Substances
How Long Can You Be on Methadone for Opioid Use Disorder (OUD)?
Medically Reviewed By
Written By
Last medically reviewed March 17, 2025
Substances
Medically Reviewed By
Written By
Last medically reviewed March 17, 2025
Methadone is a man-made opioid that is mainly used to help people with opioid use disorder.[1][2] It works by blocking the feelings of pleasure that come from using illegal drugs like heroin and cocaine.[3] This helps people control their cravings and lessen the tough withdrawal symptoms they may experience. Every year, over 400,000 patients receive methadone at treatment centers across the United States, making it an important part of the treatment for those dealing with opioid addiction.[4]
While methadone is considered a gold standard for managing opioid withdrawal, it carries a risk for addiction.[5] Prescribers must consider this risk when dispensing it to their patients and will usually only do so if the benefits outweigh these risks. The duration for which someone can take methadone depends on their recovery goals and their body’s response to the medication. Additionally, federal regulations dictate who is authorized to prescribe methadone and the length of time it can be used.
The first step in treating someone with an opioid use disorder (OUD) is detox. During this stage, the patient stops using opioids, which allows their body to clear the drugs out. Stopping suddenly can lead to uncomfortable withdrawal symptoms, so doctors often give patients medication to help.[6] One common medication used is methadone.
Doctors usually start OUD patients on 10 to 20 mg of methadone to help manage withdrawal symptoms.[6] They may increase the dose by 10 mg until they reach the right amount, typically around 40 mg for most people.[6]
After the patient stabilizes on this dose for two to three days, doctors will gradually lower the dosage until the patient can safely stop using opioids. This tapering process can take anywhere from a few weeks to several months.[6]
Yes, a physician can provide daily doses of methadone to inpatients with an opioid use disorder (OUD). Typically, the daily dose ranges from 10 to 20 mg, but it can be adjusted to find the right amount for each individual.[7] This dose must not exceed 40 mg per day to avoid negative effects.
The dosage will gradually decrease once the patient is stable over several weeks. If cravings for opioids arise, the dose can be increased by 5 to 10 mg every few days without exceeding 20 mg in a week.[7] This careful approach helps avoid some common side effects of methadone treatment, such as chronic constipation.
The number of doses prescribers can provide to patients with OUD unsupervised varies from state to state. The patient and prescriber must follow specific guidelines set by their state to dispense and receive methadone. The following information published by the Substance Abuse and Mental Health Services Administration explains the general guidelines for methadone dispensing in the states that allow this flexibility:[8]
It’s important to note that before the OTP supplies any take-home doses, they must determine that you can safely manage these doses unsupervised. Furthermore, they must note their rationale for making this decision in their clinical files.[8] How long you can be unsupervised on methadone is ultimately determined by the OTP but may not exceed 28 days after attending 31 days of treatment.[8] Should you need more, you may be advised to re-enter treatment.
The three-day rule is a federal regulation that outlines restrictions on the administration of methadone outside of a licensed methadone program.[9] This rule permits physicians who are not affiliated with an opioid treatment clinic to administer a daily dose of methadone for a maximum of three days to patients experiencing acute opioid withdrawal symptoms who are seeking treatment. Once these three doses are given, the physician cannot renew or extend the treatment.
Most studies primarily examine the short-term effects of using methadone to treat opioid use disorder. As a result, the safety of long-term methadone maintenance remains unclear. Each prescriber will assess whether the benefits of long-term methadone maintenance therapy outweigh the risks for their patients. However, the Substance Abuse and Mental Health Services Administration (SAMHSA) recommends a minimum treatment duration of 12 months with methadone to achieve the best outcomes in therapy.[1]
There isn’t a maximum timeframe for using methadone for addiction treatment. However, there are restrictions regarding how many doses you can take home. Should you need more than 28 days’ worth of take-home methadone, you will have to receive subsequent doses in a treatment program. Additionally, it’s important to remember that methadone is addictive, so the longer you remain on the medication, the higher the risk of becoming physically and mentally dependent on it, even when you no longer need it.[5]
If you have been diagnosed with an opioid use disorder, you might feel better after using methadone for a while. However, this doesn’t mean the OUD has been adequately treated. Therefore, it is not advisable to stop taking methadone, as doing so can lead to a relapse. Additionally, methadone is classified as a Schedule II Controlled Substance, meaning it has a high potential for abuse and dependence, which can result in severe withdrawal symptoms for those who abruptly discontinue its use.[5]
The safest way to quit methadone is to speak to your physician about a taper schedule to avoid withdrawal and relapse.
