Methadone treatment
A daily liquid that holds withdrawal and craving steady for a full twenty four hours.
What it is
A long acting opioid agonist, taken by mouth as a measured liquid. It occupies the same receptors as fentanyl, but releases slowly, so there is no rush and no crash.
How you take it
Once a day, at a pharmacy while a pharmacist watches. Take home doses begin once your dose is settled, usually starting with one day a week.
What to expect
Your dose starts low and rises slowly. Reaching a dose that holds you for a full day commonly takes two to four weeks. The first week is the hardest part.
Nothing on this page is a substitute for an assessment by a clinician who knows your history.
How to start methadone in BC
Call us, walk into a clinic, or ask your pharmacy to send a request. No referral and no family doctor are needed, and appointments are billed to MSP. The first visit takes about ninety minutes: a full history, a physical assessment, a urine drug screen, and a conversation about which pharmacy you want to use.
Unlike Suboxone, methadone has no induction window, so you do not need to be in withdrawal to begin. Where it is clinically appropriate, a first dose is taken under observation at your pharmacy the same day. The starting dose is deliberately low and is raised over the following weeks.
How methadone works
Methadone is a full opioid agonist. It occupies the same receptors that fentanyl, heroin or prescription opioids act on, which is why it stops withdrawal. The difference is speed. Methadone is absorbed slowly and leaves the body slowly, so instead of the sharp rise and fall that drives the cycle of using, the level in your blood stays flat.
That flatness is the entire point. At a dose that suits you, there is no rush and no crash. Cravings quieten. Withdrawal does not arrive in the afternoon. Most people describe it not as feeling medicated but as finally feeling normal, sometimes for the first time in years.
Because methadone is long acting, it also gives a measure of protection against overdose. Tolerance is held at a steady level rather than dropping between uses, which is when the risk of a fatal overdose is highest.
What the first two weeks look like
Methadone is started low and raised slowly. This is not caution for its own sake. Methadone accumulates in the body over the first several days, so the dose you take on day one is still building on day four. Raising too quickly is the single greatest risk in early treatment, and every responsible programme in Canada works the same way.
A typical pattern looks like this:
- Day one. Assessment, a urine drug screen, and a first dose taken under observation at your pharmacy. You will be asked to stay reachable that day.
- Days two to five. Daily witnessed dosing. Expect to still feel some withdrawal. This is normal and is not a sign the medication is failing.
- Week one review. We check how long each dose is holding you and adjust upward, usually in small increments.
- Weeks two and three. Further adjustments until a dose holds you comfortably for a full twenty four hours.
Reaching a comfortable dose commonly takes two to four weeks. The waiting is the hardest part of methadone, and it is worth knowing about in advance so that a difficult third day does not read as failure.
Every death in early methadone treatment comes from starting too high or going up too fast. So we start low, and we tell you in advance that it will feel low.
Dosing, carries and daily life
At the start, methadone is taken at a pharmacy while a pharmacist watches. This is called witnessed dosing. It sounds intrusive, and for the first weeks it genuinely is inconvenient, but it exists because the early period is when the risk is real.
Take home doses, known as carries, are the standard next step. Eligibility in British Columbia depends on clinical stability rather than on time served: a settled dose, drug screens consistent with your treatment plan, somewhere safe to store the medication, and reliable attendance. Carries usually begin with one day a week and expand from there.
Once you hold carries, methadone stops organising your week. People work full time on methadone, travel, study and raise children on it. Getting to that point is the aim of the first few months.
Safety and interactions
Two things matter more than anything else. The first is that methadone and benzodiazepines, alcohol, or other sedatives together are the main cause of overdose in people on treatment. If you use any of these, tell us. We can work with it. We cannot work around what we do not know.
The second is that methadone interacts with a long list of ordinary medications, including some antibiotics, antifungals, HIV medications and antidepressants. Some raise your methadone level, some lower it. Always tell any prescriber that you are on methadone, and tell us about anything new you have been prescribed.
We recommend every patient keep a take home naloxone kit, and we can tell you where to get one at no cost. Having one is not an admission that treatment is going badly. It is the same logic as a smoke alarm.
What this treatment does well, and what to weigh up
Every option has trade offs. Here are both sides.
