The use of methadone in drug maintenance programs is controversial because methadone:

The Food and Drug Administration (FDA) has approved several different medications to treat alcohol and opioid use disorders MAT medications relieve the withdrawal symptoms and psychological cravings that cause chemical imbalances in the body. Medications used for MAT are evidence-based treatment options and do not just substitute one drug for another.

Methadone used to treat those with a confirmed diagnosis of Opioid Use Disorder can only be dispensed through a SAMHSA certified OTP. Some of the medications used in MAT are controlled substances due to their potential for misuse. Drugs, substances, and certain chemicals used to make drugs are classified by the Drug Enforcement Administration (DEA) into five distinct categories, or schedules, depending upon a drug’s acceptable medical use and potential for misuse. Learn more about DEA drug schedules.

Alcohol Use Disorder Medications - Acamprosate, disulfiram, and naltrexone are the most common drugs used to treat alcohol use disorder. They do not provide a cure for the disorder, but are most effective in people who participate in a MAT program.

• Acamprosate - is for people in recovery, who are no longer drinking alcohol and want to avoid drinking. It works to prevent people from drinking alcohol, but it does not prevent withdrawal symptoms after people drink alcohol. It has not been shown to work in people who continue drinking alcohol, consume illicit drugs, and/or engage in prescription drug misuse and abuse. The use of acamprosate typically begins on the fifth day of abstinence, reaching full effectiveness in five to eight days. It is offered in tablet form and taken three times a day, preferably at the same time every day. The medication’s side effects may include diarrhea, upset stomach, appetite loss, anxiety, dizziness, and difficulty sleeping.
• Disulfiram - treats chronic alcoholism and is most effective in people who have already gone through detoxification or are in the initial stage of abstinence. Offered in a tablet form and taken once a day, disulfiram should never be taken while intoxicated and it should not be taken for at least 12 hours after drinking alcohol. Unpleasant side effects (nausea, headache, vomiting, chest pains, difficulty breathing) can occur as soon as ten minutes after drinking even a small amount of alcohol and can last for an hour or more.
• Naltrexone - blocks the euphoric effects and feelings of intoxication and allows people with alcohol use disorders to reduce alcohol use and to remain motivated to continue to take the medication, stay in treatment, and avoid relapses.

To learn more about MAT for alcohol use disorders view Medication for the Treatment of Alcohol Use Disorder: A Brief Guide – 2015 and TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice.

Opioid Dependency Medications - Buprenorphine, methadone, and naltrexone are used to treat opioid use disorders to short-acting opioids such as heroin, morphine, and codeine, as well as semi-synthetic opioids like oxycodone and hydrocodone. These MAT medications are safe to use for months, years, or even a lifetime. As with any medication, consult your doctor before discontinuing use.

• Buprenorphine - suppresses and reduces cravings for opioids. Learn more about buprenorphine.
• Methadone - reduces opioid cravings and withdrawal and blunts or blocks the effects of opioids. Learn more about methadone.
• Naltrexone - blocks the euphoric and sedative effects of opioids and prevents feelings of euphoria. Learn more about naltrexone.

Learn more about MAT for opioid use disorders and download TIP 63: Medications for Opioid Use Disorder – 2021.

Opioid Overdose Prevention Medication – Naloxone saves lives by reversing the toxic effects of overdose. According to the World Health Organization (WHO), naloxone is one of a number of medications considered essential to a functioning health care system.

• Naloxone – used to prevent opioid overdose, naloxone reverses the toxic effects of the overdose. Learn more about Naloxone.

MAT Medications and Child Safety

It’s important to remember that if medications are allowed to be kept at home, they must be locked in a safe place away from children. Methadone in its liquid form is colored and is sometimes mistaken for a soft drink. Children who take medications used in MAT may overdose or experience adverse reactions.

Prevent children and pets from accidental Ingestion by storing it out of reach. For more information, visit CDC’s Up and Away educational campaign. For information on how to dispose of medications in your house, refer to FDA’s information How to Safely Dispose of Unused or Expired Medicine or DEA’s drug disposal webpages.

Counseling and Behavioral Therapies

Under federal law 42.CFR 8.12, MAT patients receiving treatment in OTPs must receive counseling, which may include different forms of behavioral therapy. These services are required along with medical, vocational, educational, and other assessment and treatment services. Learn more about these treatments for substance use disorders.

Regardless of what setting MAT is provided in, it is more effective when counseling and other behavioral health therapies are included to provide patients with a whole-person approach.

Co-Occurring Disorders and Other Health Conditions

The coexistence of both a substance use disorder and a mental illness, known as a co-occurring disorder, is common among people in MAT. In addition, individuals may have other health related conditions such a hepatitis, HIV and AIDS. Learn more about co-occurring disorders and other health conditions.

Training and Resources

SAMHSA offers tools, training, and technical assistance to practitioners in the fields of mental health and substance use disorders. Find information on SAMHSA training and resources.