Methadone for Pain

What is methadone?

Methadone is a strong pain killer and is classed as an opioid.

It is sometimes used in chronic pain, were other more traditional pain- killers have failed to work. Methadone is sometimes helpful for neuropathic pain (nerve pain).

I have concerns about being prescribed methadone.

Methadone is well known for its use in the treatment of substance misuse, however its use in pain medicine is very different. Methadone for pain is prescribed in tablet form rather than the green liquid that is used for substance use disorder. Pharmacy dispensing is also very different and will usually be dispensed in the same way as other monthly medications would be.

How do I take methadone?

Methadone can be taken up to 3 times per day. You should take this alongside your existing medications unless you have been advised otherwise by your pain doctor or nurse.

Initially you will start on a small dose of methadone and increase very slowly. Please do not alter or increase your dose unless advised to do so by your pain doctor or nurse.

Tell your doctor or nurse if you are taking anything which is not prescribed i.e. anything you buy yourself over the counter, herbal medicines or medicines purchased on the internet. 

What should I do if I miss a dose?

If you miss a dose of methadone, do not double up or try to make up for the dose you have missed. Wait until your next dose is due and skip the dose that you have missed.

How should I store my methadone?

You should store your methadone securely in a cool place, out of direct sunlight and away from children, pets, or vulnerable adults.

Never share your methadone. It has been specifically prescribed for you and could harm others if used incorrectly.

Any excess or old medication should be taken to your pharmacy for safe disposal.

How long will it take to work?

You may notice an improvement in your pain within 24-48 hours, however the full benefit may not be noticed for around 7 days after you have reached a stable dose.

Most opioid medications for chronic non cancer pain need to show a reduction in your pain of one third to justify the risks of side effects and complications to continue taking it long term.

Are there any side effects from methadone?

Side effects are similar to other opioid based medications.

Commonly

• Nausea: This can be managed with anti-sickness medication if required

• Constipation: If increasing sources of fibre and fluids in your diet do not help, please speak with your GP or pharmacist for further advice.

• Drowsiness and tiredness

• Tolerance and dependency:as with any opioid based medication this needs to be considered. Please see the leaflet on opioids and chronic pain for further information.

A full list is given in the pack information sheet in the medication box.

Methadone has a very long duration of action and this can vary greatly from person to person. Because of this there is a risk that it might affect your breathing or level of alertness. This could be very dangerous and if you think this has happened you need to get urgent help by dialing 999.

Rarely, some patients may experience an altered heart rhythm as a result of methadone. Before you are commenced on methadone an ECG (simple heart rhythm tracing) will be requested and repeated annually as part of your review.

How long can I continue to take methadone?

Providing you continue to get benefit from it, you may remain on a stable dose for quite a long period of time. You will be reviewed by your pain doctor annually.

Never stop taking your methadone suddenly. Always consult your GP, pain doctor or nurse for advice first. 

Can I drink alcohol?

It is advised that you do not drink alcohol whilst using methadone. This can be hazardous as methadone can increase the effects of alcohol.        

Can I work and drive?

On starting Methadone or changing a dose, generally side effects are    more likely. These can impair your ability to function clearly and react quickly. Skilled tasks such as driving or caring for others such as children particularly may be affected.

Changing a dose may be better timed when you have additional support to help or take over these tasks, or a period when you are not in work such as weekends for some.

Driving law makes it an offence to drive if you feel affected such as feeling dizzy, drowsy, unable to concentrate and slower reaction times. You are responsible for your own fitness to drive. There is a clear link between prescription opioid use in drivers and increased odds of road traffic accidents.

If you feel well enough to function and particularly on a stable dose many of our patients feel able to work and drive.

How do I get another prescription of methadone?

Once your dose has been stabilised your pain doctor or nurse will write to your GP and request that they take over the prescribing of your methadone.

If your GP has not agreed to this, then you will need to call the pain secretaries on 0151 556 3394. It is vital that you allow 5 working days to process your request.

One of your doctors or nurses will need to contact you to discuss your request before a prescription can be issued.

Who should I contact if I have problems with my methadone?

Monday to Friday 9am to 4.30pm contact the pain clinic on 0151 556 3686. Evenings, weekends, and bank holidays please contact NHS 111.

In an emergency, please call 999.

Other resources

https://www.gov.uk/drug-driving-law

https://www.fpm.ac.uk/opioids-aware