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 (Treatment Improvement Protocol 43, Chapter 3: http://www.ncbi.nlm.nih.gov/books/NBK25695/#A82783).

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 not licensed for the treatment of drug dependence due to their ability to be injected and their high street value, but specialists may recommend their use in limited circumstances where necessary precautions are taken. Injectable methadone is used only after careful patient assessment by an addiction specialist (Royal College of General Practitioners Guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care, http://www.rcgp.org.uk/clinical-and-research/clinical-resources/~/media/Files/CIRC/RCGP%20Guidance%20%20for%20the%20use%20of %20Substitute%20Prescribing%20in%20the %20Treatment%20of%20Opioid%20Dependence%20in%20Primary%20Care%20-2011.ashx) (2.4MB).