Methadone Withdrawal Symptoms, Timeline & Detox Treatment

What is Methadone?

Methadone is a long-acting opioid medication that helps many people struggling with addiction to opioids such as heroin.¹

It is used as part of a medication-assisted treatment program that includes counseling and participation in social support programs. When taken as directed, methadone is able to reduce the symptoms of opioid withdrawal, decrease opioid cravings, and induce a significant amount of cross-tolerance to other opioids—which may block some or all of the euphoric effects of drugs such as heroin, oxycodone, and hydrocodone. In some instances, certain formulations of methadone may be prescribed for pain control.^1,2

Methadone Addiction & Scheduling

Though it has several therapeutic uses, methadone use can lead to addiction.¹ Per the National Survey on Drug Use and Health, in 2017, about 261,000 people age 12 and older reported using methadone for a non-prescribed purpose at least once in their life.³

Methadone was responsible for 3,194 overdose deaths in 2017, or about 1 per 100,000 people.⁴ In 2014, it accounted for 1% of all opioids prescribed for pain but was responsible for 23% of all prescription opioid deaths.⁵

The drug is a Schedule II controlled substance, which means it has significant abuse potential and can produce physiological dependence in users. People who abuse methadone or take it as prescribed can become dependent on it and experience withdrawal symptoms when they try to stop using it.⁶

Methadone Withdrawal Symptoms

Although methadone may be used to ease withdrawal symptoms in people who have become addicted to heroin or prescription painkillers, use of methadone itself may lead to dependence and an associated withdrawal syndrome.

Like other opioids, withdrawal symptoms for methadone include:⁷

• Agitation, restlessness, and anxiety.
• Depression.
• Insomnia.
• Yawning.
• Increased tearing or watery eyes.
• Runny nose.
• Sweating.
• Shivering, trembling, or goosebumps.
• Muscle aches or joint pain.
• Nausea or vomiting.
• Abdominal cramps.
• Diarrhea.

Methadone Withdrawal Timeline

Withdrawal symptoms may take 2-4 days to develop and fade over the course of 10 days.^7,8

Quitting Cold Turkey vs Methadone Tapering

Many people attempt to ride out methadone withdrawal on their own. Though opioid withdrawal may not be life-threatening in most cases, it can be very uncomfortable. It can also lead to cravings and a return to drug use if left untreated.⁸ In fact, one of the biggest risks of trying to stop using methadone cold turkey is relapse.⁹

In addition, other health complications may develop in connection with withdrawal sickness that may require immediate medical attention, including:⁹

• Dehydration and electrolyte imbalance from vomiting and diarrhea.
• Aspiration from breathing stomach contents into the lungs, which can cause lung infection.

The lack of medical care to manage withdrawal effects and any significant health issues, as well as the strong possibility of relapse due to the discomfort, make cold turkey an unwise method of detox.

Regardless of how someone becomes dependent on methadone, the safest way to quit is to slowly reduce the dose over time—a process known as tapering. A taper can help prevent severe withdrawal symptoms and decrease the risk of potential withdrawal-associated medical problems. A schedule for reducing methadone dosing will be best determined, and potentially adjusted, by your treating physician.

Weaning or tapering should only occur under the supervision of a medical professional, who can evaluate withdrawal progress and best help the individual regulate doses.

Methadone Withdrawal Detox Treatment

Medical detox can take place in standalone detox centers, hospitals, or inpatient rehabilitation facilities as part of a larger program to treat opioid addiction. During a medical detox, people undergoing withdrawal will be supervised by healthcare professionals and may be given medications to address specific symptoms, if necessary.

While medical detox can help a person safely and comfortably complete withdrawal, it does little to address the underlying issues that have contributed to the development of  compulsive substance misuse and addiction. For these reasons, detox should ideally be followed by comprehensive addiction treatment that involves behavioral therapy and complementary forms of treatment, such as 12-step meetings. This mix of treatment approaches is aimed at changing maladaptive behaviors and helping to establish social support systems and better methods of coping with stress.

Medications Used in Methadone Detox

A doctor may prescribe other medications during withdrawal or in addition to a methadone taper to help ease symptoms should they occur. These medications include:

• Clonidine—can help treat symptoms such as high blood pressure, nausea, cramps, and rapid heart rate⁹
• Over-the-counter pain medications (e.g., Tylenol, aspirin, or ibuprofen)—can help manage headache, muscle ache, and bone pain¹⁰
• Bismuth subsalicylate (Pepto Bismol)—can help with diarrhea¹⁰
• Benadryl or trazodone—can help people with insomnia during withdrawal fall asleep¹⁰

If you or someone you know is interested in quitting methadone, seek out a detox program today or find a healthcare provider who can help you taper off the medication.

Sources

1. Substance Abuse and Mental Health Services Administration. (2015). Methadone.
2. Baxter, L. et al. (2013). Safe Methadone Induction and Stabilization: Report of an Expert Panel. Journal of Addiction Medicine, 7(6), 377-386.
3. Substance Abuse and Mental Health Services Administration. (2018). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables.
4. Centers for Disease Control and Prevention. Data Brief 329. Drug Overdose Deaths in the United States, 1999-2017.
5. Faul, M., Bohm, M., and Alexander, C. (2017). Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies—United States, 2007-2014. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, 66(12), 320-323.
6. Drug Enforcement Administration. (2014). Methadone.
7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
8. Elsevier. (2017). Opioid withdrawal.
9. U.S. National Library of Medicine. (2013). Opiate Withdrawal.
10. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment: TIP 45.