withdrawal are calm, and the brain is back to normal function again. In practical terms, that means methadone can relieve the severe discomfort of withdrawal, reduce cravings, and help a person feel physically and emotionally steady enough to focus on treatment and recovery. Rather than being trapped in a constant state of distress, the brain and body are able to move out of crisis mode.
How Methadone Is Prescribed in Treatment Plans
For opioid use disorder, methadone treatment begins at a certified opioid treatment program, sometimes called an OTP, like Community Medical Services. A medical provider first evaluates the person’s opioid use, withdrawal symptoms, medical history, and any other medications they are taking to decide whether methadone is the right fit and to choose a safe starting dose.
Methadone is not prescribed for opioid use disorder the same way many other medications are. Because it is long-acting and powerful, treatment is started carefully and the dose is adjusted gradually over time. The goal is to find a dose that prevents withdrawal symptoms and reduces cravings without causing over-sedation.
Early in treatment, many patients receive methadone under supervision so the care team can see how they respond and make changes safely. As a person becomes more stable in treatment, they may be able to receive take-home doses based on clinical judgment, safety considerations, and their progress in care.
Methadone treatment is individualized. There is no one-size-fits-all dose or timeline. Some people need dose adjustments, added support, or longer treatment to stay comfortable and stable. When prescribed and monitored appropriately, methadone can help people move out of the cycle of withdrawal and cravings so they can focus on recovery.
Frequently Asked Questions About Methadone Treatment
Do People Taking Methadone Get “High”?
Not at all. People with an opioid addiction who are treated with methadone function normally. They don’t get “high” or drowsy.
When you are around them, you would never notice anything different about them – because their brains are now back in balance. Because they no longer need to worry about withdrawal symptoms, they can return to living their everyday lives.
Is Methadone Dangerous?
When given in the proper dose, methadone is not dangerous or toxic. It does not damage the body in any way. It does not hurt the heart, lungs, liver, kidneys, or other organs. Rumors that it “crumbles your bones” or “rots your teeth” are false. Methadone is perfectly safe when taken as directed at the proper dose.
Methadone can lead to overdoses and death when not taken properly. An overdose can occur if people take too much, take methadone that is not prescribed to them, or if they combine it with other drugs or alcohol. That is why it is essential for people taking methadone only to take it as directed, keep it safe from children and adolescents, and never to give or sell your medication to anyone else.
What Are the Short-Term Effects of Methadone Treatment?
Short-term methadone treatment focuses on stabilizing the body by reducing the intense physical and mental strain of opioid withdrawal. In the first few days, it’s common to experience a calming effect as cravings subside and your system reaches a more balanced state.
Some individuals may also notice temporary physical changes such as dry mouth, sweating, or minor digestive shifts like nausea or constipation. These typically signal that the medication is working to block withdrawal symptoms, which allows for a smoother transition into a consistent daily routine. Regular check-ins with your care team during this early phase are crucial to ensuring the dosage effectively manages discomfort while helping you maintain clear-headed focus throughout the day.
What Are the Long-Term Effects of Methadone Treatment?
Since methadone does not damage the body in any way, there is no urgency to stop it if it is helping. Once the abnormal brain circuits have been normalized, people can stay on a dose that works for them or decide to taper off slowly. By tapering slowly, they can give the brain time to heal. Eventually, they may be able to go back to how they were before their opioid addiction without assistance from medication.
How Well Does Methadone Work?
Methadone is by far the safest and most effective treatment available for people who are struggling with opioid addiction. If you or someone you know needs help, please let them know that effective treatment is available and that they are not alone in their suffering.
Get Treatment for Opioid Addiction at Community Medical Services
At Community Medical Services, we care about our clients and dedicate ourselves to treating all with respect and compassion. We understand how difficult it can be to struggle with opioid addiction. We are here to listen and help in any way we can.
Our primary goals are to keep our clients alive (prevent overdoses) and help them thrive, working with them on their journey to recovery. The first step in that journey is to call or come into one of our clinics. Our compassionate treatment experts are there to help you every step of the way.
Book an appointment at a Community Medical Services clinic near you to discuss your medication options and see if methadone is right for you.
