The opioid medication, methadone, is used for several purposes in the treatment of opioid addiction across the United States. Like other prescriptions, methadone is typically safe and effective when used as prescribed.

Methadone may be used to ease pain and withdrawal symptoms associated with opioid use. This process is commonly referred to as detoxification, or detox for short. Detox is a grueling process for those suffering from substance use disorders. Methadone is used as a safer alternative to quitting cold turkey. In its entirety, the process may take anywhere from three days to upwards of 20 weeks.

Additionally, many patients are prescribed the drug as a means to maintain their progress in opioid recovery, while also reducing their dependence on these detrimental substances.

Methadone may be used for maintenance treatment, sometimes lasting several years. In methadone maintenance therapy, the goal is to reduce opioid use by users who have struggled with abstinence in the past. This can sometimes be a lifelong battle. Many clinics and rehabilitation centers also offer methadone reduction programs focused on achieving complete opioid recovery.

Those with an addiction to heroin have the most to gain from methadone treatment. The drug is used to block heroin cravings, with effects lasting much longer than heroin itself.

Unfortunately, methadone treatment can lead to a troubling result: methadone addiction. Methadone misuse comes with the potential of a lethal overdose, so, it’s essential to distinguish the signs and symptoms of overdosing on this medication.

Methadone Overdose Symptoms

In 2019, methadone was attributed to about 4% of opioid fatalities, so the rate is relatively low compared to other opioids. About 3,000 overdose deaths occurred that year due to methadone.

Methadone overdose often occurs because the drug remains in the body for a long period of time. Even after several hours have passed and the pain relief has subsided, methadone is not clear of the body. There is a reason why those in treatment programs are only given one dose per day. Accumulation of dose after dose can have deadly consequences.

Overdose symptoms should never be overlooked or disregarded. Different areas of the body may exhibit different symptoms:

  • Gastrointestinal System: The stomach and surrounding muscle structures are susceptible to a number of complications due to a methadone overdose. These may include spasms, vomiting, constipation and more.
  • Vascular and Respiratory System: The lungs are a primary attack point for methadone overdose. Labored breathing, slow breathing and a tight chest can occur.
  • Central Nervous System: Becoming confused or disoriented is not out of the question with a methadone overdose. On top of this, one may experience drowsiness or fatigue.

Signs of a Methadone Overdose

If you come across someone demonstrating signs of a methadone overdose, seek medical attention right away. Signs of overdose may include:

  • Low blood pressure and a weak pulse
  • Constricted or pinpoint pupils
  • Body spasms at irregular intervals
  • Dizziness or disoriented behavior
  • Cold, clammy skin
  • Blue lips and fingernails
  • Absence of breathing or consciousness

If an individual is able to speak, they may attempt to talk you out of taking them to the hospital. They may insinuate that they feel no pain whatsoever. This may be the residual effects of the methadone masking their true discomfort. Overdose signs may present themselves immediately or shortly after ingesting methadone. Do not sit idly by; always react to the threat of an overdose in others.

Methadone Overdose (mg)

Methadone, like other opioids, has a large range in terms of lethal dosage because of the body’s rapid ability to increase tolerance. Due to increased tolerance, consistent opioid users may be able to get away with using more methadone at a time.

Alcohol is known to aggravate the situation and lower the amount of methadone it takes to produce a lethal overdose. The two substances should not be mixed under any circumstances. The same can be said for combining methadone and benzodiazepine.

As bizarre as it may sound, some experts also suggest that methadone patients avoid drinking grapefruit juice while on the drug. There appears to be a slight correlation between an increased methadone bioavailability — the rate at which the substance is absorbed by the body — and consumption of the beverage.

Methadone Overdose Treatment

Getting someone who may be experiencing a methadone overdose to the nearest emergency room is priority number one. Overdosing on methadone means that a large amount of the medication is in the system and immediate procedures must take place to remove it.

Depending on the severity, physicians may choose to use activated charcoal to neutralize the drug in the stomach or perform gastric lavage to remove stomach contents entirely. Victims will then be put on a regimen of IV fluids and monitored until overdose symptoms dissipate.

Addiction may feel like an uphill battle, but recovery is possible with the right treatment program. If you or someone you know is struggling with a substance use disorder involving methadone or other drugs, The Recovery Village can help. Reach out to an intake coordinator today for more information. 

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Medically Reviewed By – Dr. Conor Sheehy, PharmD, BCPS, CACP
Dr. Sheehy completed his BS in Molecular Biology at the University of Idaho and went on to complete his Doctor of Pharmacy (PharmD) at the University of Washington in Seattle. Read more
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Editor – Nicole LaNeve
Nicole leads a team of passionate, experienced writers, editors and other contributors to create and share accurate, trustworthy information about drug and alcohol addiction, treatment and recovery for The Recovery Village and all Advanced Recovery Systems sites. Read more

American Journal of Drug and Alcohol Abuse. “Effects of methadone plus alcohol on cog[…]intained volunteers.” Jan 2015. Accessed Aug 29, 2021.

Kaiser Family Foundation. “Opioid Overdose Deaths by Type of Opioid.” 2019. Accessed Aug 29, 2021.

MedlinePlus. “Opioid Overdose.” June 2021. Accessed Aug 29, 2021.

World Health Organization. “Clinical Guidelines for Withdrawal Manag[…] in Closed Settings.” 2009. Accessed Aug 29, 2021.

Ershad, Muhammed; Dela Cruz, Maricel; Mostafa, Ahmed; Mckeever, Rita; Vearrier, David; and Greenberg, Michael. “Opioid Toxidrome Following Grapefruit Ju[…]ethadone Maintenance.” Journal of Addiction Medicine, March/April 2020. Accessed November 5, 2021.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.