Methadone Withdrawal Symptoms, Detox, Timeline, and Treatment
Methadone is a medication that is approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid use disorder (OUD). It is also sometimes used to manage chronic pain.1 An OUD is a chronic brain disease characterized by a problematic pattern of opioid use leading to clinically significant impairment or distress.2
Methadone is a full opioid agonist, which means that it binds to the opioid receptors in the brain, where it works similarly to other opioids.3 It is a long-acting opioid that can reduce or eliminate opioid withdrawal symptoms, reduce cravings for opioids, and blunt or block the euphoria-producing effects of other opioids in someone who is physiologically dependent on opioids.1,3,4
If a person who’s developed a physiological dependence on methadone abruptly stops using it or significantly reduces their dose, they will experience symptoms of opioid withdrawal.3 This underscores the importance of medication adherence for patients who take methadone to manage opioid use disorder.
How Is Methadone Used?
Methadone (sold under the brand names Dolophine and Methadose) is typically administered as a liquid, but it may also be available as dispersible tablets (scored tablets that can be dissolved in water), tablets, or in powder form.1,3,4 Methadone can be used alone, but many benefit from a whole-person approach to treating opioid addiction that includes combining medications and behavioral therapy. Methadone has been shown to be effective in reducing the use of opioids and overdose deaths.3
Methadone is a critical treatment medication that has been used since the 1960s to treat heroin dependence.5 It has the largest, most robust evidence base for success in opioid maintenance treatment compared to other OUD medications, and studies have shown that it can both help retain patients in treatment and reduce illicit opioid use more effectively than a placebo, medically supervised withdrawal, or no treatment.3 Methadone is also associated with a reduced risk of HIV and hepatitis C infections, lower rates of cellulitis, lower rates of HIV risk behavior, and reduced criminal behavior.3
Methadone works more slowly than oxycodone and other prescription opioids, as well as illicit opioids like heroin, and when it is taken at an appropriate therapeutic dose by an opioid-dependent person, methadone does not cause euphoria.6 Methadone can’t be obtained from just any physician or healthcare provider; it must be dispensed through a federally certified and accredited opioid treatment program or by a clinician who has undergone training and has the necessary waiver to dispense the narcotic. Treatment staff supervise patients as they take the medication. This is done not only to ensure adherence and assess the patient’s response to the medication, but also to minimize diversion. Methadone is a powerful medication, and illegal distribution or diversion of the drug can lead to misuse or methadone overdose, particularly if it is ingested by an opioid-naïve individual.3
Methadone Treatment for Opioid Use Disorder
When initiating methadone treatment for someone with an OUD, doctors increase the dose gradually, carefully ensuring the patient isn’t over-sedated, but also making sure to keep opioid withdrawal symptoms at bay.3 Take-home doses may be given to the patient once they are stable and can adhere to regular doses (which may be confirmed via drug testing).
Although this does present a risk of diversion and misuse, a balance of care and control must exist, and take-home doses are carefully monitored.1 Diversion and misuse do occur, but this is frequently a result of a lack of actual OUD treatment access. Research suggests that people with OUD who are not in treatment more frequently use illicit methadone to self-medicate withdrawal symptoms than to achieve euphoria.5
This page will help you learn more about when and how methadone withdrawal can occur, as well as the signs and symptoms of methadone withdrawal, the timeline of methadone withdrawal symptoms, and how to get help if you or a loved one has an OUD involving methadone or other opioids.
What Is Methadone Withdrawal?
Opioid withdrawal symptoms will emerge if someone who is opioid-dependent stops using opioids.3 Dependence describes the state when the body has adapted to the sustained presence of a drug. Once someone is dependent on a drug, removing it from the body results in withdrawal symptoms.7 This is a natural, normal adaptation, and dependence on opioids is likely to develop after several weeks of regular use.
Dependence does not necessarily mean that someone is addicted to a substance, and while experiencing withdrawal symptoms is one of the criteria that can contribute to the diagnosis of an OUD, a person who is taking opioids like methadone under the direction of a physician does not meet the diagnostic criteria.8
Someone taking methadone to manage an OUD will develop a physiological dependence on methadone, and it is important for patients to be aware of this.3 This means that if you stop taking methadone abruptly or significantly reduce the amount you take, you can experience symptoms of opioid withdrawal.3
Symptoms of withdrawal from methadone are usually highly unpleasant, though they are rarely dangerous.9 Occasionally, a person may have a complication from withdrawal, but, most often, it will be something that can be treated and managed easily.9
Signs and Symptoms of Methadone Withdrawal
All opioids, including methadone, follow a similar presentation of withdrawal symptoms.9 However, many factors impact the severity and duration of methadone withdrawal symptoms, including:9
- How long the person has been using methadone or other opioids.
