Methadone Withdrawal Symptoms

Methadone Withdrawal Symptoms, Timeline, Side Effects & Treatment

What is Methadone Withdrawal?

Methadone is physically addictive, especially when used in high doses. The drug is typically taken to treat opioid addictions, leading some heroin users to switch one addiction for another. If taken repeatedly, tolerance to Methadone can develop fast. This means the user will need to take more Methadone to achieve the desired effects.

Once the body becomes reliant on this prescription drug to operate normally, a dependence has developed. Those with a dependence on this drug will experience methadone withdrawal symptoms if they discontinue taking the medication.

Withdrawal happens because the body has to relearn how to function without Methadone in its system. While the body tries to reestablish normal functions, uncomfortable withdrawal symptoms occur, making recovery difficult.

Methadone Withdrawal Symptoms
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Because the methadone withdrawal symptoms can cause adverse effects, methadone users are advised to detox in a medical environment. Most inpatient treatment programs offer medically-assisted detox, which can help reduce the severity of Methadone withdrawal symptoms.

The methadone withdrawal process is different for everyone. The methadone withdrawal timeline will vary depending on the severity and length of the user’s addiction. The user’s tolerance and body chemistry will also affect their methadone withdrawal symptoms and how long the withdrawal process takes.

The methadone withdrawal symptoms, duration, and severity can vary from person to person based on factors such as:

  • The duration of methadone use
  • The frequency of methadone use
  • The dose of methadone consumed
  • The method of consumption 
  • The severity of methadone addiction  

Is Methadone Withdrawal Dangerous?

Methadone withdrawal symptoms and process share many resemblances to other forms of opiate and opioid withdrawal. Though lowering or ending the dose 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 appropriately managed.

Physically, methadone withdrawal can have risks related to aspiration (choking) from vomiting (a typical methadone withdrawal symptom) and dehydration from persistent diarrhea and vomiting during this period. Psychologically, opioid and opiate withdrawal can cause mental health symptoms such as depression and anxiety linked with thoughts or attempts to self-harm.

Possibly the most evident danger of methadone withdrawal is the risk of relapse. While methadone withdrawal 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.

Methadone Withdrawal Symptoms

The methadone withdrawal symptoms will be more uncomfortable than harmful for most individuals. With other opioids like heroin, withdrawal symptoms start within roughly 12 hours. Methadone is quite different. How long does methadone stay in your system? Because the substance remains in the body for a longer time, methadone withdrawal symptoms may not begin for as long as 30 hours after the last use.

The first methadone withdrawal symptoms mark the onset of acute withdrawal, which is distinguished by symptoms, including:

  • 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

Tips to Help You with Methadone Withdrawal Symptoms

Some individuals may find it challenging to tolerate methadone withdrawal symptoms. Always talk to an addiction specialist or a psychiatrist if you want to come off this drug. Do not try to stop it yourself. Things that may help may include:

  • Keeping yourself well hydrated
  • Keeping occupied with movies, books, or other distractions
  • Physical activity like exercise and yoga
  • Medication-assisted Treatment, such as clonidine, meclizine, loperamide, or oxybutynin to ease withdrawal symptoms
  • Complementary therapies such as acupuncture or Chinese herbal medicines
  • Slower tapering of the methadone dosage
  • Joining a support group or surrounding yourself with supportive people
  • Restarting Methadone at a lower dose, then attempting to taper it off more slowly than before.
Methadone Withdrawal Symptoms
Withdrawal can cause much discomfort, and the risk of returning to the use of other opiates can increase. 

Methadone Withdrawal Symptoms Timeline

Days 1-2

Symptoms of withdrawal usually don’t begin until at least 30 hours after the user’s last dose of Methadone, and it may take even longer depending on the amount used. Physical symptoms, such as chills, fever, rapid heartbeat, and muscle aches, will begin during this time.

