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  • Addiction & recovery

Methadone Withdrawal – Symptoms & Treatment

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David Schwartz, MD

January 3, 2022

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Methadone was first approved by the U.S. Food and Drug Administration (FDA) for chronic pain management in 1947. However, its efficacy as a medication for opioid use disorder (MOUD) led to its widespread use and approval by the FDA in the late 1970s for this purpose. Methadone maintenance treatment (MMT) is the use of methadone along with counseling and behavioral therapies to provide a “whole-person” approach to treatment. This approach helps individuals achieve and sustain recovery and reclaim active, healthier lives. 

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), methadone is a schedule II controlled substance that can only be dispensed through methadone clinics. It’s available in liquid, powder, and diskette forms under the brand names of Methadose, Dolophine, and Methadone HCI Intensol, among others. 

 

What Does Methadone Do?

Methadone changes how the brain and the nervous system respond to pain to provide pain relief from injuries, surgeries, and long-term illnesses. When used as part of a MOUD treatment, methadone interacts with the opioid receptors in the brain to reduce withdrawal symptoms and opioid cravings. It also blocks the intoxicating effects of other opioids to help reduce the risk of relapse and maintain long-term sobriety. 

Methadone maintenance treatment is often a long-term commitment. The length of treatment can vary from one or two years to beyond, depending on individual treatment needs. However, since methadone is an opioid with addictive properties, prolonged use can lead to dependence and addiction. Individuals with a dependence or addiction to methadone may experience withdrawal symptoms when quitting the medication abruptly. Hence, individuals in an MMT program are gradually weaned off the medication during the end of their methadone treatment to help mitigate the withdrawal symptoms.

 

Methadone Withdrawal Symptoms 

Methadone withdrawal symptoms occur during the absence of methadone after prolonged use triggers a chemical imbalance in the body. Symptoms of methadone withdrawal generally appear within 24-36 hours of the last dose. However, some people may not encounter it until several days after the last dose due to its long-acting nature. Withdrawal symptoms of methadone are similar to other opioid withdrawal symptoms but are usually moderate and flu-like. 

Some of the symptoms of methadone withdrawal include:

  • Runny nose 
  • Muscle aches 
  • Stomach cramps 
  • Chills
  • Fever
  • Anxiety 
  • Nausea
  • Vomiting 
  • Sweating
  • Rapid heartbeat
  • Irritability
  • Paranoia
  • Tiredness
  • Restlessness 
  • Watery eyes
  • Sleeping troubles 
  • Goosebumps 
  • Diarrhea
  • Depression 
  • Hallucinations 
  • Cravings 

The methadone withdrawal process can be a painful experience. Individuals who wish to stop using methadone must do so under the supervision and guidance of their healthcare practitioner.

 

Methadone Detox Timeline 

Since methadone is a long-acting opioid, withdrawals generally set in much later and for much longer than most opioids. In addition, methadone can also stay in some form for up to one to three days in the body. 

Methadone withdrawal generally follows the below timeline:

  • Days 1-2:  Symptoms of withdrawal during the initial stage include flu-like symptoms such as chills, fever, muscle aches, and sweating. 
  • Days 2-10: Withdrawal symptoms peak and individuals are more likely to relapse during this period. Some of the most common symptoms during this stage include irritability, anxiety, hallucinations, cravings, and insomnia. 
  • Days 11-21: Most of the symptoms of withdrawal would have subsided by day 10. However, cravings, insomnia, anxiety, mood swings, depression, and fatigue may likely remain during this period. 
  • Above 22 Days: Most individuals may also experience post-acute withdrawal syndrome (PAWS) after three to six weeks. PAWS can last anywhere between a few months to a couple of years and generally include anxiety, irritability, depression, poor concentration, sleeping troubles, and the inability to feel pleasure. 

 

Factors That Influence Methadone Withdrawal 

The duration and severity of methadone withdrawal can vary drastically from one person to another based on various factors. For example, individuals with a severe methadone addiction or dependence may experience a more intense and long withdrawal process than someone with a mild dependence. 

Some of the other factors that influence methadone withdrawal are:

  • Age
  • Weight 
  • Genetics
  • The dose of methadone used
  • The frequency of methadone use
  • The duration of methadone use
  • The method of consumption 

Although withdrawal from any narcotic medication is challenging, the long-term benefits of methadone treatment for opioid addiction significantly outweigh the drawbacks.

 

Methadone Withdrawal Treatment 

The best way to manage methadone withdrawal is to undergo a gradual tapering-down program under the supervision of a healthcare practitioner. A tapering-down program involves gradually reducing methadone doses over a certain period to help reduce the severity of withdrawal symptoms. The tapering-down process may vary from one person to another based on individual conditions and is most often offered by MMT programs at the end of treatment. 

The National Center for Biotechnology Information (NCBI) recommends reducing methadone doses by 10mg per week until a dose of 40mg per day is reached. After that, dose reduction should slow down to 5mg per day until a zero dose is reached. 

Although tapering down helps reduce withdrawal symptoms and other health complications, it’s still possible to experience uncomfortable symptoms each time the dose is reduced. When this happens, doctors suggest maintaining the current dose over a few weeks before reducing them again. Doctors may also utilize certain medications in such instances to treat the withdrawal symptoms, such as:

  • Clonidine for high blood pressure
  • Loperamide for diarrhea 
  • Ondansetron for nausea and vomiting 
  • Benzodiazepines or other anxiety medication  such as hydroxyzine
  • Over-the-counter pain relievers such as Tylenol or Advil for aches and pains 

Emotional support can also be vital for long-term recovery from methadone. Thus, engaging in support groups such as 12-step programs can also help people stay committed to recovery. As evidence shows, both Medication Assisted Treatment and therapy have significantly better outcomes than one treatment by itself. 

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