Methadone Withdrawal & Detox

Methadone is prescribed to help people with heroin use disorders manage their withdrawal symptoms. Methadone itself causes dependence and withdrawal can be challenging.

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 Symptoms

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, diarrhea, itchy skin, muscle aches, headache or lightheadedness, sweating, chills, hypertension, and 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 drowsiness, restlessness, anxiety, lack of pleasure, insomnia, depression, changes in sex drive, paranoia, and 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 Timeline

The timeline of methadone withdrawal can be somewhat variable, depending on the degree of dependence that someone has developed, but the long half-life of methadone leads to prolonged withdrawal symptoms. What makes methadone withdrawal different from other opioids is the long-half life, which substantially increases how long withdrawal symptoms will be felt.

In some cases, methadone withdrawal symptoms can set in as early as 12 hours after the last dose, but symptom onset usually occurs between 30-48 hours after the last dose. Symptoms of acute withdrawal can persist for up to 20 days.

Persistent, fluctuating withdrawal symptoms may be present for weeks or months after symptoms were expected to resolve. This is called post-acute withdrawal syndrome (PAWS). Although PAWS is incredibly frustrating, it is important for people in recovery to understand that their symptoms will subside as time goes on.

The timeline of methadone detox and acute withdrawal will be different for each person, but a general overview of a typical methadone withdrawal timeline is as follows:

• 12 hours – 2 days: onset of withdrawal symptoms
• 2 – 4 days: the peak of symptom severity
• 4 – 20 days: symptom severity will gradually subside

In some cases, fluctuating symptoms may persist for several weeks or months.

Factors Impacting Methadone Withdrawal

The key determinant in how long methadone withdrawal will last is the degree of dependence that someone has developed. Additional factors that affect the methadone withdrawal timeline include:

• Methadone dosage
• Frequency of use
• Duration of use
• Polysubstance abuse (abuse of other drugs or alcohol simultaneously or concurrently)
• Age
• Metabolism
• Genetics
• Physical health
• Mental health
• The presence of a support system (friends, loved ones, rehab professionals)

Methadone dosage Frequency of use Duration of use Polysubstance abuse (abuse of other drugs or alcohol simultaneously or concurrently) Age Metabolism Genetics Physical health Mental health The presence of a support system (friends, loved ones, rehab professionals)

The Dangers of Withdrawing from Methadone Alone

Methadone withdrawal is usually not dangerous for people with mild to moderate dependence. However, people with severe chronic dependence may have an increased risk of seizures if they quit methadone abruptly.

People who suddenly choose to stop taking methadone often face extremely uncomfortable, even debilitating symptoms. Relapse rates are high among people who quit cold turkey, and there is an increased risk of overdose if people enduring withdrawal give in to the desire to take more methadone.

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.

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 Related Topic: Methadone Treatment

Outpatient Detox

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. Related Topic: Clonidine dosage for withdrawal

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.