Editing Methadone (section)

== Medical uses ==
[[File:Methadone 40mg.jpg|thumb|40&nbsp;mg of methadone]]
[[File:Chlorydrate de Méthadone.jpg|thumb|Two single-dose bottles of Methadone Hydrochloride syrup for oral administration (two different dosages: 10mg and 20mg)]]

=== Opioid addiction ===
Methadone is used for the treatment of [[opioid use disorder]].<ref>{{cite web |url= https://www.lecturio.com/concepts/opioid-use-disorder/ | title= Opioid Use Disorder | website= The Lecturio Medical Concept Library | access-date=25 June 2021}}</ref>
It may be used as maintenance therapy or in shorter periods to manage opioid withdrawal symptoms. Its use for the treatment of addiction is usually strictly regulated. In the US, outpatient treatment programs must be certified by the federal [[Substance Abuse and Mental Health Services Administration]] (SAMHSA) and registered by the [[Drug Enforcement Administration]] (DEA) to prescribe methadone for opioid addiction.

A 2009 [[Cochrane review]] found methadone was effective in retaining people in treatment and the reduction or cessation of heroin use as measured by self-report and urine/hair analysis and did not affect criminal activity or risk of death.<ref>{{cite journal | vauthors = Mattick RP, Breen C, Kimber J, Davoli M | title = Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD002209 | date = July 2009 | volume = 2009 | pmid = 19588333 | pmc = 7097731 | doi = 10.1002/14651858.CD002209.pub2 | veditors = Mattick RP }}</ref>

Treatment of opioid-dependent persons with methadone follows one of two routes: maintenance or withdrawal management.<ref>{{cite journal | vauthors = Stotts AL, Dodrill CL, Kosten TR | title = Opioid dependence treatment: options in pharmacotherapy | journal = Expert Opinion on Pharmacotherapy | volume = 10 | issue = 11 | pages = 1727–1740 | date = August 2009 | pmid = 19538000 | pmc = 2874458 | doi = 10.1517/14656560903037168 }}</ref> Methadone maintenance therapy (MMT) usually takes place in outpatient settings. It is usually prescribed as a single daily dose medication for those who wish to abstain from illicit opioid use. Treatment models for MMT differ. It is not uncommon for treatment recipients to be administered methadone in a specialized clinic, where they are observed for around 15–20 minutes post-dosing, to reduce the risk of diversion of medication.<ref>{{cite book | vauthors=((World Health Organization)) | year=2009 | title=Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. Manila : WHO Regional Office for the Western Pacific | hdl=10665/207032 | hdl-access=free | isbn=9789290614302 | chapter=Methadone maintenance treatment | publisher=WHO Regional Office for the Western Pacific }}</ref>

The duration of methadone treatment programs ranges from a few months to years. Given opioid dependence is characteristically a chronic relapsing/remitting disorder, MMT may be lifelong. The length of time a person remains in treatment depends on a number of factors. While starting doses may be adjusted based on the amount of opioids reportedly used, most clinical guidelines suggest doses start low (e.g., at doses not exceeding 40&nbsp;mg daily) and are incremented gradually.<ref name="JosephStancliffLangrod" /><ref name="Connock">{{cite journal | vauthors = Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, Fry-Smith A, Day E, Lintzeris N, Roberts T, Burls A, Taylor RS | title = Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation | journal = Health Technology Assessment | volume = 11 | issue = 9 | pages = 1–171, iii–iv | date = March 2007 | pmid = 17313907 | doi = 10.3310/hta11090 | doi-access = free | title-link = doi }}</ref> It has been found that doses of 40&nbsp;mg per day were sufficient to help control the withdrawal symptoms but not enough to curb the cravings for the drug. Doses of 80 to 100&nbsp;mg per day have shown higher rates of success in patients and less illicit [[heroin]] use during the maintenance therapy.<ref name="Anderson_2000">{{cite journal |vauthors=Anderson IB, Kearney TE |date=January 2000 |title=Use of methadone |journal=The Western Journal of Medicine |volume=172 |issue=1 |pages=43–46 |doi=10.1136/ewjm.172.1.43 |pmc=1070723 |pmid=10695444}}</ref> However, higher doses do put a patient more at risk for overdose than a moderately low dose (e.g. 20&nbsp;mg/day).<ref name="Gris2011"/>

Methadone [[Maintenance dose|maintenance]] has been shown to reduce the transmission of bloodborne viruses associated with opioid injection, such as hepatitis B and C, and/or HIV.<ref name="JosephStancliffLangrod" /> The principal goals of methadone maintenance are to relieve opioid cravings, suppress the abstinence syndrome, and block the euphoric effects associated with opioids.

Chronic methadone dosing will eventually lead to neuroadaptation, characterised by [[Drug tolerance|tolerance]] and [[Substance dependence|dependence]]. However, when used correctly in treatment, maintenance therapy is medically safe, non-sedating, and can provide a slow recovery from opioid addiction.<ref name="JosephStancliffLangrod" /> Methadone has been widely used for pregnant women addicted to opioids.<ref name="JosephStancliffLangrod">{{cite journal | vauthors = Joseph H, Stancliff S, Langrod J | title = Methadone maintenance treatment (MMT): a review of historical and clinical issues | journal = The Mount Sinai Journal of Medicine, New York | volume = 67 | issue = 5–6 | pages = 347–364 | year = 2000 | pmid = 11064485 }}</ref>

=== Pain ===
Methadone is used as an [[analgesic]] in chronic pain, often in [[opioid rotation|rotation with other opioids]].<ref name="Kraychete_2012">{{cite journal | vauthors = Kraychete DC, Sakata RK | title = Use and rotation of opioids in chronic non-oncologic pain | journal = Revista Brasileira de Anestesiologia | volume = 62 | issue = 4 | pages = 554–562 | date = July 2012 | pmid = 22793972 | doi = 10.1016/S0034-7094(12)70155-1 | doi-access = free | title-link = doi }}</ref><ref name="Mercadante_2016">{{cite journal | vauthors = Mercadante S, Bruera E | title = Opioid switching in cancer pain: From the beginning to nowadays | journal = Critical Reviews in Oncology/Hematology | volume = 99 | pages = 241–248 | date = March 2016 | pmid = 26806145 | doi = 10.1016/j.critrevonc.2015.12.011 }}</ref> Due to its activity at the [[NMDA receptor]], it may be more effective against [[neuropathic pain]]; for the same reason, tolerance to the analgesic effects may be less than that of other opioids.<ref>{{cite journal | vauthors = Leppert W | title = The role of methadone in cancer pain treatment--a review | journal = International Journal of Clinical Practice | volume = 63 | issue = 7 | pages = 1095–1109 | date = July 2009 | pmid = 19570126 | doi = 10.1111/j.1742-1241.2008.01990.x | s2cid = 205875314 }}</ref><ref>{{cite journal | vauthors = Nicholson AB, Watson GR, Derry S, Wiffen PJ | title = Methadone for cancer pain | journal = The Cochrane Database of Systematic Reviews | volume = 2 | issue = 3 | pages = CD003971 | date = February 2017 | pmid = 28177515 | pmc = 6464101 | doi = 10.1002/14651858.CD003971.pub4 }}</ref>