Updated March 2012
If you are addicted to heroin or another opiate (opium, codeine, morphine), your health care provider may recommend methadone treatment. Methadone is a prescription drug that can help you manage your addiction. Methadone takes away your craving for heroin but does not make you feel stoned or tired. It does not interfere with day-to-day activities such as driving a car or going to work.
Each dose of methadone lasts for about 24 hours so you will only need to take it once a day. Used at the appropriate dose, methadone is a safe drug that may not have difficult side effects even if you take it for 10 years or more.
Combined with behavioral therapies, counseling, and other supportive services, methadone can help you stop using heroin and other opiates, including prescription narcotics like Percodan, Vicodin, OxyContin, and Percocet. Taking care of a substance abuse problem can greatly increase the success of your HIV therapy.
Because methadone is a federally controlled drug you must meet the requirements of the US Food and Drug Administration (FDA). Federal requirements along with state laws can influence whether or not methadone treatment is available in your area.
You cannot get methadone in every pharmacy and you may have to go to the clinic to get your medicine. Currently advocates are pushing for methadone to be treated like any other prescription medication.
Methadone's common side effects are constipation and excessive sweating. However, some people on methadone also report having dry mouth, trouble urinating, erectile dysfunction, skin rash, low blood pressure (which can result in feeling tired or dizzy), and nausea.
There are street stories that methadone rots the bones and makes teeth fall out. However, there is no scientific or medical evidence that supports these myths.
Methadone can interact with other medications. Sometimes drug interactions are minor and do not cause any problems. Other times the wrong combination of drugs can cause serious side effects. In addition, any type of liver disease (e.g., hepatitis) may make these interactions worse.
If you are taking methadone and HIV drugs you must be carefully monitored by your health care provider. In some cases methadone causes the HIV drugs to become less effective. In some cases the HIV drugs cause the methadone to become less effective. It is important to talk to your provider to see if you need to have the dose of your methadone or any of your other medications changed.
The US Department of Health and Human Services (DHHS) creates HIV treatment guidelines that it updates periodically. They are very technical and designed to guide providers as they care for people living with HIV (HIV+). Table 11 of the guidelines has a complete list of the interactions between HIV drugs and methadone. To look at this table, go to: http://www.aidsinfo.nih.gov/guidelines and click on Tables under Adult and Adolescent Treatment Guidelines. Then go to Table 11 on p. 16-17 (“Drug Interactions between Antiretroviral Agents and Drugs Used to Treat Opioid Addiction,” last updated on January 10, 2011). The DHHS table uses abbreviations for HIV drug names, so you may find it helpful to look at our HIV Drug Chart info sheet to find your HIV drugs’ other names.
Some other drugs used by HIV+ people, such as the antibiotic rifampin, also interact with methadone. Talk to your HIV provider or methadone program associate so they can provide you with the proper medical advice.
If you cannot take methadone because of drug interactions, other recovery treatments may be used:
- Drug therapies such as LAAM (Levo-Alpha Acetyl Methadol), naloxone, naltrexone and buprenorphine
- Detoxification (clearing the body of drugs)
- Behavioral therapies
Methadone treatment may cause changes to and even stop your monthly menstrual period. It will not, however, prevent you from getting pregnant or from having a normal pregnancy.
Methadone does cross the placenta and your baby may be dependent on methadone at first and need to be weaned. Long-term studies have shown that there is no increased risk of birth defects or developmental difficulties in babies born to methadone-treated women.
If you are on methadone and become pregnant, you should not stop your treatment without first speaking to your health care provider.
Methadone is an important tool for treating addiction to heroin and other opiates, including prescription painkillers. Get the most out of your methadone and your HIV drugs by keeping your health care provider informed of all the drugs you are taking so any necessary dose adjustments can be made.