Commentary: Countering the Myths About Methadone


Methadone maintenance has been used in the United States for approximately 50 years as an effective treatment for opioid addiction. Yet many myths about its use persist, discouraging patients from using methadone, and leading family members to pressure patients using the treatment to stop.

Dr. Vincent Dole of Rockefeller University in New York, who pioneered the use of methadone as an opioid addiction treatment, found his patients no longer craved heroin. They were able to return to work and school, and participate in family life and community affairs.

As methadone’s use grew, the federal government decided it should only be dispensed in licensed treatment programs, which would provide a whole range of services such as counseling, vocational help and medical and psychiatric treatment.

This creation of the clinic system developed into a double-edged sword. On the one hand, it was advantageous to have many services available in the methadone clinic, but very stringent regulations came along with the clinic concept, including the requirement that patients come to the clinic daily for their methadone. Clinic hours often conflict with patients’ work schedules, and make it very difficult to take a vacation. In some areas of the country, the clinics are few and far between, requiring traveling many miles each day. The biggest and probably most important obstacle has been the stigma associated with being seen entering or exiting a methadone clinic.

In an attempt to reduce that stigma, I present the six most common myths about methadone and explain why they are incorrect.

Myth #1: Methadone is a substitute for heroin or prescription opioids. Methadone is a treatment for opioid addiction, not a substitute for heroin. Methadone is long-acting, requiring one daily dose. Heroin is short-acting, and generally takes at least three to four daily doses to prevent withdrawal symptoms from emerging.

Myth #2: Patients who are on a stable dose of methadone, who are not using any other non-prescribed or illicit medications, are addicted to the methadone. Patients taking methadone are physically dependent on it, but not addicted to it. Methadone does not cause harm, and provides benefits. People with many common chronic illnesses are physically dependent on their medication to keep them well, such as insulin for diabetes, inhalers for asthma and blood pressure pills for hypertension.

Myth #3: Patients who are stable on their methadone dose, who are not using other non-prescribed or illicit drugs, are not able to perform well in many jobs. People who are stable on methadone should be able to do any job they are otherwise qualified to do. A person stabilized on the correct dose is not sedated, in withdrawal or euphoric. The most common description of how a person feels on methadone is “normal.”

Myth #4: Methadone rots teeth and bones. After 50 years of use, methadone remains a safe medication. There are side effects from taking methadone and other opioids, such as constipation and increased sweating. These are usually easily manageable. If patients engage in good dental hygiene, they should not have any dental problems.

Myth #5: Methadone is not advisable in pregnant women. The evidence over the years has shown that a pregnant woman addicted to opioids has the best possible outcome for herself and her fetus if she takes either methadone or buprenorphine. A pregnancy’s outcomes are better for mother and newborn if the mother remains on methadone than if she tapers off and attempts to be abstinent during pregnancy. Methadone does not cause any abnormalities in the fetus and does not appear to cause cognitive or any other abnormalities in these children as they grow up. Babies born to mothers on methadone will experience neonatal abstinence syndrome, which occurs in most newborns whose mothers were taking opioids during pregnancy. This syndrome is treated and managed somewhat easily and outcomes for the newborn are good—it is not a reason for a pregnant woman to avoid methadone treatment. Mothers on methadone should breastfeed unless there is some other contraindication, such as being HIV-positive.

Myth #6: Methadone makes you sterile. This is untrue. Methadone may lower serum testosterone in men, but this problem is easily diagnosed and treated.

These myths, and the stigma of methadone treatment that accompanies them, are pervasive and persistent issues for methadone patients. They are often embarrassed to tell their other physicians, dentists and family members about their treatment. They may feel they are doing something wrong, when in fact they are doing something very positive for themselves and their loved ones. These misperceptions can only be corrected with more education for patients, families, health care providers and the general public.

Dr. Edwin A. Salsitz_Join Together_PhotoEdwin A. Salsitz, MD, FASAM, is Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center in New York.