Days 3-8

Over the next week or so, Methadone cravings will be strong. Users may face anxiety, body aches and pains, nausea, and insomnia, as well as irritability and anxiety. Flu-like physical symptoms will persist. Due to how long Methadone stays in the body, it often takes between 3 and 8 days for symptoms to the peak. At this point, additional symptoms such as depression, vomiting, and cramps begin to appear.

Days 9-15

After withdrawal peaks, symptoms will begin to subside, although some will remain such as irritability, diarrhea, and physical discomfort. Users may still feel strong drug cravings and depression may set in. Depression can become severe and some patients may have difficulty feeling pleasure or getting motivated.

Days 15+

Withdrawal symptoms from methadone such as low energy levels, anxiety, trouble sleeping, and cravings typically persist for 2-3 weeks. After the 3-6 week detox process is over, many former Methadone users will experience post-acute withdrawal symptoms, or PAWS. 

PAWS may continue for many months, and in some cases for up to 2 years. PAWS may include irritability, anxiety, depression, the inability to feel pleasure, difficulty sleeping, and poor concentration.

How to Stop Methadone Withdrawal Symptoms?

Methadone withdrawal is hard, so it’s best not to attempt to do it on your own. Let your doctor know any troubles you are having so that they can help treat your withdrawal symptoms if they arise. Support groups can connect you with others who understand what you’re going through.

Drug Treatment for Withdrawal

Consult with a healthcare professional trained in addiction in cases of acute methadone withdrawal management and detoxification program admission. The medical staff can provide treatments to ease the methadone withdrawal symptoms. These treatments make it much more likely that you’ll recover fully. Buprenorphine, naloxone, and clonidine are drugs used to shorten the methadone withdrawal process and relieve some of the related symptoms.

Guided Methadone Therapy

Due to the risk of methadone misuse and overdose, methadone therapy is only available to people who are enrolled in a government-approved treatment program. A doctor monitors your methadone intake and response to ensure that the withdrawal process is safe and effective. Then, the doctor continues the therapy until your body no longer needs the drug at all.

Emotional Support

Group support can be crucial for long-term recovery. In some cases, you may not find a lot of support from your family because they may not understand. Seeking out other recovering methadone users can help you find people who know what you’re going through and help you stay on track with your recovery.

Drug Treatment for Methadone withdrawal

Methadone Withdrawal Symptoms
One of the biggest risks of trying to stop using methadone cold turkey is relapse

The principal site in the brain that triggers the onset of methadone withdrawal symptoms is the locus coeruleus at the base of the brain. Neurons present in locus coeruleus are noradrenergic and have an increased number of opioid receptors. The locus coeruleus region is the main source of NAergic innervation of the limbic system and cerebral and cerebellar cortices. 

The NAergic activity in locus coeruleus neurons, opioid receptor linked mechanism, is a prime causative site of methadone withdrawal symptoms. Furthermore, research has shown that gray matter and nucleus raphe Magnus is also involved in the presentation of methadone withdrawal symptoms.

Although there is no diagnostic test for methadone withdrawal, urine toxicology must be checked to rule out withdrawal from any other drugs or combination of drugs. Urine toxicology is positive for most opioids such as morphine, heroin, codeine, oxycodone, propoxyphene) for 12 to 36 hours after use.

Methadone, buprenorphine, and LAAM (L-alpha-acetylmethadol) will not be detected in positive urine opiate tests, and they must be specifically tested. Urine toxicology for other drugs (marijuana, cocaine, benzodiazepine, and amphetamines) may also be commonly positive in opiate users. ECG, complete blood count (CBC), blood alcohol level, and basic metabolic panel (BMP) should also be done.

COWS (Clinical Opioid Withdrawal Scale) assessment for opioid withdrawal is commonly used to determine the severity of methadone withdrawal. The COWS assessment consists of 11 items of commonly seen signs and symptoms of methadone withdrawal. The total scores, 0 to 47, range from mild (5 to 12), moderate (13 to 24), moderately severe (25 to 36), and severe (greater than 37) methadone withdrawal. 

