Substance Use

Methadone Withdrawal

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Zinnia Healing

Methadone Withdrawal Symptoms, Timeline & Detox Treatment Options

Methadone is a drug commonly used to treat opioid use disorder. Although chemically it is not like heroin or morphine, it produces many similar effects. This FDA-approved drug is often used in medication-assisted treatment and may also be prescribed for pain management. When taken as prescribed, it can be safe and effective. However, when taken in high doses or for extended periods, methadone dependence and addiction can develop — particularly among those with a history of drug abuse. 

The use of methadone to treat opioid dependence has been ongoing since the 1950s. When someone is dependent on opioids, such as heroin, they take a daily dose of methadone, either in pill or liquid form. When taking methadone, they can reduce their cravings and opioid withdrawal symptoms. That said, methadone is still an addictive opioid. The DEA classifies methadone as a Schedule II controlled substance. This classification means methadone helps treat several medical conditions and yields a significant potential to be abused. 

When abused, physical and psychological dependence develop, leading to methadone withdrawal syndrome. The route of administration also matters. For example, if you inject methadone, it’s time to seek professional assistance. When using methadone for long periods, especially when injected, you can develop cardiovascular issues. If you decide to stop using, you must take your health into account and receive professional help.

One case study showed the potential implications of methadone withdrawal. One patient experienced heart failure after the methadone withdrawal process because of apical ballooning — a unique case of cardiomyopathy, a heart muscle disease. This case was stress-induced and connected to the abrupt discontinuation of long-term methadone use, and although reasonably extreme, it shows how dangerous the withdrawal period can be. 

To treat your methadone dependence, a related opioid use disorder, your mental health, or all of the above, you will require specialized support–a professional team of experts. Here is what you need to know about methadone withdrawal so that you can take the necessary steps.

What Are the Symptoms of Methadone Withdrawal?

Methadone offers value within the medical community. This drug helps many addicts overcome a potentially life-threatening addiction, reducing the number of overdose deaths each year. However, it is an addictive substance, resulting in methadone withdrawal syndrome among many users. Once dependence develops, if you abruptly stop using methadone, you will experience withdrawal symptoms because of prolonged use.

The symptoms of methadone withdrawal are similar to other opioids. Still, they will range in severity depending on several factors, such as dosage, duration of use, and whether you combine methadone with other substances. 

Symptoms include:

  • Insomnia 
  • Muscle cramps
  • Nausea and vomiting 
  • Hot and cold flashes
  • Sweating 
  • Diarrhea 

That said, everyone has a different experience. Some individuals find methadone withdrawal less intense than anticipated; others find it more challenging than withdrawal from a short-acting opioid, such as heroin. 

After the physical symptoms of methadone withdrawal subside, you may develop post-acute withdrawal syndrome (PAWS), which is discussed in detail below. These psychological symptoms may include:

  • Irritability 
  • Poor mood 
  • Feelings of anxiety and panic 
  • Difficulty with cognitive tasks, including problem-solving, learning, and memory recall 

The withdrawal process is a highly individualized experience. You could also experience increased sensitivity to stress, intense cravings, obsessive-compulsive behaviors, apathy, all of the above, or none of the above. For this reason, it’s essential to work closely with your care team that will help you navigate these troublesome symptoms so that you can significantly reduce your risk of relapse. 

Although the methadone withdrawal symptoms can be uncomfortable, if you’re abusing this drug, it is more dangerous to continue using, especially if you often combine several drugs. Interactions between methadone and other drugs can result in an overdose or death. For example, drugs that suppress the respiratory system, such as benzodiazepines, will increase the effects of methadone. Methadone withdrawal symptoms will also develop when taking drugs that affect metabolism. Here is a list of the most critical interactions to be aware of, ranging from alcohol to nevirapine — a drug used to treat HIV.

If you begin taking higher and higher doses because of greater tolerance, you face the risk of a methadone overdose. Your risk is even higher if you combine methadone with other painkillers, such as morphine, hydrocodone, or oxycodone. When taken in large doses, you may stop breathing. Seizures may also develop, and in severe cases, a methadone overdose can be fatal.

Regardless of the situation, if you struggle with methadone addiction (or any substance abuse disorder), you must seek professional support. The withdrawal process can be dangerous. If you overcome the withdrawal period on your own, you can increase your risk of an overdose if you relapse. Since your tolerance will lower, serious complications can result if you take similar doses to what you were taking prior to the detoxification period. Having the support of a professional substance abuse and mental health team can make a world of difference concerning your road to recovery and your ongoing safety. 

What Causes Methadone Withdrawal?

Although methadone has been widely used since the 50s and 60s to treat heroin addiction, little is known about the potential side effects. Researchers are concerned that there are significant knowledge gaps in the field. Prolonged use may affect your nerve cells and behavior.

Like other opioids, methadone works by changing how the brain and central nervous system respond to pain. Although methadone is effective in treating opioid withdrawal symptoms, such as those associated with morphine, codeine, and heroin, it still has a high potential for abuse. Patients taking methadone must take it exactly as prescribed, which can be problematic for individuals with a history of drug abuse who begin taking methadone at home.

