When used correctly at a “maintenance dose,” methadone prevents withdrawal symptoms without making you high or sedated. People take methadone for months or years at a time. Generally, the longer you use it the better your chances of recovery, but because it’s an opioid, stopping methadone causes opioid withdrawal.
Overview
Methadone withdrawal is no picnic. Doctors prescribe it for two reasons—the first is to give opioid addicts a safe, long-term option for relapse prevention, the second to treat stubborn cases of severe chronic pain. In both these scenarios, the goal of doctors is to find an immediate solution to a serious problem. Methadone does work really well for most people, preventing innumerable overdose deaths every year. Its primary drawback is the prolonged withdrawal syndrome it can cause. Everyone’s experience getting off methadone is different. Some people find methadone withdrawal less intense than they expected. Other people think it’s worse than withdrawing from a short-acting opioid like heroin. If you have an opioid use disorder (addiction), then you probably have an idea of what to expect from opioid withdrawal. Feeling like you have a bad flu, vomiting, diarrhea, sweating, and insomnia are all common. With a short-acting opioid, these withdrawal symptoms can be intense, but they typically peak within a couple of days and then begin to resolve. Acute methadone withdrawal symptoms can last up to 14 days, but many people also experience post-acute withdrawal symptoms for months after their last dose. These lingering psychological symptoms leave many people feeling uncomfortable in their own skin, dissatisfied with their decision to get clean, and frustrated about their lack of progress.
Signs and Symptoms
Some doctors recommend continuing methadone therapy indefinitely. If you are thinking about quitting, talk with a doctor about the pros and cons. Quitting methadone can be a long and frustrating process, even for people without an opioid addiction. If you are using methadone to treat pain, you are still physically dependent on it and will experience withdrawal symptoms when you try to quit or reduce your dose. Your experience with methadone withdrawal will depend on a variety of factors, including your past experiences and expectations. Some people go into it thinking it’s going to be a nightmare, but it turns out to be milder than they anticipated. Others go into it thinking it will be easy and find that it requires a much greater commitment than they thought. Your symptoms may start off mild and become more severe over the course of a few days. Once they reach peak severity, your symptoms will begin to resolve. The acute (short-term) symptoms should disappear within two weeks. Common acute withdrawal symptoms include:
Agitation Anxiety or restlessness Bone and joint aches and pain Chills Cramping or diarrhea Flu-like feeling Gooseflesh Insomnia or disturbed sleep Nausea or vomiting Runny nose Skin-crawling Sweating Teary eyes Tremors
Methadone withdrawal symptoms vary from mild to moderate. To get a better idea of the scale, you can check out the Clinical Opiate Withdrawal Scale (COWS) that doctors use to diagnose their patients. Post-acute withdrawal, which is also known as protracted withdrawal, begins in the weeks following your detox. These symptoms are most common in long-term opioid abusers. Opioids affect the way your brain works, flooding your brain with euphoria-inducing neurotransmitters every time you get high. After you detox, your brain is operating with depleted stores of neurotransmitters. It can take up to six months for your brain to return to normal. During that time, you may experience symptoms such as:
A low tolerance for stress (short fuse) DepressionIrritability or agitation Low energy levels Problems with memory or concentrationThe inability to experience pleasure from anything Trouble sleeping
These symptoms may come and go over the course of several weeks or months. They can be extremely frustrating for both people in recovery and their loved ones. It helps to keep in mind that these symptoms are temporary and should resolve within the year.
Coping and Relief
The best way to cope with methadone withdrawal is to avoid skipping doses or trying to quit abruptly. Even if you are frustrated and sick of going to a clinic or pharmacy every day for a supervised dose, it is best to avoid abrupt cessation. Instead, talk to your prescribing doctor about tapering. Tapering methadone means gradually taking smaller doses over the course of several weeks or months. Although tapering is considered the best way of detoxing from methadone, it can still be challenging. You are likely to experience withdrawal symptoms each time your dose is cut. Working closely with a doctor, you can extend your taper timeline and reduce your dose by smaller increments if necessary. They acknowledge that this is only a general recommendation and that the taper schedule should be tailored to each individual’s needs. Dose reductions can occur once a week, once every two weeks, or less often. Sometimes one dose reduction is harder than the others and uncomfortable withdrawal symptoms occur. When this happens, your doctor can pause the taper at that level and wait several weeks before reducing the dose again. If you are experiencing withdrawal symptoms when you reduce your dose, your doctor may recommend treating your symptoms with other medications. The American Society for Addiction Medicine recommends doctors consider prescribing the following medications:
Clonidine, a hypertension drug regularly used off-label to treat opioid withdrawal symptoms. It is available as a pill or a transdermal patch. Loperamide to treat diarrhea. Ondansetron to treat nausea and vomiting. Benzodiazepines to treat short-term anxiety. OTC pain relievers, like Tylenol or Advil, to treat aches and pains.
