Methadone Withdrawal

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Methadone is a prescription opioid medication primarily used for the treatment of opioid addiction and dependence. When used in this manner, it is highly controlled and only dispensed from locations that meet high standards to monitor use 1,2,3. More recently, it has been prescribed at increasing rates to treat cases of severe pain 1.

In 2013, there were 3.9 million total prescriptions for methadone 1. Like other opioid medications, methadone alters the user’s perception of pain, but also depresses certain central nervous system (CNS) activity 2,3.

Methadone has a long duration of action in the body, making it particularly suitable for the treatment of opioid dependence—when used as prescribed, it can effectively stave off withdrawal symptoms for a long time. However, this drug becomes dangerous when it is abused for its ability to produce similar euphoric and painkilling effects as other opioids such as morphine (especially when misused, e.g., taken at higher or more frequent doses, taken without a prescription).

Methadone is available in various forms under the brand names Diskets, Dolophine, and Methadose 3.

People abusing methadone may refer to it in slang as 1:

  • Fizzies.
  • Amidone.
  • Chocolate chip cookies.

While it is a vital tool in the treatment of opioid addiction, when it is abused, the consequences can be deadly. According to the Drug Enforcement Administration 1:

  • In 2012, roughly 5 million people reported abusing methadone during their lifetime.
  • Nearly 4,700 calls to poison control centers involved methadone in 2012.
  • Almost 67,000 visits to emergency rooms were linked to methadone in 2011.

The risks linked to the abuse of methadone are many, so those misusing and/or addicted to this substance are advised to seek treatment from a professional to safely end their use. Professional detox during acute withdrawal helps to increase the comfort of detoxing individuals and manage any complications that may arise during this tenuous period.


What Is Methadone Withdrawal?

With continued use over time, the brain additionally becomes dependent on the drug to simply feel good and perform as expected.

Substances that produce physical dependence can trigger a withdrawal syndrome when use ends or is reduced too quickly. To understand methadone withdrawal, it helps to know the influence of methadone in the brain.

When it is consumed, it produces effects similar to other opioids. As methadone travels through the bloodstream, it attaches to specialized locations throughout the brain called mu-opioid receptors and concomitantly activates neural processes involved in the feelings of reward and pleasure 4. When opioids like methadone are taken in the absence of legitimate need (e.g., for pain relief), these rewarding feelings (akin to those provided naturally by sex or eating) can contribute to the development of compulsive patterns of misuse 4.

As use becomes chronic, the opioid begins to elicit less of a robust response when stimulated by methadone—both less of a pain-relieving effect and any accompanying pleasurable sensations. Because of this developing tolerance, more methadone is needed to approximate the original drug effects. The phenomenon of tolerance development is a normal, expected aspect of prolonged methadone use 2,4,5.

With continued use over time, the brain additionally becomes dependent on the drug to simply feel good and perform as expected 4.

This state is a delicate balance that is easily upset when the user misses or receives a lower dose of the substance. When this occurs, it will generate an array of distressing symptoms in the user. This is what is referred to as methadone withdrawal 4.


Is Methadone Withdrawal Dangerous?

Man experiencing methadone withdrawal symptoms

Methadone withdrawal shares many similarities to other forms of opioid withdrawal. Though ending or lowering the dose of it seldom leads to life-threatening consequences, it can result in certain medical and psychological complications that can put the detoxing user in harm’s way if they aren’t managed.

Physically, methadone withdrawal can produce risks related to aspiration (choking) from vomiting (a normal withdrawal symptom), as well as dehydration from continued diarrhea and vomiting during this period 6. Psychologically, opioid withdrawal can cause mental health symptoms such as anxiety and depression 6,7 that may be associated with thoughts or attempts to self-harm.

Probably the most pronounced danger of opioid withdrawal is the risk of relapse. While symptoms aren’t generally life-threatening, they can be so distressing to the user that they do anything to avoid them, including returning to methadone use even when they truly want to quit.


Signs and Symptoms

The withdrawal syndrome associated with methadone will be more uncomfortable than harmful for most people. With other opioids like heroin, withdrawal symptoms begin within approximately 12 hours 6. Methadone is different. Because the substance remains in the body for a longer time, withdrawal symptoms may not begin for as long as 30 hours after the last use 6.

