Methadone treatment for fentanyl addiction is an evidence-based therapeutic approach for opioid use disorder (OUD) that’s one option in medication-assisted treatment (MAT), which involves the use of medications for opioid use disorder (MOUD). In MAT programs for OUD, clinicians prescribe one of three medications approved by the Food and Drug Administration (FDA) for OUD treatment:
MAT programs with methadone are part of a harm-reduction approach to fentanyl addiction treatment. Programs with MAT prioritize treating the whole person in a collaborative, patient-centered environment. In MAT programs, mutual cooperation between patient and provider is essential. These programs stress individual input, personalized treatment based on self-identified goals, and an effort to help each patient to improve overall health and wellbeing by facilitating engagement in significant lifestyle changes and accessing all possible avenues of social support services available.
People in comprehensive, harm-reduction oriented, whole-person MAT programs experience:
- Reduction in opioid use
- Reduction overdose fatality
- Improved treatment retention/adherence
- Increased social and family function
- Increased work and school function
- Decreased rates of relapse
- Decreased rates of criminal behavior
That’s why it’s called the gold standard treatment for OUD. We know from firsthand observation that methadone:
- Stabilizes brain chemistry
- Eases physiological cravings
- Normalizes physiological functioning
- Allows a person to successfully initiate and engage in counseling/therapy
Opioid use disorder (OUD) appears in many forms. People may develop addiction to illicit opioids like heroin, prescription medications that contain opioids, and other street drugs and/or illicitly manufactured drugs designed to look like legitimate prescription medication. In recent years, a dramatic influx of an opioid called fentanyl has complicated efforts to mitigate the harm caused by the ongoing opioid crisis in the U.S.
To learn more about the risks associated with fentanyl, please read this article on our blog:
Why is Fentanyl So Dangerous?
Spoiler alert: fentanyl is 50 times stronger than heroin, 100 times stronger than morphine, and so powerful that a single dose of only 2 mg can cause fatal overdose.
Methadone Treatment: More Effective Than Other MOUDs for Fentanyl Addiction
There are two primary reasons methadone treatment works best or fentanyl addiction:
- The strength of fentanyl
- The way methadone works
We mention above that fentanyl is a powerful opioid, significantly stronger than heroin, morphine, and all the common prescription opioids that carry risk of misuse, disordered use, and addiction, such as oxycontin, Percocet, Vicodin, and others.
What we don’t mention above is that among the FDA-approved medications for opioid used disorder (MOUD), methadone is a full opioid receptor agonist. Opioids achieve their effect by binding to opioid receptors in the brain, which results in significant pain reduction and euphoria, among other effects. When a person stops taking opioids, withdrawal symptoms appear within hours, including:
- Nausea
- Chills
- Sweating
- Vomiting
- Agitation
- Cravings for opioids
- Insomnia
- Anxiety
Among the opioids of misuse and disordered use driving the opioid crisis, fentanyl – aside from a far less common variation, carfentanil – is the most powerful. Treatment professionals and addiction scientists now know that because of its increased strength, withdrawal from fentanyl is more intense and severe than withdrawal from other opioids.
This brings us to why methadone works best for fentanyl addiction.
As we mention above, methadone is a full opioid agonist, meaning it binds fully to and completely occupies opioid receptors in the human body. On the other hand, buprenorphine – a MOUD currently in widespread use for people with OUD – is a partial opioid agonist. This means it binds to and partially – but not completely – occupies opioid receptors in the human body.
For patients with a history of high dose, chronic fentanyl use with severe fentanyl addiction, the difference in the effectiveness between methadone and buprenorphine can be the difference between a successful recovery and relapse.
Many patients with severe fentanyl addiction report methadone is more effective at reducing the symptoms of withdrawal compared to buprenorphine, and is particularly effective in reducing opioid cravings, compared to buprenorphine.
Methadone: The Gold Standard for Fentanyl Addiction
Evidence published in a report called Methadone Treatment for People Who Use Fentanyl shows people on methadone with OUD had a lower risk of opioid related mortality compared to patient with OUD on buprenorphine:
- Methadone treatment: adjusted hazard rate (AHR) of 0.41
- Buprenorphine treatment: AHR of 0.61
Evidence from the same report shows that patients on methadone stay in treatment longer, compared to patients on buprenorphine. The longer a person stays in treatment, the lower their risk of relapse, complications associated with fentanyl use and accidental overdose.
Researchers and treatment professionals indicate that both methadone are first-line options for people with OUD. However, people with OUD who may benefit from methadone rather than buprenorphine include:
- New patients at high risk of early treatment drop-out
- All patients with a history of severe/high fentanyl use are at increased risk of early treatment drop-out
- Patients at high risk of relapse
- All patients with a history of severe/high fentanyl use are at increased risk of relapse
- Patients who’ve had success with methadone in the past
- New patients who do not want buprenorphine
- Patients who have had no success in previous treatment with buprenorphine
There’s another danger associated with fentanyl we haven’t addressed yet: its presence in illicit, non-opioid drugs. The DEA reports the presence of fentanyl in drugs such as methamphetamine, cocaine, and Adderall. A person taking these drugs – and the people around them – may not recognize the signs of opioid overdose because they don’t know they – and the people around them – may not be aware they ingested an opioid.
Signs of fentanyl overdose include:
- Slow breathing/no breathing
- Slow heartbeat/no heartbeat
- Loss of consciousness/unresponsive to attempts to waken
- Pale, clammy face/skin
- Blue/purple lips or fingernails
- Vomiting
- Trouble breathing/gurgling noises while breathing
If you observe these signs in someone, don’t wait to see what happens, think about it, or worry you’ll get in trouble. Administer naloxone immediately, if on hand, and call 911. Good Samaritan laws protect people who administer naloxone in an overdose emergency.
Advice for Patients Considering Methadone Treatment for Fentanyl Addiction
First, it’s important to understand that methadone treatment is one component part of a harm reduction approach to addiction treatment. Other components include therapy, counseling, lifestyle changes community support, and accessing social services to support improvements in all areas of life.
Second, it’s important to understand that any kind of MAT – including methadone treatment for fentanyl addiction – is not simply trading one addiction for another. It’s an evidence-based approach to addiction treatment that increases overall chances at long-term, sustainable recovery.
Third, new rules around methadone treatment instituted during COVID may soon become permanent, which means the barriers to access to methadone may soon be a thing of the past, increasing the availability of methadone for patients who need it most.
Finally, understand that methadone is the first and most widely studied form of MAT known. The first methadone clinic opened in New York City in 1964. Over the past 60 – yes, sixty years – countless studies demonstrate that MAT with methadone is safe and effective.
Treatment and Support for Fentanyl Addiction
If you or someone you love needs professional support for fentanyl addiction, evidence-based support –is available now. Treatment professionals committed to a compassionate, empathetic, harm reduction approach can help, no matter who you are. We understand taking the first step is often the most difficult, and we’re here to help as soon as you’re ready to ask for help.
We commit to helping you through your entire treatment journey. Our nationwide alumni network is strong, and our case management and peer support specialists can help you manage your recovery, keep you on track, and give you the best possible chance of sustainable, long-term recovery.
Remember: the earlier a person who need professional addiction treatment gets the treatment they need, the better the outcome.