Methadone is a prescribed medicine for people who are dependent on heroin or other opioids. It is an opioid itself, but taken daily by mouth at a steady dose it stops withdrawal and eases cravings without producing a high. In Malaysia, methadone maintenance therapy has been offered since October 2005, through government hospitals and klinik kesihatan, private clinics, the National Anti-Drugs Agency (AADK) and prisons, usually as a syrup swallowed in front of staff.
This guide covers how it works, how it compares with Suboxone, and how people come off it safely.
What methadone is and how it works
Opioids such as heroin act on receptors in the brain, the switches that control pain, reward and breathing. Methadone works on the same receptors. Doctors call it a full opioid agonist, meaning it switches those receptors fully on.
The difference is speed. NIDA, the US National Institute on Drug Abuse, explains that methadone acts more slowly than other opioids, and that treatment doses do not produce euphoria. A stable daily dose removes withdrawal symptoms and relieves cravings, so the person no longer has to chase the next dose to feel normal.
The World Health Organization (WHO) says opioid agonist maintenance treatment, with medicines such as methadone and buprenorphine, has the strongest evidence of effectiveness and cost-effectiveness for opioid dependence. NIDA reports that methadone treatment reduces opioid use, the spread of infections linked to drug use, and crime.
How methadone maintenance therapy works in Malaysia
The Ministry of Health (KKM) started the programme in October 2005 with ten centres, eight government and two private, as part of a national harm reduction programme. By December 2013, the Ministry's outcome study counted 811 centres (446 government and 365 private) treating 65,259 people. AADK runs methadone through its Cure & Care clinics, and the programme also reaches prisons.
What a typical arrangement looks like:
- Methadone is given as a syrup. KKM's methadone dispensing guidelines, from its Pharmaceutical Services Programme, ask staff to check the patient's identity, measure the dose and make sure it is swallowed completely.
- The dose is adjusted over time. WHO guidelines say maintenance doses should on average be 60 to 120 mg a day. The Ministry's study found an average of 54.8 mg among its patients, which it noted was slightly below WHO's recommended range.
- Counselling and support sit alongside the medicine. WHO recommends that psychosocial support, meaning counselling and practical help with life, is offered routinely with opioid treatment.
Take-home doses
Most people start by attending the clinic every day. Once they are stable, some are allowed to take doses home for a few days. In the Ministry's study, 60 per cent of patients had take-home doses, for an average of about 3 days at a time. The criteria clinics most often used were urine tests clear for 3 months, no behavioural problems, regular dosing and regular follow-up.
WHO's guidance is that take-home doses can be given when the benefit of fewer clinic visits outweighs the risk of the medicine going to someone else, with regular review. Keep take-home methadone out of reach of children and away from other people, in its original container.
Methadone vs Suboxone
Suboxone is a brand of buprenorphine combined with naloxone. Buprenorphine is the other main medicine for opioid dependence. It is a partial agonist: NIDA explains that it switches on the same receptors less strongly, and also reduces cravings and withdrawal without a high. It comes as a tablet or film that dissolves under the tongue.
For more on Suboxone itself, including side effects and coming off it, see our guide to Suboxone in Malaysia.
Naloxone is added to discourage injecting. It is barely absorbed under the tongue, but if the tablet is crushed and injected, the naloxone can bring on withdrawal.
In Malaysia, buprenorphine with naloxone was introduced in 2006. A 2015 paper in the Medical Journal of Malaysia noted that its use had been limited to private practice, and that government programmes preferred methadone.
On effectiveness, NIDA says methadone and buprenorphine are equally effective at reducing opioid use, provided buprenorphine is given at a high enough dose. Which one suits a person is a decision for them and their doctor.
Side effects and safety
MedlinePlus lists common side effects of methadone as headache, nausea, vomiting, sweating and lower sex drive. In the Ministry's study, the most common were constipation and dry mouth.
The serious risks need to be known:
- Breathing problems, which MedlinePlus says are most likely in the first 24 to 72 hours of treatment.