The first symptoms mark the beginning of acute withdrawal, which is characterized by symptoms, including 6:


  • Agitation and irritability.
  • Anxiety.
  • Aches and increased pain.
  • Watery eyes and runny nose.
  • Trouble sleeping.
  • Sweating.


  • Frequent yawning.
  • Stomach cramps.
  • Goose bumps.
  • Diarrhea.
  • Nausea.
  • Vomiting.


How Long Will It Last?

In the case of methadone, acute withdrawal can last for 21 days. However, aomeone withdrawing from methadone may also encounteradditional symptoms from a condition referred to as post-acute withdrawal syndrome (PAWS) 7. PAWS effects can last for months after acute withdrawal ends with symptoms like 7:

  • Depression.
  • Anxiety.
  • Sleep problems.
  • Irritability.
  • Poor focus and concentration.
  • Impaired decision-making skills.

Can Medications Help?

Unfortunately, the use of medications for methadone withdrawal will be limited because methadone itself is frequently used to aid people seeking to end their opioid dependence. One option will be clonidine 8. This substance, normally used as a blood pressure medication, has shown efficacy in treating some symptoms of methadone withdrawal, but it will not help symptoms like nausea, diarrhea, aches, and sleep problems. To manage these symptoms, prescription sleep aids and several over-the-counter options such as non-addictive pain relievers may be used 8.

After withdrawal is complete, a medication called naltrexone can be used to discourage future opioid use and minimize cravings. This substance is an opioid antagonist that works to block the effects of opioids in the body. Naltrexone is available as a pill or as a monthly injection (Vivitrol) 9.


Detox

A medically supervised detoxification program overseen by medical staff can boost patient safety and provide better symptom relief to prevent relapse.

People ending their use of methadone may benefit from seeking professional detoxification services. Detoxification (detox) is a set of strategies and interventions used to effectively treat intoxication and withdrawal. A medically supervised detoxification program overseen by medical staff can boost patient safety and provide better symptom relief to prevent relapse 8.

A common treatment with methadone detox is to gradually reduce the dose of methadone in a process called weaning or tapering. Some individuals will be switched from methadone to clonidine at this point, while others will continue to simply receive reduced doses of methadone 8. The final weeks of tapering are problematic for many. During this time, the individual may experience more intense withdrawal symptoms, which encourages relapse. For this reason, detoxing under supervision, such as in an inpatient environment, can provide the needed support for an individual to maintain abstinence.

Rapid and ultrarapid detoxification options may be available for people seeking a speedier detox. These methods involve the individual using naltrexone, or another opioid antagonist, to initiate withdrawal while using other medications like clonidine and benzodiazepines to treat the unwanted withdrawal symptoms. This method shortens detox from weeks to days but remains unproven and debated due to the risk of additional side effects 8.

Following detox, the individual should seek ongoing mental health and substance use treatment, as detox is not considered sufficient treatment for someone battling addiction. Addiction treatment post-detox can occur in residential or outpatient settings and may include 9:

  • Cognitive-behavioral therapy (CBT). Helps users understand the triggers of drug use and learn methods to change thoughts and behaviors that will help maintain abstinence.
  • Motivational interviewing (MI). Provides increased internal motivation to remain drug-free.
  • Contingency management (CM). Provides positive external reinforcements (e.g., tokens, vouchers) to reward healthy behaviors that maintain recovery.
  • Family counseling. Engages all family members in the recovery process to understand their role in substance use while finding more beneficial communication skills.

Tips to Handle Cravings

Throughout various stages of withdrawal and recovery, cravings will be a major concern. Strong cravings may encourage relapse, but they can be overcome with deliberate thinking and action. To avoid giving in to your cravings 10:

  • Change your thoughts to end your focus on the cravings.
  • Find distractions to take your mind away from the craving.
  • Seek support and feedback from others.
  • Create a secure environment to go to when a craving is at its height.
  • Build and practice a relapse prevention plan.
  • Understand the connection between triggers, actions, and the consequences of those actions.


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Eric Patterson, MSCP, NCC, LPC, is a professional counselor who has been working for over a decade to help children, adolescents, and adults in western Pennsylvania reach their goals and improve their well-being.

Along the way, Eric worked as a collaborating investigator for the field trials of the DSM-5 and completed an agreement to provide mental health treatment to underserved communities with the National Health Service Corp.

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