Methadone is an opioid that is commonly prescribed to treat severe pain and withdrawal associated with other opioids, such as heroin, fentanyl and oxycodone. Methadone is a powerful pain reliever and is generally not associated with the euphoric high that other opioids provide.
Because methadone generally does not lead to intoxication, people can mistakenly believe that there is no risk of developing dependence. However, methadone use can rapidly lead to tolerance (the need for larger doses to achieve the same effect) and dependence, even when used as directed.
What Causes Methadone Withdrawal?
The brain has a vast network of opioid receptors that regulate endogenous (naturally present) opioid signaling. The brain self-regulates opioid signaling to prevent overstimulation. An increase in endogenous opioids leads to a reduced response from the brain. The brain’s ability to self-regulate opioid signaling causes tolerance. When drugs are used to increase the effects of opioid signaling, the body responds by reducing its receptiveness to additional opioids. Thus, over time, more drugs are needed in order to achieve the same effect.
Methadone tolerance and dependence develop somewhat independently of each other. The severity of these factors depends on the amount of methadone that is used. Dependence means the body has adapted to the drug, and a person will experience withdrawal symptoms when the drug is removed from their system.
Dependence is different from addiction. Unlike addiction, dependence does not involve compulsive drug-seeking behavior in an effort to obtain a euphoric effect in spite of harmful consequences. Methadone is associated with tolerance and dependence, but it is much less likely to cause addiction. However, dependence and addiction are both capable of producing uncomfortable withdrawal symptoms.
When someone who is dependent on methadone suddenly stops taking it, the body tries to restore opioid levels. It does this through physical and psychological withdrawal symptoms. These symptoms are essentially instructing the body to find more methadone because the body is dependent on it. Methadone withdrawal is not completely understood, and it is still an area of active research.
Methadone withdrawal is associated with uncomfortable physical and psychological symptoms. While these symptoms generally subside over time, extreme cases of methadone withdrawal can be fatal. Methadone is somewhat unique among opioids because of its long half-life (up to 55 hours), so acute withdrawal symptoms can last longer than other opioids.
Physical Withdrawal Symptoms
Physical withdrawal symptoms that are often associated with methadone include:
- Increased pain sensitivity
- Nausea or vomiting
- Itchy skin
- Muscle aches
- Headache or lightheadedness
- Seizure or stroke, in extreme cases
Many people report that physical methadone withdrawal feels like a very bad flu.
Psychological Withdrawal Symptoms
Psychological withdrawal symptoms that are often associated with methadone include:
- Lack of pleasure
- Changes in sex drive
- Suicidal ideation
- In extreme cases, visual or auditory hallucinations, delirium and psychosis
Symptoms of Post-Acute Withdrawal Syndrome (PAWS)
Post-acute withdrawal syndrome (PAWS) can be a frustrating component of methadone rehab. Many people expect that once acute withdrawal symptoms have passed, they should be free of physical and psychological symptoms associated with withdrawal. Unfortunately, methadone causes substantial, long-lasting changes in the brain that persist even in the absence of methadone. These symptoms are often experienced for months or years after cessation.
The symptoms are typically similar to those experienced during acute withdrawal. The degree and duration of PAWS symptoms may fluctuate, but they subside over time. It is important to recognize that experiencing PAWS or cravings long after you’ve quit does not mean that your recovery has failed.
Protracted Withdrawal Symptoms
Protracted withdrawal is a synonym of PAWS. The Substance Abuse and Mental Health Services Administration defines protracted withdrawal as “the presence of substance-specific signs and symptoms common to acute withdrawal but persisting beyond the generally expected acute withdrawal timeframes.”
Helping Methadone Withdrawal
A first-line approach to help ease the methadone withdrawal process is to taper the dose. By gradually weaning off of methadone, people can stave off debilitating withdrawal symptoms and cravings. Moderate to severe methadone withdrawal management may call for medication. The most common medications associated with methadone withdrawal are clonidine and buprenorphine (Suboxone). These drugs each help reduce the severity of methadone withdrawal symptoms.
Methadone Withdrawal and Death
Death as a result of methadone withdrawal is rare but possible, particularly for people who have used methadone heavily for a long time. Withdrawal-related deaths are likely the consequence of persistent vomiting and diarrhea that go untreated. Vomiting and diarrhea can rapidly cause severe dehydration and massive electrolyte imbalances in the blood, which can cause heart failure.
How Long Does Methadone Stay in Your System?
Methadone has a relatively long half-life (up to 55 hours) compared to other opioids. The length of time that methadone is measurable in your system depends on dosage amount, frequency of use and factors like weight and health status. Methadone will often be present in blood and urine for up to 10–12 days.
People who have a history of opioid use usually metabolize methadone more quickly than opioid-naive people. It is important to understand that the methadone withdrawal timeline is only partially related to how long it takes for the body to remove the drug. Methadone causes chemical changes in your brain that can persist even after the drug is completely out of your system.