- How long it has been since the last use of methadone or other opioids.
- How much methadone or other opioids someone usually takes.
- Physiological, genetic, and psychological characteristics.
In general, withdrawal from methadone, or any opioid, results in symptoms that can include:9
- Abdominal cramps, nausea, vomiting, diarrhea
- High blood pressure
- High body temperature
- Runny nose
- Rapid pulse
- Faster breathing
- Bone, muscle, and joint pain
- Muscle spasms
- Abnormal reflexes
- Large pupils
- Teary eyes
Symptoms of methadone withdrawal are highly unpleasant and uncomfortable, though experiencing the symptoms themselves is rarely dangerous.9 The real risk is that patients who discontinue OUD treatment medication like methadone generally return to illicit opioid use.3 Restarting opioids after a period of abstinence can increase a person’s risk of life-threatening opioid overdose.3
Patients who decide to discontinue methadone as a treatment for OUD can benefit from discussing the decision with their doctor or healthcare provider to ensure that appropriate measures can be taken to both minimize withdrawal symptoms and sustain abstinence from illicit opioid use.3
Methadone Withdrawal Timeline
One question people sometimes have about withdrawal symptoms is how long they will last. Medically managed withdrawal from opioids that includes the use of an opioid agonist like methadone or buprenorphine can eliminate or greatly reduce the severity of withdrawal symptoms.3 However, in the absence of medical support and without opioid agonist maintenance, methadone withdrawal timelines will vary from one person to another.9
As methadone is a long-acting opioid, the timeline for withdrawal may look like this:1, 3
- Onset of symptoms: The first symptoms are likely to begin within 36 hours after the last dose. These symptoms might include sweating, yawning, runny nose, restlessness, and insomnia. At times, people might also have gooseflesh, stomach cramps, achy muscles, and sometimes muscle twitches.
- Peak withdrawal symptoms: Withdrawal will be fully developed around 3–4 days after the last dose of methadone. A person might experience symptoms such as fever, high blood pressure, rapid heart rate, vomiting, diarrhea, and dehydration.
- Total duration of withdrawal: Symptoms will usually be resolved within 14 days or more after the last dose of methadone.
Find Addiction Treatment and Detox
Treatment for an OUD typically comprises behavioral therapy combined with medication for OUD (MOUD)—such as methadone.1 These behavioral and pharmacological treatments can be delivered through:4
- Detoxification programs, which offer a set of interventions to help manage withdrawal symptoms. Detox stabilizes patients so that they can participate in behavioral therapy.
- Inpatient treatment, where you stay in a treatment facility 24/7 with medical oversight and receive medical, psychological, and social support to help you recover from the effects of opioid misuse. Inpatient programs offer a treatment program that usually involves behavioral therapy and medications for opioid use disorder. Inpatient programs may be short-term or long-term.
- Outpatient treatment, where you live at home and commute to a treatment facility. Can range from just a few hours per week of treatment to up to 20 hours or more per week. Outpatient treatment uses similar behavioral therapy approaches as inpatient treatment, typically in both individual and group formats.
Addiction treatment can start anyone battling substance misuse on the path to a happier and healthier life. Rehab centers are located throughout the U.S., and many offer specialized treatment that can cater to individual needs. You can use SAMHSA’s Behavioral Services Locator to search for treatment centers. Many state government websites will also provide local drug and alcohol resources to those in need. To find your state government’s website, do a web search for your state name and ‘.gov.’ Once your state website is located, substance use resources shouldn’t be hard to find, and they should provide further phone contacts for your assistance.
American Addiction Centers (AAC) is a leading provider of addiction treatment programs and has trusted rehab facilities across the country. If you or a loved one is struggling with an opioid use disorder, including self-medicating with methadone to keep opioid withdrawal symptoms at bay, call us free today at to talk to an admissions navigator who can help you find the best rehab program for your needs where we can help manage your medications for opioid use disorder and you can begin the journey to recovery. If you are looking for a rehab program, you can start with our online directory.