Methadone withdrawal begins with physical dependence. This dependence is associated with your brain’s reward system in most cases. When taking opioids, you will experience a surge of dopamine, which initiates a vicious cycle. Your brain will naturally release less dopamine following repeated opioid use. As a result, things you used to find pleasurable can seem dull. 

Opioid addiction, regardless of your drug of choice, is defined as opioid self-administration, with the development of tolerance, physical dependence, and drug-seeking behavior. Tolerance is an adaptation of the physiological systems of the body to opioids. Following chronic use, physical dependence develops when the physiological systems have adapted to the point they require the opioid (in this case, methadone) just to maintain balance. When you are dependent on opioids, practically all physiological systems are affected. You will begin to seek out your drug of choice. In this case, methadone and potentially other opioids. 

If you were originally prescribed methadone to treat opioid addiction, you must work with your healthcare team to quit using this drug gradually. For most, the minimum length of methadone treatment is twelve months. If you feel as though you’re ready to stop using methadone, a tapering program is recommended. This approach will help prevent methadone withdrawal symptoms. 

How Long Does Methadone Withdrawal Take?

Unlike short-acting opioids, methadone is a long-acting opioid. As a result, this drug remains active, causing methadone withdrawal symptoms to come on more slowly and last longer. On average, most people begin to experience methadone withdrawal symptoms 24-36 hours after their last dose. Once you start to experience methadone withdrawal symptoms, the effects can last up to two weeks, on average. However, this timeline will vary from person to person. For example, the onset of methadone withdrawal symptoms can occur anytime between 12-48 hours after your last dose and last anywhere from 10-20 days. 

At first, methadone withdrawal symptoms will likely be mild, becoming more severe over the coming days and weeks. However, many individuals also experience post-acute withdrawal syndrome (PAWS). These symptoms can linger for weeks, months, or even years. Post-acute withdrawal symptoms are highly psychological and are often similar to those found in anxiety and mood disorders, including insomnia, mood swings, and increasing anxiety. This syndrome can develop following the cessation of any psychoactive substance. However, it is most common among opioid users. Data shows that up to 90% of recovering opioid users will experience PAWS to some degree. 

Researchers are still uncovering how and why this syndrome develops but believe physical changes in the brain during substance abuse may play a role. The symptoms of PAWS will fluctuate in severity, disappear, and then reappear later. The withdrawal process can be very long for some, even among those without an opioid addiction. For example, those who began using methadone for pain can quickly become physically dependent, experiencing withdrawal symptoms when they try to quit. 

How to Safely Manage Methadone Detox

Addiction is a brain disease, and just like any disease, specialized treatment is required. The withdrawal process and required treatment are complex — it’s not like giving insulin to someone with diabetes. There are many variables to consider, and each case is unique. For this reason, you or your loved one must seek specialized support. An expert treatment facility will have the resources and evidence-based treatment programs you need to succeed. 

Methadone detoxification often involves the short-term administration of methadone hydrochloride, a drug used for opioid maintenance therapy. This drug helps blunt the symptoms of individuals dependent on opioids, and then the tapering of methadone begins. The ultimate goal is to achieve a drug-free state. Depending on the circumstances, you may have been taking other opioids prior to methadone, which would influence your tapering plan. Although this plan will differ for each patient, a dose reduction will begin once you are stabilized on a dose where you no longer experience withdrawal symptoms. A 10% to 20% reduction is often tolerated.

By law, in the United States, only a SAMHSA-certified treatment program can give patients methadone to treat opioid use disorder. Regardless of whether you’re addicted to several opioids or just methadone, it’s crucial you work with your care team to develop a treatment plan that addresses your needs. A professional facility will initiate a full assessment to ensure you have the best chance of success. The goal is to understand the severity of methadone use while becoming aware of your medical history, both physical and mental. Taking this step will allow your care team to better assess any potential risks associated with the withdrawal period. With this information, they will also provide the highest quality care. Your safety is their number one concern while you detox. 

Withdrawal symptoms will vary from one individual to the next, which is why physicians often use the Clinical Opiate Withdrawal Scale (COWS). This 11-item scale is used for outpatient and inpatient settings to rate common symptoms of opioid withdrawal and to monitor these symptoms over time. Some of the symptoms include restlessness (rated from 0-5), joint aches (rated 0-4), anxiety (rated 0-4), and tremors (rated 0-4). The final score determines whether symptoms are mild, moderate, moderately severe, or severe. 

Your care team may prescribe other medications to support your tapering plan, depending on the circumstances. For example, clonidine can help treat symptoms such as nausea, cramps, rapid heart rate, and high blood pressure. This study shows that when using clonidine for treatment, 80% of patients could withdraw by the end of two weeks. Clonidine administration for 10-11 days helped reduce symptoms and blood pressure. Some symptoms, such as anxiety, insomnia, and restlessness, were resistant to clonidine treatment, which is why additional therapy and ongoing support are essential. 

Other medications may be administered to help combat symptoms such as sleep issues, diarrhea, headaches, and muscle aches. 

To treat PAWS, you will likely require ongoing support. Psychotherapy has been shown to be highly effective. The leading treatment centers will offer various therapy options, ranging from cognitive-behavioral therapy to group therapy. 

A professional treatment facility will help you every step of the way — but you must take that first step. If you are struggling with methadone abuse, opioid use disorder, or your mental health, contact Zinnia Healing today.