In general, one way to estimate the amount of time needed for a drug to be fully metabolized is to multiply the half-life by five. This estimate can be useful for blood and urine screens. However, hair follicle tests can identify drug use for up to several months after last use.
How to Get Methadone Out of Your System
There are no reliable ways to flush methadone out of your system. People with fast metabolisms may produce methadone byproducts slightly faster than people with slower metabolisms. Overall, the only way to get methadone out of your system is to stop taking it and wait.
Detoxing Off Methadone
People who are struggling with methadone use disorder should find a quality rehab center. These centers can evaluate the severity of dependence and provide information about what the client can expect during detox and withdrawal. The most successful recoveries start with a plan, which may include:
- What to take for methadone withdrawals: For most people, following a scheduled taper is an effective way to safely detox. People with moderate or severe dependence may be prescribed clonidine or buprenorphine (Suboxone) to help with withdrawal symptoms.
- Alternative treatments for methadone withdrawal: Individuals should consult their doctor before undertaking any methadone treatment plan that includes over-the-counter medications or herbal remedies, especially if they are on other prescription drugs. Though there is no shortcut for ending detox and withdrawal, steps can be taken to lessen the severity of symptoms:
- NSAIDs for pain management
- St. John’s wort may ease trembling, especially if you restrict caffeine intake. However, St. John’s wort should not be taken if you are on antidepressants, blood thinners or birth control. Ask your doctor if St. John’s wort will interfere with your prescription medications
- Imodium for diarrhea
- Meclizine or dimenhydrinate can quell nausea
- Vitamin supplements (particularly B-vitamins and magnesium) may be helpful, as these vitamins can be depleted with methadone use
- Light exercise may be helpful
- Some studies have found that acupuncture and Chinese herbal medicine can reduce withdrawal symptoms, although the data is preliminary
Many people with mild to moderate methadone dependence have found success in outpatient detox and rehab programs. After an initial evaluation, clinicians can work with you to identify goals, set expectations and deliver a tapering protocol that you can follow at home.
Outpatient detox provides substantial benefits, including access to medical professionals who can address questions or concerns that arise during detox. People with moderate methadone use disorder may be prescribed clonidine or buprenorphine (Suboxone), which can be taken at home to ease symptoms.
Detox at Home
People with mild or moderate methadone dependence can detox at home. However, if you are considering a methadone detox at home, you should discuss your plans with your doctor ahead of time. It also helps to have friends or family who know what you’re doing and can offer support and encouragement. There are no shortcuts in rehab, and home remedies for methadone withdrawal remain unreliable.
Going “cold turkey” is never a recommended plan for methadone rehab. Tapered doses allow your body to gradually wean itself off of the opioid that has been causing chemical and physical changes. People who quit cold turkey suffer from extremely uncomfortable and potentially debilitating withdrawal symptoms. Intense cravings can be difficult to ignore, and relapse is more likely in people who attempt to quit cold turkey.
Finding a Detox Center
Several factors should be considered when you are evaluating rehab facilities:
- Location: Early days of recovery can be difficult. Many people find that distant detox centers allow them to avoid triggers and maximize success.
- Cost: Many insurance programs (including Medicaid in many states) can help with the costs of rehab. Other options include sliding fee scales and grants or scholarships.
- Effectiveness: Many quality rehab centers provide endorsements from satisfied clients, but be cautious of any program that reports 100% success.
- Accreditation: Facilities that are accredited by either The Joint Commission or CARF International guarantee a certain standard of care.
- Staff-to-patient ratio: A low staff-to-patient ratio will ensure that you have access to medical staff.
Key Points: Understanding Methadone Withdrawal and Detox
A few important points to remember about methadone use include:
- Regular use of methadone (even as prescribed) can lead to dependence
- Methadone withdrawal is associated with physical and psychological symptoms that can be profoundly uncomfortable
- PAWS, also known as protracted withdrawal symptoms, may manifest long after you have recovered from acute withdrawal. This is the result of long-term chemical changes that occur in the brain during methadone use, and it does not reflect a failure to recover completely.
- Ending methadone use suddenly (cold turkey) is never recommended. Instead, talk to your doctor about a tapered dose in order to minimize withdrawal symptoms and prevent relapse
- People facing moderate to severe methadone use disorder may be prescribed clonidine or buprenorphine (Suboxone) to relieve discomfort associated with detox and withdrawal.
- Detoxing at home is possible, but it is recommended that you discuss your plans with your doctor in order to establish the correct tapering doses and know what to expect.
- Detox centers provide on-site medical staff who will be there to address questions or concerns that may arise as you undergo methadone detox.
If you or a loved one is struggling with methadone or other opioid use disorders, The Recovery Village Palm Beach at Baptist Health can help. Our multidisciplinary team of experts will guide you through the early days of recovery and get you established on a long-term path to a sober and fulfilling life. Contact us today to learn more about treatment plans that can work well for you.
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