Methadone is a drug that treats chronic pain and the symptoms of opioid withdrawal. It is a commonly used drug in drug treatment (MAT) for opioid addiction. When used correctly, methadone enables people to get off heroin and prescription pain medication without going into withdrawal. It’s a synthetic opioid that works like other common opioids, which means it’s addicting.
When used correctly at a “maintenance dose”, methadone will prevent withdrawal symptoms without leaving you high or sedated. People take methadone for months or years. In general, the longer you use it, the better your chances of recovery. However, since it is an opioid, withdrawal from methadone will result in opioid withdrawal.
overview
Methadone withdrawal is not a picnic. Doctors prescribe it for two reasons: one, to provide opioid addicts with a safe, long-term relapse prevention option, and the other, to treat stubborn cases of severe chronic pain. In both scenarios, the goal of doctors is to find an immediate solution to a serious problem.
Methadone works very well for most people, preventing countless overdose deaths each year. Its main disadvantage is the prolonged withdrawal syndrome that it can cause.
Everyone has different experiences with methadone. Some people find methadone withdrawal less intense than expected. Other people think it’s worse than withdrawing from a short-acting opioid like heroin.
If you have an opioid use disorder (addiction) you probably have an idea of what to expect from opioid withdrawal. Feeling like you have a bad flu, vomiting, diarrhea, sweating, and insomnia are common. With a short-acting opioid, these withdrawal symptoms can be intense, but they usually peak within a few days and then begin to resolve.
Because methadone is a long-acting opioid, the drug can stay active between 8 and 59 hours, which means withdrawal is slower and lasts longer.
Acute methadone withdrawal symptoms can last up to 14 days, but many people will experience post-acute withdrawal symptoms months after their last dose.
These persistent mental symptoms leave many people uncomfortable with their own skin, dissatisfied with their decision to get clean, and frustrated with their lack of progress.
Signs and symptoms
Some doctors recommend continuing methadone therapy indefinitely. If you are thinking of quitting, speak to a doctor about the pros and cons.
Quitting methadone can be a long and frustrating process, even for people who are not addicted to opioids. If you use methadone to treat pain you are still physically dependent on it and withdrawal symptoms will occur when you try to stop or reduce your dose.
Your experience with methadone withdrawal will depend on a variety of factors, including your previous experience and expectations. Some people think it’s going to be a nightmare, but it turns out to be milder than expected. Others step in and think it will be easy and find that it takes a lot more commitment than they thought.
Most people will experience withdrawal symptoms within 2 to 4 days of their last dose.
Your symptoms can start out mild and worsen over a few days. Once they reach the highest level, your symptoms will gradually subside. The acute (short-term) symptoms should go away within two weeks.
Common acute withdrawal symptoms are:
- Bone and joint aches and pains
- flu-like feeling
- sweat
- runny nose
- chills
- Nausea or vomiting
- Cramps or diarrhea
- Insomnia or trouble sleeping
- watery eyes
- Tremble
- Fear or anxiety
- goose bumps
- agitation
- Skin crawl
Methadone withdrawal symptoms vary from mild to moderate. To get a better idea of the scale, you can check the Opiate Withdrawal Clinical Scale (COWS) that doctors use to diagnose their patients.
Post-acute withdrawal, also known as protracted withdrawal, begins in the weeks following your detox. These symptoms are most common in long-term opioid addicts. Opioids affect the way your brain works, flooding your brain with euphoria-inducing neurotransmitters every time you get high. After the detox, your brain works with depleted stores of neurotransmitters. It can take up to six months for your brain to return to normal.
During this time you may experience symptoms such as:
- depression
- low energy levels
- a low load tolerance (short fuse)
- sleep disorders
- the inability to experience joy in anything
- Problems with memory or concentration
- Irritability or restlessness
These symptoms can appear and recur over several weeks or months. They can be extremely frustrating for both people in recovery and their loved ones. It is helpful to remember that these symptoms are temporary and should go away within a year.
Coping and Relief
The best way to deal with methadone withdrawal is to avoid skipping doses or suddenly dropping out. Even if you are frustrated and tired of going to a clinic or pharmacy every day for a monitored dose, it is best to avoid abrupt discontinuation. Instead, talk to your prescribing doctor about rejuvenation.
Reducing methadone means taking gradually smaller doses over several weeks or months. While rejuvenation is considered to be the best way to detoxify methadone, it can still be challenging. With any dose reduction, withdrawal symptoms are likely to occur. Working closely with a doctor, you can extend your rejuvenation time and reduce your dose in smaller steps if necessary.
The World Health Organization recommends reducing your dose by 5 to 10 mg per week until you reach a dose of 40 mg. After that, the reduction should slow down to 5 mg per week.
You acknowledge that this is only a general recommendation and that the rejuvenation plan should be tailored to the needs of each individual.
Dose reductions can occur once a week, every two weeks, or less often. Sometimes one dose reduction is more difficult than the others and unpleasant withdrawal symptoms occur. In this case, your doctor may stop the tapering at this level and wait a few weeks before reducing the dose again.