- A rare heart rhythm problem called QT prolongation.
- Mixing. Alcohol, other medicines or street drugs taken with methadone raise the risk of slowed breathing, heavy sedation and coma. Tell the doctor about everything you take, including sleeping pills and cough syrup.
WHO describes three signs of opioid overdose: very small pupils, being unconscious or impossible to wake, and difficulty breathing. If you see these, call 999.
Why some people want to come off methadone
Some people on methadone want to stop, and their reasons are understandable. In a study of people leaving methadone treatment in Vietnam, the reasons included feeling they were no longer dependent on heroin, and the daily clinic visits clashing with work. In Malaysia, CodeBlue reported patients during the 2020 Movement Control Order who were afraid of police roadblocks on the way to the clinic, and others who preferred a private clinic because of stigma.
Wanting to stop is a reasonable goal to raise with your doctor. WHO's guidance is that most patients should be advised to stay on maintenance treatment, because coming off opioids leads to poor long-term outcomes for many people, and also that patients should be helped to withdraw if it is their informed choice. NIDA notes high relapse rates in some studies among people tapered off buprenorphine compared with those who stayed on it longer.
How coming off methadone is done safely
Do not stop methadone suddenly. MedlinePlus advises talking to your doctor first, who will usually reduce the dose gradually. Stopping suddenly causes withdrawal: restlessness, a runny nose and watery eyes, yawning, sweating, chills, aches, stomach cramps, diarrhoea, poor sleep and anxiety. A Western Australian clinical guideline notes that a staged reduction makes withdrawal less severe.
What helps a taper go well:
- A plan agreed with the prescribing doctor, with the pace set by how the person is coping.
- Counselling and support during and after the taper, as WHO recommends.
- Somewhere steady to live and something to fill the days.
- Knowing the overdose risk. Tolerance falls as the dose comes down, so a dose of heroin that once felt normal can now kill. WHO says people coming off opioids should be warned about this risk if they use again.
If a taper becomes too hard, tell the doctor. Pausing, going back up a step or staying on methadone are all options to weigh with the doctor.
Common questions
What is methadone used for?
Methadone treats dependence on heroin and other opioids by preventing withdrawal and reducing cravings. Doctors also prescribe it for pain. In Malaysia it is mainly known through methadone maintenance therapy at government and private clinics.
Is methadone just swapping one drug for another?
Methadone is an opioid, but it is taken by mouth, daily, at a measured dose that does not produce a high. WHO rates opioid agonist maintenance as having the strongest evidence of any treatment for opioid dependence.
Where are methadone clinics in Malaysia?
Methadone is given at government hospitals, klinik kesihatan, private clinics and AADK Cure & Care clinics. Your own doctor or the nearest clinic can explain how to start.
Can I go to rehab while I am on methadone?
Yes. If you are planning residential care, tell the centre your current dose before you arrive, and do not stop the medicine on your own. Our page on heroin and opioid addiction treatment explains how Salus reviews existing medication.
Which is better, methadone or Suboxone?
Neither is better for everyone. NIDA reports they are equally effective at reducing opioid use when given at the right dose. In Malaysia, government programmes have mainly used methadone, while buprenorphine with naloxone has been prescribed mostly in private practice.
How Salus can help
Salus is a private, confidential, voluntary 90-day residential programme for adults aged 18 and over in Cyberjaya, Selangor. It suits people who want to deal with opioid use, including those planning a supervised methadone taper with their own doctor. Every guest has a medical, psychiatric and psychological assessment on arrival, the medical team reviews any medicine the person already takes, and withdrawal is managed alongside medical care. A Salus Clinician plans daily life alongside medical care, with individual and group therapy, family sessions and an aftercare plan, for RM7,000 per month, all-inclusive. Our guide on why we use 90 days explains the length.
To talk it through, call or WhatsApp Salus for a confidential conversation. Families can call first, before the person has agreed to anything.
This article is general information, not medical advice.
