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Medically Reviewed By: Elena Hill, MD, MPH -

Liquid Methadone: Common Medication to Treat Opioid Misuse

Medications For Addiction Treatment (MAT) Suboxone Alternatives Treatment

Liquid methadone is a medication used to treat opioid use disorder (OUD). It is proven to be effective for that purpose.

While liquid methadone has some side effects and risks, these are generally outweighed by its potential benefits, at least when used as prescribed.

What Is Liquid Methadone?

Liquid methadone is a long-acting opioid in liquid form. It usually comes in a sweetened cherry flavor, although it sometimes comes in a dye-free, sugar-free, unflavored form.[1] The liquid will generally be either red (if dyed and flavored) or clear (if dye-free). 

While methadone is a true opioid and has its own addiction and misuse potential, it’s an accepted, evidence-based treatment option for opioid use disorder. When used as prescribed and combined with other treatments, it can potentially be lifesaving in treating OUD.  

What is Liquid Methadone Used For?

Methadone generally has two uses. The first is as a pain relief medication specifically for people who suffer from severe pain, need long-lasting pain relief, and for whom other medications won’t help. 

The second and more common use is to treat patients with OUD. Methadone binds to opioid receptors in the brain and prevents withdrawal from opioids, allowing individuals to “feel normal” and to live their daily lives with less cravings to return to illicit opioid use. 

Unfortunately at this time, the only way to receive methadone for OUD legally in the United States is to be part of a methadone program. This involves going on a daily basis (at least at first) to a registered methadone clinic to receive your medication. Once you are more established in your recovery, you are often able to get “take home doses” so that you do not need to go to the clinic as frequently. This daily schedule can be a burden on some individuals, particularly if you are working, have children to take care of, or have other daily responsibilities. However, the trade off may be worth it if you feel methadone is important in helping you maintain abstinence from opioids. The decision to enroll in a methadone program is an individualized choice, but it may be right for you. 

Proper Use & Dosing

The exact dosing a person is prescribed will depend on their unique situation as determined by their doctor. Dosing of methadone is widely variable. The standard starting dose for addiction treatment is 20 to 40 mg to suppress withdrawal symptoms.[3] Patients can quickly receive higher doses as needed over the coming days to get their withdrawal symptoms under control. Some patients may need much higher doses, as high as 160-200 mg per day, particularly these days when the supply of illicit highly potent fentanyl products is so common. 

Common Side Effects Associated With Methadone

Methadone tends to cause the same common side effects as the other opioid medications. There are several common side effects associated with methadone and opioids in general, including:[4]

  • Constipation 
  • Dry mouth
  • Itching 
  • Nausea/vomiting
  • Dizziness 

More serious side effects, particularly at high doses of the medication, include:

  • Sedation
  • Respiratory depression 
  • Arrhythmias

If someone has been taking more potent illicit opioids, the symptoms above may actually improve on methadone because it is slower acting and less potent than drugs like heroin or fentanyl. However, if you do experience any of the above side effects, talk to your methadone clinic. They may be able to adjust your dose or offer you alternative options for how to mitigate these side effects. They can also monitor you closely for any of the more serious side effects on this list, including respiratory depression, sedation, or arrhythmias. 

Can Liquid Methadone Be Diverted?

“Diversion” means giving your medication – either sharing or selling – to others. 

The risk of liquid methadone diversion is low because it is dispensed in a supervised, controlled setting. However, if a patient takes home doses, it is possible to divert the medication to others. This might be done with good intentions,  perhaps in an effort to help others in withdrawal. [5] However, it can also be sold for profit to others who are attempting to use it to “get high”. If you are in a methadone program, it is NEVER safe or advisable to give or sell your doses to others. Diverting your medication to others is illegal and can result in discharge from your methadone clinic or even legal repercussions. 

Can Methadone Cause Overdose?

Yes. Methadone is an opioid, a class of drug that can cause respiratory depression and other serious health effects. If a person’s respiration is too depressed through the use of medication, it can become difficult or impossible to draw in enough breath to fully meet the brain’s oxygen needs, which can be life-threatening.

A methadone overdose is characterized by the following symptoms:

  • Slowed, shallow, or stopped breathing
  • Notably difficulty breathing
  • Limp muscles
  • Cool, clammy skin
  • Small, pinpoint pupils
  • Drowsiness or sleepiness
  • Confusion or difficulty responding to others
  • A complete inability to respond to others
  • Unconsciousness, with difficulty waking up or being unable to wake up

An opioid overdose has the potential to cause permanent brain damage or death. It is a medical emergency.

If you are taking Methadone through a methadone clinic, you will usually start on low doses to monitor for any risk of over-sedation or overdose, and your dose can be slowly increased with time as needed. However, if you do accidentally or intentionally take more than your prescribed dose, you could put yourself at risk of an overdose.

If you believe you or someone else may be overdosing, even if you’re not sure, call 911 immediately. Additionally, administer naloxone if available. This drug can counteract opioids and reverse an opioid overdose.

Addiction Treatment Options Other Than Methadone 

Methadone is a wonderful and life saving treatment for OUD for some individuals, but it is not right for everyone. Fortunately, there are two other evidence-based treatment options available to people who know they have a problem and want help.[6] These options include Suboxone and Naltrexone. 

Suboxone and Naltrexone, unlike methadone, are often available via telehealth services, making treatment for OUD accessible to many more people. With virtual appointments, it’s a convenient way to embrace recovery, increasing rates of treatment compliance and improving stats for sustained recovery. If you are interested in using telehealth for OUD treatment, reach out to us at Bicycle health to get started.


Medically Reviewed By: Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.
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Citations

  1. Methadose™ Oral Concentrate (Methadone Hydrochloride Oral Concentrate USP) and Methadose™ Sugar-Free Oral Concentrate (Methadone Hydrochloride Oral Concentrate USP) Dye-Free, Sugar-Free, Unflavored. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/017116s021lbl.pdf. Accessed November 2022. 
  2. “It’s Like ‘Liquid Handcuffs”: The Effects of Take-Home Dosing Policies on Methadone Maintenance Treatment (MMT) Patients’ Lives. https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00535-y. Harm Reduction Journal. August 2021. Accessed November 2022.
  3. Methadone Dosing. New York State Office of Addiction Services and Supports. https://oasas.ny.gov/news/methadone-dosing. December 2006. Accessed November 2022.
  4. Methadone. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a682134.html. February 2021. Accessed November 2022.
  5. 'Diversion’ of Methadone or Buprenorphine: 'Harm’ Versus 'Helping’. Harm Reduction Journal. https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-10-24. October 2013. Accessed November 2022.
  6. Effective Treatments for Opioid Addiction. National Institute on Drug Abuse. https://nida.nih.gov/publications/effective-treatments-opioid-addiction. November 2016. Accessed November 2022.

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