Part D: Critical Questions and Links to Information Regarding Clinical and Regulatory Requirements for Implementing Methadone Maintenance Programs: Examples of Approaches

Question 2: What forms of methadone are acceptable for treatment?

Answer:

United States
Methadone is provided in various forms, including diskettes, tablets, oral solution, liquid concentrate, and powder. In the United States, methadone used in medically assisted treatment is almost always administered orally in liquid form. Parenteral administration is prohibited in opioid treatment programs. Parenteral abuse of methadone is not widespread, and people rarely inject the methadone dispensed in U.S. programs because it is mixed with substances (e.g., flavored drinks) that make injection unattractive
(www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.82775; www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.section.82907).

England
Oral methadone solution is the form of choice in England, and the standard dose contains 1 mg of methadone in 1 ml of liquid. Oral solution is preferred because of its clinically proven effectiveness, ability to alleviate oral withdrawal symptoms, potential for reducing risks associated with injection, and ability to be adjusted to an optimal level. Other forms of approved methadone include a concentrated mixture of oral solution (10 mg and 20 mg), methadone tablets (5 mg), and injectable ampules. Methadone tablets are seldom recommended due to their ability to be injected and their high street value. Injectable methadone is used only after careful patient assessment by an addiction specialist (http://opiateaddictionrx.info/pdfs/RCGP_UseOfMethadone.pdf).