Methadone is a synthetic opioid used for chronic pain management and, more commonly, as a treatment for opioid use disorder (OUD). Due to its long half-life, methadone stabilizes patients by preventing withdrawal symptoms, making it a cornerstone of medication-assisted treatment. When a person on a steady methadone regimen faces surgery, the central question is whether the medication must be stopped. The answer is no; safely undergoing an operation while continuing methadone is possible, but it requires careful coordination and specialized pain management strategies.
The Danger of Stopping Methadone
Discontinuing methadone before surgery creates substantial health risks. Abrupt cessation can rapidly trigger acute opioid withdrawal syndrome, a physically severe and intensely uncomfortable experience. Symptoms often include severe nausea, vomiting, intense anxiety, muscle cramping, and widespread body pain, which complicates the patient’s condition before the procedure. Stopping methadone also significantly increases the likelihood of an opioid relapse, posing a serious threat to long-term recovery.
Patients who halt their OUD medication before surgery are approximately three times more likely to experience an overdose or be hospitalized for complications following the operation. Withdrawal symptoms can also heighten the patient’s overall pain sensitivity, a phenomenon known as opioid-induced hyperalgesia, making surgical pain much harder to control. Current medical consensus strongly recommends continuing the patient’s established methadone dose throughout the entire perioperative period.
Essential Preoperative Coordination Steps
Effective communication between all parties is paramount for a safe surgical outcome. The patient must inform their surgeon, anesthesiologist, and primary care provider of their exact methadone dose and the name of their prescribing clinic or Methadone Treatment Program (MTP). The surgical team should then contact the MTP directly to confirm the patient’s current dose and schedule. This coordination prevents misunderstandings about the home regimen and allows for logistical planning.
A common logistical challenge is the NPO (nothing by mouth) period required before surgery, which prevents the patient from taking their oral methadone dose. The MTP must ensure the patient receives their usual dose on the morning of surgery, often by arranging a take-home dose or coordinating direct hospital administration. If the patient cannot take the medication orally, the dose can be administered intravenously, typically reduced and split into multiple doses throughout the day. Preoperative coordination may also involve converting the once-daily methadone dose into a divided, three-times-a-day schedule to provide more stable plasma levels and better foundational pain control postoperatively.
Navigating Anesthesia and Post-Surgical Pain
Methadone in the patient’s system does not interfere with general anesthesia, allowing the procedure to proceed as planned. The primary clinical challenge is that the established methadone dose, which prevents withdrawal, is often insufficient for acute surgical pain relief. Due to chronic opioid exposure, patients on methadone maintenance develop opioid tolerance requiring a specialized pain management strategy.
The medical team must anticipate that the patient will require significantly higher doses of short-acting opioids, such as hydromorphone or morphine, to manage breakthrough pain following surgery. This increased requirement is due to cross-tolerance, meaning the body is less responsive to all opioid medications. To reduce reliance on high-dose supplemental opioids, anesthesiologists employ a multimodal pain management approach that combines multiple medications working on different pain pathways.
Multimodal treatment involves the concurrent use of non-opioid medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, alongside nerve-blocking agents such as gabapentinoids or ketamine. Regional anesthesia, such as nerve blocks or epidurals, may also be used to numb the surgical site for an extended period, dramatically decreasing the need for systemic pain medication. The care team must diligently monitor the patient, distinguishing genuine surgical pain from signs of opioid withdrawal if the foundational methadone dose is missed or ineffective.