Black box warning
Methadone has the following US FDA black box warning:
Risk of addiction and abuse
Potentially fatal respiratory depression
Lethal overdose in accidental ingestion
QT prolongation
Neonatal opioid withdrawal syndrome in children of pregnant women
CYP450 drug interactions
Risks when used with benzodiazepines and other CNS depressants, including alcohol. A certified opioid treatment program is required under federal law (42 CFR 8.12) when dispensing methadone for the treatment of opioid addiction or detoxification. Overdose
Most people who overdose on methadone show some of the following symptoms:

Miosis (constricted pupils)
Vomiting
Spasms of the stomach and intestines
Hypoventilation (breathing that is too slow/shallow)
Drowsiness, sleepiness, disorientation, sedation, unresponsiveness
Skin that is cool, clammy (damp), and pale
Blue fingernails and lips
Limp muscles, trouble staying awake, nausea
Unconsciousness and comaThe respiratory depression of an overdose can be treated with naloxone. Naloxone is preferred to the newer, longer-acting antagonist naltrexone. Despite methadones much longer duration of action compared to either heroin and other shorter-acting agonists and the need for repeat doses of the antagonist naloxone, it is still used for overdose therapy. As naltrexone has a longer half-life, it is more difficult to titrate. If too large a dose of the opioid antagonist is given to a dependent person, it will result in withdrawal symptoms (possibly severe). When using naloxone, the naloxone will be quickly eliminated and the withdrawal will be short-lived. Doses of naltrexone take longer to be eliminated from the persons system.
It is on the World Health Organizations List of Essential Medicines. Medical uses
Opioid addiction
Methadone is used for the treatment of opioid use disorder. It may be used as maintenance therapy or in shorter periods for detoxification to manage opioid withdrawal symptoms. Its use for the treatment of addiction is usually strictly regulated. In the US, outpatient treatment programs must be certified by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and registered by the Drug Enforcement Administration (DEA) in order to prescribe methadone for opioid addiction. A 2009 Cochrane review found methadone was effective in retaining people in treatment and in the reduction or cessation of heroin use as measured by self-report and urine/hair analysis but did not affect criminal activity or risk of death.Treatment of opioid-dependent persons with methadone follows one of two routes: maintenance or detoxification. Methadone maintenance therapy (MMT) usually takes place in outpatient settings. It is usually prescribed as a single daily dose medication for those who wish to abstain from illicit opioid use. Treatment models for MMT differ. It is not uncommon for treatment recipients to be administered methadone in a specialist clinic, where they are observed for around 15–20 minutes post-dosing, to reduce the risk of diversion of medication.The duration of methadone treatment programs range from a few months to years. Given opioid dependence is characteristically a chronic relapsing/remitting disorder, MMT may be lifelong. The length of time a person remains in treatment depends on a number of factors.