Methadone Withdrawal

Methadone is an opioid meant to help manage and treat pain. However, it is primarily used to wean people off opioid dependence and ease withdrawal symptoms in a process known as medication-assisted treatment (MAT).

Methadone can be an invaluable tool in treating opioid dependence, whether that is heroin or prescription painkiller addiction. Methadone has been especially useful in the fight against the ongoing opioid epidemic, which claims more than 130 lives a day through overdose.

It also appears on the World Health Organization’s List of Essential Medicines, which includes medications that are most necessary for an effective health system.

While no one can argue that methadone has undeniably saved lives that might have otherwise been lost to a deadly opioid overdose, it is not without its dangers and detriments.

The most obvious problem with methadone is that despite being significantly less potent than the opioids it treats, like heroin or oxycodone, its use still poses significant risks. A user can become addicted to methadone unless its use is tightly restricted and closely monitored by a medical professional.

If methadone is used without any restriction, someone can all too easily end up swapping out one addiction for another, or, instead of using it as a way to taper down doses of stronger opioids, methadone becomes a way to stave off cravings in between uses.

In fact, as the opioid epidemic first began to explode, so did methadone abuse, with overdose deaths from methadone rising a whopping 460 percent from 1999 to 2005. Now, it accounts for nearly 1 in 4 prescription opioid-related overdose deaths.

 

How can you end addiction? Get a call from our experts and find out!

 

How can you end addiction? Get a call from our experts and find out!

What Are the Methadone Withdrawal Symptoms?

Because it is a “full opioid,” methadone works in a way that’s similar to heroin and other opioids. Methadone binds itself to the brain’s opioid receptors, the neurotransmitters in charge of regulating pain, stress levels, and more.

By occupying those receptors, methadone helps to reduce drug cravings and, by extension, withdrawal symptoms. It also blocks the euphoric and sedative effects of stronger opioids. Doses of methadone can still generate its own high.

However, its effects are significantly milder than the opioids it blocks, so the user doesn’t feel the spike of pleasure he or she would experience with heroin or oxycodone.

However, even with lessened effects, methadone is still an opioid, and when someone has been regularly abusing it long enough, they will become dependent on methadone, physically and psychologically.

When they stop using methadone, their body will endure a kind of shock as it struggles to function without the pain-blocking effects and dopamine produced by methadone. During this state, the user will experience withdrawal symptoms.

The symptoms of methadone withdrawal are, if not exactly identical, definitely similar to the usual symptoms associated with opioid withdrawal, including:

The symptoms of methadone withdrawal are, if not exactly identical, definitely similar to the usual symptoms associated with opioid withdrawal, including:

  • Fever
  • Runny nose
  • Nausea
  • Vomiting
  • Diarrhea
  • Chills
  • Paranoia
  • Anxiety and panic attacks
  • Hallucinations
  • Insomnia
  • General restlessness
  • Depression
  • Tremors
  • Muscle aches

Can Methadone Withdrawal Kill You?

While the symptoms listed above will typically present themselves with less intensity than other opioids, if someone attempts to do a methadone detox by stopping their methadone use abruptly (going “cold turkey”), the symptoms will become significantly more uncomfortable and difficult to manage.

This is compounded by the fact that because methadone stays in your system much longer than fast-acting opioids like heroin, oxycodone, or even tramadol, you’ll be feeling these symptoms for a long stretch of time. This effect only heightens the risk of relapse.

Methadone Treatment Steps

When someone relapses during the methadone withdrawal process, they are more likely to take a much larger dose than they normally would to relieve the methadone cravings and other symptoms. Relapse may also mean they are more likely to accidentally overdose.

MedlinePlus.gov reports that methadone overdose can produce symptoms like constipation, nausea and vomiting, low blood pressure, weak pulse, slow, shallow or labored breathing, or no breathing.

Overdose symptoms can also include coma, confusion, dizziness, disorientation, muscle spasms, weakness, and fatigue. It can also cause people to get cold, clammy skin, blue fingernails, and lips, and pinpoint pupils.

And while the process of methadone withdrawal itself is rarely fatal, the withdrawal symptoms themselves can indirectly put someone in a life-threatening situation. The combination of depression, paranoia, and hallucinations can, if not closely monitored, cause someone to try to harm themselves or even attempt to commit suicide.

In short, methadone withdrawal will not kill you, but attempting to do a detox on your own creates a needlessly dangerous situation that can have deadly consequences.

This is why the best and safest way to do a methadone detox is under the supervision of a medical professional in a medical detoxification center. Not only can doctors provide around-the-clock care at a detox center, but they can also help relieve the worst of your withdrawal symptoms, taking away the risk of relapse, and implementing a schedule to help you taper your methadone use safely.

What are the Stages of the Methadone Withdrawal Timeline?