In May 2018, the FDA approved lofexidine hydrochloride, the first non-opioid for managing opioid withdrawal syndrome. It received FDA approval in 2018. Lofexidine hydrochloride is an alpha-2 adrenergic agonist indicated for acute discontinuation of opioids. It works by binding to receptors on adrenergic neurons, which decreases norepinephrine release (NE).

Additional medications that may be used in the treatment of methadone include:

  • Clonidine – this medication will reduce anxiety and also helps with many of the flu-like symptoms of methadone withdrawal, including runny nose, sweating, and muscle pain or spasms.
  • Zofran– this medication is commonly used to reduce nausea and vomiting. Zofran can be used in conjunction with other medications to reduce risk of dehydration.
  • Naltrexone – this medication prevents relapse by blocking the effects of opiates such as methadone or other drugs.

Methadone Side Effects Withdrawal Symptom

The addictive nature of this drug may cause people to experience withdrawal symptoms upon quitting the Methadone abruptly. After continued use, the sudden absence of this drug triggers uncomfortable reactions while the body relearns to operate without the medication again. 

Methadone withdrawal symptoms l are similar to withdrawal from other opioids such as morphine and heroin but are usually moderate and flu-like. Some of the most common side effects of methadone withdrawal symptoms are:

  • Chills
  • Fever
  • Anxiety 
  • Runny nose 
  • Watery eyes 
  • Excessive sweating
  • Muscle aches and pains 
  • Nausea
  • Vomiting 
  • Rapid heartbeat
  • Stomach cramps 
  • Irritability
  • Paranoia
  • Diarrhea
  • Cravings 
  • Insomnia 
  • Hallucinations 
  • Depression 

Methadone withdrawal can be a painful experience. Thus, people receiving methadone maintenance treatment are slowly weaned off the medication at the end of their drugs for opioid use disorder treatment under the guidance and supervision of their healthcare provider. 

Treatment for Methadone Addiction

Individuals ending their use of Methadone may benefit from seeking professional detoxification services. Detoxification (detox) is a set of interventions and strategies used to effectively treat intoxication and withdrawal. 

A medically-assisted detox program supervised by medical staff can increase a person’s safety and provide better symptom relief to prevent relapse.

A typical treatment with methadone detox is to slowly lower the dose of methadone in a process called weaning or tapering. Some people will be switched from methadone to clonidine at this point, while others will continue to simply receive reduced doses of methadone. 

The final weeks of tapering are challenging for many. The person may undergo more intense methadone withdrawal symptoms during this time, 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.

Following the medically-assisted detox, the person should seek ongoing substance abuse and mental health treatment because detox is not considered sufficient treatment for someone struggling with addiction. 

Addiction treatment post-detox can occur in residential settings and may include:

  • Cognitive-behavioral therapy (CBT). It helps users understand the triggers of drug use and learn methods to change thoughts and behaviors to 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. Family counseling is a great help for family members of drug addicts. It engages all family members in the recovery process to understand their role in substance use while finding more beneficial communication skills.

Methadone Withdrawal Symptoms
Detox should ideally be followed by comprehensive addiction treatment that involves behavioral therapy and complementary forms of treatment

A person will likely experience many different side effects from their drug use. These methadone side effects may be emotional, physical, or mental. For example, someone in methadone withdrawal will likely experience many uncomfortable feelings and negative thoughts as part of the methadone withdrawal symptoms. Unfortunately for those with dependency and addiction, detox is an unavoidable first step to recovery.

Please, do not try to detox on your own. The Methadone detox process can be painful and difficult without medical assistance. However, getting through the detox process is crucial for continued treatment. We Level Up NJ provide proper care with round-the-clock medical staff to medically assist your recovery. So, reclaim your life, call us to speak with one of our treatment specialists. Our counselors know what you are going through and will answer any of your questions.

Sources:

[1] NCBI – https://www.ncbi.nlm.nih.gov/books/NBK526012/

[2] SAMHSA – https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone