Last Updated: November 02, 2022

Methadone belongs to the family of opioids along with heroin but has a gradual mode of action relative to heroin. Methadone is used to alleviate the withdrawal symptoms of heroin and other opiates as well as in long-term maintenance treatment to ensure abstinence from heroin use.

However, long-term use of prescription methadone or misuse of this drug can lead to the development of dependence on the drug. Meanwhile, abstinence from methadone intake after long-term use can also lead to unpleasant withdrawal symptoms. This is because the brain adapts to the use of the rewarding stimulus in the form of the drug. Abstinence from drug use results in a negative response in the form of withdrawal symptoms. The symptoms of methadone withdrawal can be very unpleasant and enrollment in a detox facility is necessary to cope with these symptoms and avoid a relapse.

Methadone Withdrawal Symptoms

The symptoms of methadone withdrawal are similar to those experienced with other opioids. The withdrawal symptoms do differ, however, in their intensity and duration depending upon the opioid used. Methadone has a long half-life and stays longer in the body. Consequently, the withdrawal symptoms occurring as a result of abstinence from methadone use take longer to emerge – and tend to last longer than those due to short-acting opioids like heroin.

Physical Withdrawal Symptoms

Some of the physical symptoms of methadone withdrawal include

• Muscle pain
• Diarrhea
• Vomiting
• Nausea
• Abdominal cramps
• Hyperalgesia or increased sensitivity to pain
• Weakness
• Dilation of pupils
• Cold flashes with goosebumps
• Hypertension
• Hyperthermia or high body temperature
• Excessive sweating
• Watery discharge from the nose and eyes

Psychological Withdrawal Symptoms

Some of the common psychological effects of methadone withdrawal include:

• Anxiety
• Agitation and irritability
• Insomnia
• Nervousness
• Depression
• Severe cravings

Symptoms of Post Acute Withdrawal Syndrome (PAWS)

Post-Acute Withdrawal Syndrome (PAWS) refers to the symptoms due to methadone withdrawal that persist beyond the initial withdrawal period and last for weeks or months. About 90% of individuals recovering from opioid dependence experience PAWS. PAWS, also referred to as protracted withdrawal symptoms, generally involve psychological symptoms and include cognitive deficits involving learning, memory and attention, increased irritability, anxiety, panic and depression. Other symptoms may include sleep disturbances, drug cravings, apathy and lack of interest in social relationships.

Death from Methadone Withdrawal

Although withdrawal from opioids involves symptoms that result in significant discomfort to the individual, the symptoms of methadone withdrawal are generally not life-threatening. However, withdrawal from methadone can lead to severe diarrhea and vomiting. This can result in severe dehydration and increase sodium levels in the blood or hyponatremia. Methadone-induced hyponatremia can, in turn, lead to cardiac arrest and death.

How Long Does Methadone Withdrawal Last?

Methadone has a long half-life and stays longer in the body. The first symptoms of methadone withdrawal appear between 12-48 hours (generally 30 hours) after the onset of abstinence from drug intake. The symptoms of methadone withdrawal may last for around 10 days but may persist until 3 weeks after the onset of abstinence.

Stages of Withdrawal

The symptoms of methadone withdrawal are generally observed in two stages. The initial phase begins 12-48 hours after the onset of abstinence and lasts until 5 days after discontinuation of drug use. The symptoms are more severe during this phase and reduce in severity over the period of the subsequent phase. The initial phase is marked by symptoms such as chills, muscle aches, insomnia, anxiety, agitation and cravings. The later phase is marked by gastrointestinal disturbances (nausea, vomiting, diarrhea), dilated pupils, sleep disturbances and goosebumps.

Factors Affecting Withdrawal Duration

The factors affecting the duration of withdrawal symptoms include the duration of intake, the frequency and dosage of methadone and the physiological (metabolic) characteristics of the individual. Intermittent use of the drug may not even result in withdrawal symptoms, whereas the use of high dose for a long duration of time may result in severe withdrawal symptoms.

Metabolic characteristics, influenced by age, genes and environmental factors, can also significantly influence the duration of withdrawal symptoms. Withdrawal symptoms may also be more severe and prolonged in cases involving the use of other substances such as alcohol or illicit drugs.