So, how long will methadone withdrawal last? As we mentioned before, methadone’s long half-life creates a prolonged withdrawal period than the standard opioid withdrawal timeline.

However, the methadone timeline will vary from person to person, because there are many factors that determine an individual’s withdrawal experience in terms of the length and severity of symptoms, including:

  • How long someone has been abusing methadone
  • How they were taking it (via injection, as a pill, snorted as a powder, etc.)
  • How much methadone they were taking
  • If they were taking methadone at the same time as other drugs or alcohol (which is often the case due to methadone’s use in medication-assisted treatment)
  • If they have a history of previous addictions or mental health issues
  • The overall state of their current health
  • If they are on a tapering schedule or stopping methadone cold turkey
man in need of methadone treatment

Depending on the answers to these questions, someone’s methadone withdrawal timeline may be longer or shorter or more intense or milder. Still, it will at least follow what has been established as the general stages of methadone withdrawal. That general timeline can look like the following:

  •   15-60 hours: Unlike the opioids it treats, methadone is a long-acting drug that stays in your body for a long time. The physical, flu-like symptoms will usually start within about 24 hours after the last use, but it can sometimes be as early as 15, or as late as almost three days.
  •     1-2 weeks: During the next 10 days to two weeks, all of the symptoms will have manifested and be at their peak intensity. This is also when methadone cravings are at their strongest and the point of detox when people are at the highest risk of relapse.
  •   3 weeks: At this point, the worst of the symptoms will have passed or become easier to manage. They can also fade away completely. Psychological symptoms like depression and anxiety, however, most likely will persist.
  •     Beyond: After three weeks, any remaining symptoms should be very weak if not already gone. Still, even after the methadone withdrawal has run its course, individuals can expect intermittent periods of depression and drug cravings in the following weeks or even months as their body adjusts to life without methadone.

While some symptoms of lingering depression are to be expected, there is also the chance of experiencing what is known as post-acute withdrawal syndrome, or PAWS. This is a secondary withdrawal period that can randomly appear after the initial withdrawal period. PAWS can last months after someone has stopped using methadone. According to Verywell Mind, signs and symptoms of PAWS include:

  • Depression, sadness, and anxiety
  • Irritability, aggression or hostility
  • Mood swings characterized by severe highs and lows
  • Fatigue or insomnia
  • Chronic pain
  • Thought fog
  • Lack of focus
  • Diminished interest in sex

There is, unfortunately, no established timeline for how long PAWS can last. At The Palm Beach Institute, we can help provide you with plenty of resources that you can go to for help.

What Can Help Methadone Withdrawal?

Most medical detox centers will use medication-assisted treatment (MAT) for patients with opioid dependence so that they can slowly lower the dosage instead of stopping all at once.

But since methadone is used to help wean someone off opioids like heroin, what medications can be used to help relieve the symptoms of methadone withdrawal and help taper down usage?

There are several options. The most common of which include:

Buprenorphine: This treatment medication is similar to methadone. However, unlike methadone, it is only a partial opioid agonist. As a partial agonist, buprenorphine’s effects are milder than those of methadone, creating a much lower risk of dependence and making it a safer option for medical maintenance therapy.

Suboxone: This medication is a combination of buprenorphine and naloxone. It has no opioid components and completely blocks the effects of opioids. Naloxone is too strong to be used on its own in cases outside of reversing an overdose, and so it is paired with buprenorphine.

Clonidine: This drug is perhaps more widely known as a blood pressure medication. However, it has been shown to be successful in helping to suppress cravings. It also works with methadone, since it is weaker than other opioids.

Naltrexone: Unlike most MAT drugs, naltrexone carries no risk of addiction or opioid qualities and instead negates any feelings or effects of an opioid high.

What Is the Next Treatment Step?

While detoxification works to flush the methadone out of your system and puts a stop to the damage caused by prolonged abuse, what it doesn’t do is solve the addictive behavior that led to this point, especially if this addiction developed during methadone maintenance while detoxing from a stronger opioid.

If someone does not address the root issues of their addictive behavior, then they will most likely be unable to change it, almost guaranteeing a swift relapse.

Whether you choose an inpatient or outpatient program, ongoing recovery treatment will help you understand the underlying causes of your addiction and provide you the tools needed to manage your addiction and maintain sobriety.

In treatment, you will have access to various evidence-based and alternative approaches proven to address the mental and emotional aspects of addiction.

Residential treatment services include the following therapies:

  • Dialectical behavioral therapy
  • Dialectical behavioral therapy
  • Motivational interviewing
  • Family therapy

The following services are offered in outpatient treatment:

  • Family therapy
  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Detoxification treatment
  • Medication-assisted treatment (MAT)
  • Individual therapy
  • Group therapy
  • Motivational Interviewing
  • Relapse prevention planning
  • Dual diagnosis treatment
  • Stress management
  • Educational workshops