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266 Responses

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    Jane doe

    October 23, 2018 at 10:44 PM

    My husband has been on methadone for over two years but he is now on to 5mg started at 30. My question is can a patient on methadone feel actual pain at the end of every day? My husband doesn’t work and I’m stuck paying for his marijuana habit. When I’m broke AF trying to save up gas money to make my daily 40 mile drive to work and back it’s hard. He doesn’t even care. He gets mad at me saying I wouldn’t understand and he is right. I don’t. So I’m glad I found this. Hopefully someone can help me. I can’t keep tossing money away like that. At LEAST 50$ a month and he gets mad at me if I don’t just cough up the money. If it actually painful then guess I’ll have to deal with the current hand we’re held.

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      Josie Feliz

      October 24, 2018 at 10:27 AM

      Thanks for your message Jane. We have forwarded your message to one of our helpline specialists who can help better answer your question, and she will be reaching out to you shortly.

      Our Helpline is a good place to start if you’d like to talk to someone about what you’re going through. Feel free to connect with us in whichever manner you choose in the future:

      Thank you. -The Partnership for Drug-Free Kids

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    Andrew Galloway

    May 11, 2017 at 5:49 AM

    Methadone does not enter your bones or damage your teeth. In doses above about 50mg you will not feel the effects of heroin or any other opioid drug for that matter. Spending money on opiates to try and gain a high on this dose is just wasting your money and you’d be better sending your cash to me so I can put it in my account and laugh at your gullibility.

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      June 25, 2018 at 2:44 PM

      Lol…..Everything you said is very TRUE !!!!

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    Roy Miller

    March 22, 2017 at 7:09 PM

    How ever one wants to improve they’re life. But consider also many have found methadone much more difficult to kick than heroin. Who ever wrote this says that.

    A. People don’t get high on methadone? Maybe not after you have a tolerance. You will get high as hell if your not already using heroin.

    B. Saying it’s not addictive, have obviously not watched someone tapper off it to fast, or stopped taking it all together. Odd, it’s just like watching someone kick heroin only drawn out much longer.

    If your attending a 12 step program base on abstaining than you are not clean at that program. Most at these programs consider it a tool for harm reduction and not clean time. So keep that in mind if you have chosen to attend a program base in abstinence. They may not consider you clean. NA for example, may chose not to let you share because of this. Depends on group, may chose to speak with you before or after the actual meeting.

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      June 25, 2018 at 2:52 PM

      Im sorry Roy…but any NA meeting will let you share regardless of being on methadone. A few members may say that you are NOT clean if on methadone but the ones who have been down the same road useing herion, they will totally understand & be proud of the methadone maintenance person for even showing up to the meeting !! I dont know where you are from but that is unheard of where i am from. Quit discouraging people NOT to go to meetings if on methadone.

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    March 18, 2017 at 9:28 PM

    Thank you for this article. I have recently began the MMTP and every issue you adressed has been of upmost concern . I can admit, I had believed the stigma attached to being on Methadone.
    Today, I limit who I share my treatment with because :
    1- It’s personal. I wouldnt tell my neighbor I was prescribed medication for lets say… hemorrhoids right? Lol
    2- I do feel some what less than for being on the program. After reading this article, perhaps more education from professionals like yourself will begin to change my thinking.
    i’d like to say thank you for writing such an honest, informative article.
    I’m 2008, I overdosed due to opiate abuse and by the grace of god, I’m alive and well.
    So tomorrow I will walk into my clinic with my head held high. My 12 year son will get to have his mom alive, sober and happy. So…lMethadone, suboxone .. and all the medical professionals that assist us daily on our journey .My son and I Thank You !!!!!!

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    Carl Howard

    March 15, 2017 at 3:44 PM

    alcohol is the worse drug that anyone can every do.