If you experience withdrawal symptoms while reducing your dose, your doctor may recommend other medications to manage your symptoms. The American Society for Addiction Medicine recommends doctors consider prescribing the following drugs:
- Clonidine, a high blood pressure drug that is regularly used off-label to treat opioid withdrawal symptoms. It is available as a pill or as a transdermal patch.
- Loperamide, used to treat diarrhea.
- Ondansetron, used to treat nausea and vomiting.
- Benzodiazepines, used to treat short-term anxiety.
- OTC pain relievers like Tylenol or Advil, used to treat pain.
There is one other option you may want to talk to your doctor about: Lucemyra (Lofexidine hydrochloride). Lucemyra is a new drug; It is similar to clonidine and was recently approved by the FDA for treating symptoms of opioid withdrawal. It is the first clinically proven non-opioid drug. Lucemyra reduces the release of norepinephrine, a neurotransmitter that researchers believe may play a role in symptoms of opioid withdrawal.
If you have insomnia or trouble sleeping, you should also ask your doctor for something to help you sleep. Your doctor might give you a prescription for trazadone or suggest an over-the-counter antihistamine like Benadryl to help you sleep.
Warnings
Opioid withdrawal is rarely dangerous for healthy adults, but some people need to be more careful than others. Especially pregnant women.
Opioid withdrawal can cause pregnancy complications, including miscarriages and premature births.
If you are currently using methadone or other opioids, it is best to continue methadone until the end of your pregnancy. Methadone has been shown to be safe and effective during pregnancy. It doesn’t cause birth defects or pregnancy complications. While it is possible that your child could be born with an opioid addiction, it does mean they need to detox.
It is important to stay in touch with both an obstetrician (OBGYN) and an addiction doctor during your pregnancy. Pregnancy affects the way your body metabolizes methadone. Therefore, your dose may need to be adjusted as your pregnancy progresses.
Although laws about opioid abuse during pregnancy vary across states, methadone is safe and legal – you shouldn’t run into any problems trying to find treatment.
You should also speak to your doctors about your plans after the birth. Breastfeeding is generally considered safe during methadone treatment. If you decide to stop taking methadone, your doctor will discuss a suitable schedule for rejuvenation with you. You may advise waiting until your body feels normal again.
One final warning: relapses are common among opioid users. After detox with methadone, your opioid tolerance is much lower than it used to be. If you relapse on heroin or prescription pain medication, there is a risk of a life-threatening overdose.
Long-term treatment
It’s not uncommon for people with opioid use disorder to turn methadone on and off for several months or years. Detoxing methadone is a big step, but that doesn’t mean you’ve beaten your addiction. Proper addiction treatment takes a diverse approach that combines drug management with psychotherapy and social support.
The main goal of long-term treatment is to prevent relapse.
Relapse rates among people with opioid use disorders are very high. Research shows that approximately 3 in 4 people who go off opioid use will relapse within 2 to 3 years. These numbers aren’t pretty, but don’t let them scare or discourage you. Relapse is part of the recovery process. Knowing the odds will help you better understand the value of ongoing treatment.
Remember, it’s not uncommon for people to overdose and die during a relapse. Fortunately, there is a non-opioid drug that can help reduce your risk.
Naltrexone is a so-called opioid antagonist (similar to the naloxone in Suboxone). Naltrexone binds to the opioid receptors and acts like a blockade, preventing other opioids from binding to the same receptors. This means that even if you relapse and use an opioid, you won’t get high (but you can overdose). If you know that opioid use will not make you feel high, you should be deterred from relapsing impulsively.
Naltrexone requires a prescription and can be taken as a daily pill or monthly injection. Because naltrexone can cause immediate withdrawal, you should not use it until all of the methadone has been cleared from your system. This can take up to 14 days.
Research shows that a combination of talk therapy and drug management is more effective than drugs alone in treating opioid use disorders.
When it comes to therapy, you have a wide variety of options. Most methadone clinics offer some form of advice. So this is a good start. Once you’ve rejuvenated, you may want to find something more convenient, like a therapist in a private practice or a local health clinic. You can also view group therapy sessions, which are often held in hospitals and other addiction treatment facilities.
After all, social support is a key aspect of relapse prevention. Many people find support at local 12-step meetings like Narcotics Anonymous.
resources
For more information on Narcotics Anonymous (NA) meetings in your area, visit their website. You can find a meeting near you using the searchable directory.
If you or a loved one is struggling with substance use or addiction, contact the National Substance Abuse and Mental Health Agency (SAMHSA) helpline at 1-800-662-4357 Information about support and treatment facilities in your area.
Additional mental health resources can be found in our National Helpline Database.
If your loved one is trying to recover from an opioid addiction, consider a support group for friends and family like Nar-Anon.
A word from Verywell
Methadone detox is not easy. Just take it one step at a time and don’t let the speed of your progress discourage you. Recovery can be slow and exhausting at times, but things get better – just hold on.