Where methadone is strongest
- Works reliably at high opioid tolerance, including long term fentanyl use
- No induction window, so you do not need to be in withdrawal to start
- The most studied opioid agonist treatment, with sixty years of evidence
- Often effective for people for whom Suboxone did not hold
- Liquid dosing allows very fine adjustment
What to weigh up
- Daily pharmacy visits at first, which takes real organising
- Reaching a comfortable dose usually takes two to four weeks
- Interacts with many common medications, so tell every prescriber
- Stopping abruptly causes prolonged withdrawal, so any taper is planned slowly
- Dangerous in combination with benzodiazepines or alcohol
Methadone treatment: your questions answered
These are the questions our physicians are asked most often about this treatment. If yours is not here, call us and ask.
How quickly will methadone stop my withdrawal?
The first dose usually takes the edge off within two to four hours, but it will not hold you for a full day. That is expected. Because methadone builds up gradually, most people need two to four weeks of small increases before a dose covers twenty four hours comfortably.
The most common reason people leave methadone treatment is quitting during this window, believing it is not working. If day three is hard, tell us rather than deciding on your own. We can adjust supportive medication for symptoms while the main dose catches up.
Will methadone make me feel high or sedated?
At the right dose, no. What people describe is the absence of something: no withdrawal, no clock watching, no craving in the background. That flatness can feel strange at first if the rhythm of using has structured your day for years.
Feeling drowsy, nodding off, or slurring speech means the dose is too high or something is interacting with it. That is a reason to contact us the same day, not to wait for your next appointment.
Do I have to go to the pharmacy every single day?
At the beginning, yes. Witnessed daily dosing is standard while your dose is being established, because that is the period when the risk of overdose is highest.
Take home doses are the goal, not a reward we withhold. Once your dose is stable, your drug screens match your treatment plan, and you have somewhere safe to store medication, carries usually start with a single day and build from there. Many long term patients collect once or twice a week.
Can I drive while taking methadone?
Once you are on a stable dose and not sedated, yes. Being on methadone does not by itself prevent you from holding a driver licence in British Columbia.
During the first weeks, while your dose is still being adjusted, be careful. Do not drive if you feel drowsy, and never drive after combining methadone with alcohol, benzodiazepines or other sedating drugs. Commercial licence holders should raise it with us directly, because different rules apply.
What should I do if I miss a methadone dose?
Tell us and tell your pharmacy. Tolerance to methadone falls faster than most people expect. After three consecutive missed days, your previous dose may no longer be safe, and we will need to restart at a lower amount and build back up.
This is a safety measure rather than a penalty. Taking a full previous dose after a gap is a genuine cause of fatal overdose. Missing doses does not put you out of the programme, and it is not something to hide from us.
Does methadone damage your teeth or your bones?
Methadone does not dissolve teeth. What it does is reduce saliva, and a dry mouth over years allows decay that would otherwise not happen. The liquid is also sweetened. Rinsing with water after each dose, not brushing immediately afterwards, and regular dental care make a large difference.
Long term opioid use of any kind can lower sex hormone levels, which over many years can affect bone density. It is worth mentioning to us if you have other risk factors, because it is measurable and treatable.
How long will I need to stay on methadone?
There is no fixed course. Opioid use disorder behaves like other long term conditions, and the evidence is consistent: the longer someone stays in treatment, the better the outcome. Many people remain on methadone for years, and some stay on it indefinitely, in the same way someone might stay on blood pressure medication.
If you decide you want to come off, that is your call, and we will support it. A planned taper is gradual, often over many months, and can be paused or reversed at any point. Nobody is discharged for changing their mind.
What does methadone treatment cost in British Columbia?
Appointments with our physicians are billed to the Medical Services Plan, so there is no fee for the visit if you have active MSP coverage. The medication itself is covered by BC PharmaCare for most residents, and people receiving income assistance or disability assistance are generally covered in full including dispensing fees.
Exact coverage depends on which PharmaCare plan you fall under and whether your deductible is met. Our team checks this with you at your first visit. If you have no coverage at all, say so early, because it can usually be arranged.
If this is an emergency, call 911. Overdose symptoms, trouble breathing, chest pain, seizures or an immediate mental health crisis need emergency care, not a callback form. In British Columbia you can also reach the Suicide Crisis Helpline at 988 or call 811 for HealthLink BC nurse advice.
Ready to talk about methadone treatment?
No referral needed. Assessment and, where appropriate, treatment the same day.