How Methadone Can Help with Withdrawal

Methadone belongs to the family of opioids along with hydrocodone, oxycodone, morphine and heroin. Methadone binds to the same opioid receptors as morphine and heroin but has a more gradual mode of action. Although methadone can produce a high in individuals who do not have an opioid addiction, methadone acts in a different manner in individuals who are dependent on opioids like heroin or morphine. Methadone does not produce a euphoric high due to its slow mode of action and can be useful in the treatment of individuals who are already dependent on opioids.

Opioid & Heroin WIthdrawal

Although methadone itself is an opioid that binds to the same receptors as heroin or other opioids, it has a gradual mode of action. Administration of methadone during detoxification from heroin or other opioids can be useful in alleviating the withdrawal symptoms and reducing cravings. Individuals are generally maintained on methadone or buprenorphine for long durations to avoid relapse.

Controlled Taper

Methadone maintenance treatment may be ceased once the patient shows long-term cessation from heroin use and the individual has acquired the skills and support to lead a drug-free life. This generally involves a gradual taper of the doses of methadone, undertaken over a period between 30 to 180 days to avoid severe symptoms of methadone withdrawal. After the dosage of methadone falls below a certain level (around 20 mg), individuals may begin to show signs of methadone withdrawal.

How to detox from methadone

The symptoms of methadone withdrawal are generally severe involving nausea, vomiting, diarrhea and overstimulation. These adverse symptoms make it difficult for even a motivated individual to discontinue drug use. Medical insight and supervision can help the individual cope with the symptoms of methadone withdrawal. Detoxification at a medical detox center is the best way to cope with these symptoms of methadone withdrawal.

Medical or Outpatient Detox

Detoxification can be undertaken either at an inpatient medical detox or an outpatient facility. Treatment at an inpatient medical detox requires residence at the facility and involves round-the-clock supervision by medical staff. The intensive medical care along with behavioral therapy at an inpatient detox can help the patient cope with the unpleasant withdrawal symptoms in a safe and drug-free environment.

Medical detox is especially suitable for cases of severe dependence on methadone. Treatment at an outpatient involves both medication and behavioral therapy like inpatient medical detox but is less intensive. Outpatient detox allows an individual to continue with their daily life activities, including work or education. However, this may expose the individual to triggers that lead to drug use and increase the chances of a relapse. Outpatient detox is generally more appropriate for less severe cases of methadone dependence.

Read more: Methadone detox process

One of the commonly used medications for the alleviation of the symptoms of methadone withdrawal includes clonidine. Clonidine is useful in counteracting the symptoms of overstimulation including anxiety, agitation, sleep disturbances, muscle pains, diarrhea.

Buprenorphine, another opioid, in combination with naloxone may also be used to reduce the severity of withdrawal symptoms. Buprenorphine only partially binds to the opioid receptors and may be useful in alleviating the withdrawal symptoms and reducing cravings for methadone.

Other medications may be used for the management of specific symptoms. For example, benzodiazepines may also be used for the treatment of insomnia-related symptoms, whereas non-steroidal anti-inflammatory drugs like ibuprofen may be used for treating muscle cramps.

Detoxing at Home

Methadone detoxification may be undertaken at home with the support of a family member. Medications, as prescribed by a physician, may also be useful during the detoxification process. Detoxification must be undertaken in a calm and safe environment to avoid overstimulation. The individual should be encouraged to drink large amounts of fluids to avoid dehydration due to diarrhea or vomiting. Activities that help the individual to relax such as exercises, yoga and hot baths may also be useful. The support person should maintain a watch on the individual undergoing detoxification for severe adverse effects like seizures or hallucinations. In such cases, one must immediately call 911. The chances of relapse are much higher at home due to exposure to triggers that may lead to drug use and unpleasant symptoms.

Keep in mind that there are significant risks from detoxing “cold turkey.” in fact, detoxification from methadone should be gradual and the doses of methadone used should be very gradually tapered over a period of time. Abrupt discontinuation of methadone use or withdrawing “cold turkey” in an attempt to detox quickly can result in very severe withdrawal symptoms. Quitting cold turkey can result in relapse due to these adverse effects.

Finding a Detox Center

While choosing a treatment center for methadone detoxification, it is essential to ensure that the detox center provides evidence-based, individualized treatment for opioid dependence. The withdrawal symptoms vary from person-to-person depending on their drug use history and require that the treatment protocols are tailored according to the individual’s symptoms. It is also essential to ensure that the treatment is offered by well-trained and experienced medical staff.

Another important aspect to consider while choosing a detox center is cost. Treatment at an inpatient detox center is expensive and finding a detox center covered under the health insurance plan can make treatment affordable.