There is another option that you may want to talk to your doctor about—Lucemyra (lofexidine hydrochloride). Lucemyra is a new medication; it’s similar to clonidine and recently approved by the FDA to treat the symptoms of opioid withdrawal. It is the first non-opioid medication clinically proven to do so. Lucemyra works by reducing the release of norepinephrine, a neurotransmitter that researchers believe plays a role in the symptoms of opioid withdrawal. If you are experiencing insomnia or disordered sleeping, you might also want to ask your doctor for something to help you sleep. Your doctor might give you a prescription for trazadone or suggest an OTC antihistamine, like Benadryl, to help you sleep.
Warnings
Opioid withdrawal is rarely dangerous for healthy adults, but some people need to be more cautious than others. Most notably, pregnant women. If you are currently using methadone or other opioids, it is best to continue with methadone until the end of your pregnancy. Methadone is proven safe and effective for use during pregnancy. It does not cause birth defects or pregnancy complications. However, it is possible that your child will be born with an opioid dependence, which means they will need to detox. It’s important to keep in touch with both an obstetrician (OBGYN) and an addiction doctor throughout your pregnancy. Pregnancy affects the way your body metabolizes methadone, so your dose may need adjusting as your pregnancy advances. Although the laws about opioid abuse during pregnancy do differ among the states, methadone is safe and legal—you should not run into any problems when you seek treatment. You should also talk to your doctors about your plans after giving birth. Breastfeeding is generally considered safe during methadone treatment. If you want to stop taking methadone, your doctor will talk to you about an appropriate tapering timeline. They may advise waiting until your body feels back to normal. One last warning: Relapse is common among opioid users. After you detox from methadone, your opioid tolerance will be much lower than it used to be. If you relapse with heroin or prescription painkillers, you will be at risk of a life-threatening overdose.
Long-Term Treatment
It is not unusual for people with opioid use disorders to go on and off methadone over the course of several months or years. Detoxing from methadone is a great step, but it doesn’t mean that you’ve beaten your addiction. Proper addiction treatment takes a multifaceted approach that combines medication management with psychotherapy and social support. Relapse rates among people with opioid use disorders are very high. Research shows that roughly 3 in 4 people who complete opioid detoxification relapse within 2 to 3 years. These numbers aren’t pretty, but don’t let them scare or discourage you. Relapse is a part of the recovery process. Knowing the odds will help you understand the value of ongoing treatment. Remember that it is not uncommon for people to overdose and die during a relapse. Fortunately, there is a non-opioid medication available that can help reduce your risk. Naltrexone is what’s known as an opioid antagonist (similar to the naloxone in Suboxone). Naltrexone binds to the opioid receptors and acts like a blockade, preventing other opioids from binding to those same receptors. This means that even if you relapse and use an opioid, you won’t get high (but you can overdose). Knowing that using an opioid won’t get you high should discourage you from impulsively relapsing. Naltrexone is available with a prescription and can be taken as a daily pill or a monthly injection. Because naltrexone can bring on instantaneous withdrawal, you shouldn’t start using it until all the methadone is out of your system. This can take as long as 14 days. When it comes to therapy, you have a variety of options. Most methadone clinics offer some sort of counseling, so that’s a good place to start. Once you have tapered down, you might want to find something more convenient, like a therapist in private practice or at a local community health clinic. You can also look into group therapy sessions, which are often held at hospitals and other addiction treatment facilities. Finally, social support is a key aspect of relapse prevention. Many people find support at local 12-step meetings, such as Narcotics Anonymous.
Resources
To find more information about Narcotics Anonymous (NA) meetings in your area, check out their website. You can find a meeting near you with their searchable directory. If your loved one is trying to recover from opioid addiction, you may want to consider a support group for friends and family, such as Nar-Anon. For more mental health resources, see our National Helpline Database.
A Word From Verywell
Methadone detox isn’t easy. Just take things one step at a time and don’t get discouraged by the rate of your progress. Recovery can be a slow and grueling slog at times, but things will get better—just keep at it.