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      July 15, 2017 at 9:06 AM

      Very true, I am one of the few members of my family (mothers side& father side) who’s not an alcoholic. I did drink socially (a good bit) in my early teeens to mid twentys. I have A drink maybe every six months. Usaly only have a drink if having panic feeling. With that being said I am a full blown addit. With opiates being my first choice. In 2010 I started going to the methadone clinic in my area at first I thought it was great but as time progressed and I continue to increase my dose because that’s what drug addicts do we think more is always better I finally stopped at 180 mg at that time I found out that I was sick with lupus and ra the thing with methadone is once you are on and even those and you are no longer getting high. I found that I begin to feel like s*** again which is what prompted the diction in the first place so I started taking Adderall because I had Zero Energy. I was on methadone for 7 years yes he does have some good points has i you’re not spending five and six hundred dollars a day and chasing. It does take a lot of work out of being an addict. But the clinic is hell. It takes forever to phase up. they treat you like you are a criminal, I do believe they forget that you are the one paying them for their service. It doesn’t matter how long you’ve been there and if you have never done one thing wrong they will phase you down for the simplest mistake, as in a bottle got washed in my pants pocket and they could not read the date on anymore I went from the highest Phase, which is you go twice a month. Took me back to every day. I am in no way perfect and yes I falsified plinky of drug screens just a hint for any of the new people starting if you’re going to carry pee in make sure it has Methadone in it do not take your child’s or anybody else’s clean pee made that mistake in the very beginning but the thing about the bottle and being phased down it was truly what happened. It is a true hassle after you get your lifestyle back as in you’re no longer in the chasing getting high mode It seems like they try everything possible to keep you from phasing up and try make you phase down. I recently quit all together after 7 years and let me tell you I would rather come off of oxy heroin for Methadone I have never been so sick in my life for so long and what people don’t tell you that comes along with the puking and s******* and sweats is the feeling in your head makes you literally want to kill yourself you feel like you are losing your mind and the body pain is unbearable I do not recommend methadone to anybody ever and the clinic is nothing but a legal drug house the one I went to and I am in a very small town for a clinic. is bringing in very close to 1 million dollars a day and I know this because I am friends with the accountant. So I guess that tells you why they are always wanting to make sure you stay phased down coming every day and not picking up because they won’t you totally dependent on them because they are totally dependent on your money. Deciding how to deal with any kind of addiction and trying to overcome it is a challenge within itself so read on it all you can ask questions and good luck

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        November 12, 2018 at 2:43 PM

        I sympathize with you and your story as I too have been on and off methadone for 14 years. I agree about it being much harder to kick. I also notice that staff at the clinic treat you like a piece of poo. I have never falsified my urine drug screens and have remained sober for 4 years or so. I have had my phase removed several times for bogus reasons. One time when I was prescribed oxycodone/ percocet after a surgery to take AS NEEDED and for some reason it didn’t show up in my UA. Which could have been for several reasons. Which was infuriating because I had remained clean for several years. Plus even though I have a the highest phase which is every 2 weeks, I am still at the clinic 4-5x a month. We are required to call every day during dosing hours (M-F 5:30am-11 am, Saturday6-8:30am) to check for a random drug test and or a bottle check which also requires a drug test. So, I end up there way to often.
        I disagree with you about discouraging others from methadone. Methadone has saved my life. I has given me my life back and I am able to function as a Normal person. I do consider myself as clean and by law I am also considered drug free despite what that Roy dude said. Roy seems like a very close minded person who has probably never felt what it is like to be physically dependant. What it’s like to want so badly to stop but, knowing that if you do you’re going to be physically sick and unable to care for yourself or your family because of withdrawals. He obviously has never walked down that road. He reminds me of the ignorant people who I used to see in AA or NA who would scoff at people on methadone because they felt “better than”. These type of people do not stay sober for long. They’re too concerned about what everyone else is doing instead of actually doing the work it takes to maintain a sober lifestyle.

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