Methadone continues to be an effective treatment option for individuals with opioid use disorder. However, it’s important to note that it can only be obtained through a substance use treatment program. While three doses can be provided to alleviate severe opioid withdrawal symptoms outside of a treatment center, this short-term use is insufficient for effectively treating OUD.
Even if you begin to feel better after these doses, it’s very important to join an OUD treatment program. Doing so can help you avoid withdrawal symptoms and lower your chances of relapsing, which can significantly decrease the risk of an opioid overdose.
To learn more about the use of methadone maintenance treatment for opioid recovery, contact Southeast Addiction Center GA. We provide evidence-backed services such as medication-assisted treatment, behavioral therapies, and adjunct holistic programs for individuals struggling with opioid addiction.
For convenience, we provide these services and many more at various levels of care, including partial hospitalization, inpatient treatment, intensive outpatient, and outpatient programs.
Call us today to discover more about these programs and how we can help you overcome OUD and reclaim the life you deserve.
Yes, methadone is a Schedule II Controlled Substance, and drugs in this category have a high potential for abuse and misuse, especially when used in a manner other than prescribed.
It is not advised to stop using methadone without medical supervision. Abrupt methadone cessation can cause severe, life-threatening withdrawal symptoms. Speak to your prescriber before reducing or stopping the dose to avoid these effects.
There is no limit to how long someone can be on methadone. Some people only need it briefly, whereas others may stay on it indefinitely. The amount of time one remains on methadone is dependent on one’s treatment goals and needs. However, SAMHSA recommends a minimum of 12 months.
The three-day rule is a government regulation allowing patients with acute opioid withdrawal to receive three daily doses of methadone from a physician not participating in an opioid treatment program.
If, after titrating the doses, you find that methadone doesn’t curb your cravings or withdrawal, the treating physician may substitute it for another FDA-approved medication such as buprenorphine, naloxone, or suboxone.
[1] The Substance Abuse and Mental Health Services Administration (SAMHSA). (2024 Mar 29) Methadone. Retrieved from https://www.samhsa.gov/substance-use/treatment/options/Methadone on 2025 Jan 9.
[2] Medline Plus. (2024 Mar 27) Opioid Use Disorder. Retrieved from https://medlineplus.gov/opioidusedisorderoudtreatment.html on 2025 Jan 9.
[3] National Library of Medicine. (2000 Jan) Use of Methadone. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC1070723 on 2025 Jan 9.
[4] Columbia University Department of Psychiatry. (2023 Dec 6) No Spike in Overdoses with COVID-era Expansion of Methadone Access. Retrieved from https://www.columbiapsychiatry.org/news/study-no-spike-overdose-deaths-covid-era-expansion-Methadone-access on 20205 Jan 9.
[5] United States Drug Enforcement Administration. (n.d.) Drug Scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling on 2025 Jan 8.
[6] National Library of Medicine. (n.d.) Withdrawal Management. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK310652/ on 2025 Jan 9.
[7] National Library of Medicine. (n.d.) Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK143167/ on 2025 Jan 9.
[8] The Substance Abuse and Mental Health Services Administration (SAMHSA). (2024 Nov 6) Methadone Take-Home Flexibilities Extension Guidance. Retrieved from https://www.samhsa.gov/substance-use/treatment/opioid-treatment-program/Methadone-guidance on 2025 Jan 9.
[9] The Federal Register. (2023 Aug 8) Dispensing of Narcotic Drugs To Relieve Acute Withdrawal Symptoms of Opioid Use Disorder. Retrieved from https://www.federalregister.gov/documents/2023/08/08/2023-16892/dispensing-of-narcotic-drugs-to-relieve-acute-withdrawal-symptoms-of-opioid-use-disorder on 2025 Jan 9.