Methadone Withdrawal

Methadone is an opioid drug most known for its treatment of opioid dependence and addiction. It is also a prescription painkiller with analgesic effects.

Methadone has a long half-life of 24 hours to 60 hours. Because of this, it can be dispensed in federally regulated clinics once or twice per day to manage opioid withdrawal symptoms and for use in medication-assisted treatment (MAT) as a maintenance medication.

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Most opioid drugs of abuse, such as heroin or oxycodone (OxyContin), have much shorter half-lives and, therefore, need to be dosed more frequently to keep opioid receptors in the brain activated. Methadone, on the other hand, can be doled out less often to keep cravings and withdrawal symptoms from setting in. As a result, methadone is used as an opioid substitution medication during opioid maintenance therapy.

Methadone is still an opioid drug, however. It is still diverted, abused, and classified as a highly addictive drug. More than 200,000 Americans misused methadone in 2016, according to the National Survey on Drug Use and Health (NSDUH).

If stopped suddenly, methadone can lead to significant drug cravings and withdrawal symptoms. As such, a detox program that weans the drug out of the body slowly, allowing it to process out of the brain safely, is the optimal method for managing methadone withdrawal.

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Withdrawal Timeline

Methadone processes out of the body slowly over a few days. Its analgesic, sedative, and euphoric effects can wear off much quicker, in about four hours to eight hours. In someone who is opioid-tolerant (which means the person uses opioids regularly and it takes higher doses to feel the drugs’ effects), methadone can stop being active in the bloodstream faster than in someone who is not a regular user of an opioid drug.

The journal Pharmacy and Therapeutics explains that in a person who is opioid-tolerant, the half-life of methadone is 24 hours; but in someone who is not, it is 55 hours on average. The detox and withdrawal timeline can, therefore, be quite different from person to person.

methadone

Other factors that will affect the severity and duration of methadone withdrawal include metabolism and whether or not other drugs (and/or alcohol) were also used regularly. The presence of any co-occurring medical issues or mental illnesses can also influence withdrawal.

The main factor in the methadone withdrawal timeline and the significance of the side effects is the level of drug dependence. Drug dependence is determined by how long a person took methadone, how regularly they took it, and how much they took each time.

The way methadone was used also plays a role. Snorting, smoking, or injecting methadone leads to greater drug dependence more rapidly than ingesting it orally.

The U.S. National Library of Medicine (NLM) reports that methadone withdrawal symptoms typically begin within 30 hours after the last dose of the drug.

A generalized methadone withdrawal timeline can look like this:

One or two days after the last dose of methadone, sleep problems, mood swings, agitation, anxiety, muscle aches, watery eyes, a runny nose, fatigue, lethargy, yawning, and sweating can occur.

Within two to three days, withdrawal symptoms often peak. They likely will include stomach cramps, nausea, vomiting, diarrhea, racing heart, goosebumps, breathing difficulties, elevated blood pressure, increased sensitivity to pain, cravings, memory lapses, concentration issues, and dilated pupils.

For the next three to seven days, withdrawal symptoms continue. It can be difficult to think clearly, remember things, and feel pleasure from normal things. Mood swings are common.

After about a week to 10 days, withdrawal symptoms start to subside, although sleep disturbances, depression, drug cravings, and anxiety can continue for a few weeks to months.

As an opioid drug, methadone works by binding to opioid receptors in the brain. When methadone stops being active, the brain has to work to restore its natural balance. The presence of methadone in the brain increases levels of the “happy” neurotransmitter dopamine, which aids in emotional regulation, sleep functions, and movement abilities. With repeated drug-related interaction, the brain can struggle to continue to make, transmit, and reabsorb dopamine on its own.

A kind of vacuum can occur when methadone wears off after a level of drug dependence has been formed. This drop in dopamine levels is what leads to difficult withdrawal symptoms and intense opioid drug cravings. The brain and body feel very low without the high produced by methadone. Since methadone also is a central nervous system (CNS) depressant, when it stops suppressing functions like breathing, body temperature, heart rate, and blood pressure, these things can spring back at an overactive level.

All in all, methadone is not a drug that should be stopped cold turkey after any level of dependence. Opioid withdrawal can be intense both emotionally and physically, so a safe withdrawal process is essential.

Detox for Methadone

Methadone detox can be offered in a variety of settings, from the flexibility of an outpatient treatment program to a more intensive and highly structured inpatient medical detox program. Methadone for the treatment of opioid dependence has to be dispensed through clinics that are federally regulated. As of 2016, there were nearly 1,500 substance abuse treatment programs that also had opioid treatment programs (OTPs) dispensing methadone, the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes.

A methadone detox program will often work to taper the dosage of methadone down in an attempt to wean it completely from the body. Dosage will be lowered slowly over a safe period to keep withdrawal symptoms and drug cravings at a minimal and manageable level.

Methadone may be switched out for the partial opioid agonist medication buprenorphine during detox. Buprenorphine has less potential for abuse than methadone, as it does not create the same high when abused. Buprenorphine also has a ceiling level at which the drug becomes ineffective, rendering it less desirable to misuse.

Additional medications can be helpful for specific symptoms. They include:

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  • Antidepressants or anti-anxiety medications
  • Sleep aids
  • Non-narcotic and nonsteroidal pain relievers
  • Gastrointestinal medications

Supportive measures, as well as therapeutic and adjunctive treatment methods, can help during detox, and withdrawal programs should be well-rounded and attend to the whole person. For example, nutrition planning that includes balanced and healthy meals can aid in the healing process, as can staying hydrated and keeping away from nicotine and caffeine. Sticking to a set sleeping and waking schedule to promote sufficient sleep can be highly beneficial as well. Mindfulness meditation, yoga, and massage therapy are great ways to relieve stress, cope with mood swings, enhance sleep, and alleviate physical pain during detox.

A good methadone detox program will be comprehensive. It will help to improve overall life functioning while seeking to restore physical and emotional balance before admission into a specialized addiction treatment program.

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Finding the Right Treatment Program

The U.S. Department of Health and Human Services (HHS) publishes that just more than 2 million people in the United States battled addiction involving an opioid drug in 2016. Methadone is a drug that may be abused on its own as an opioid agonist, as a form of self-medicating opioid withdrawal or the crash from other rapid-acting opiates like heroin, or in combination with other drugs or alcohol. All forms of abuse are considered cause for concern and problematic drug use that an addiction treatment program could benefit.

Addiction treatment and detox programs are highly variable, and it is important to find the right fit. SAMHSA operates a Behavioral Health Treatment Services Locator that can help people to narrow down options for treatment according to type and location. Before enrollment in a specialty program, staff members will help to design a treatment plan to optimize care and aid in sustaining a long and healthy recovery.

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SOURCES

(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm

(August 2011). Keeping Patients Safe From Methadone Overdoses. Pharmacy and Therapeutics. Retrieved September 2018 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171821/

(August 2018). Opiate and Opioid Withdrawal. U.S. National Library of Medicine. Retrieved September 2018 from https://medlineplus.gov/ency/article/000949.htm

(August 2017). Trends in the Use of Methadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003-2015 (Update). Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from https://www.samhsa.gov/data/sites/default/files/report_3192/ShortReport-3192.html

(March 2018). What is the U.S. Opioid Epidemic? U.S. Department of Human Health and Services. Retrieved September 2018 from https://www.hhs.gov/opioids/about-the-epidemic/index.html

Behavioral Health Treatment Services Locator. Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from https://www.findtreatment.samhsa.gov/