According to the National Survey on Drug Use and Health (NSDUH), more than 200,000 people in the United States abused methadone in 2016. Methadone is an opioid drug that is approved to treat opioid addiction; however, since it is still a full agonist opioid, it can also be misused.
Methadone is dispensed through clinics licensed as opioid treatment programs (OTPs) through the Substance Abuse and Mental Health Services Administration (SAMHSA). It is usually given once a day in either liquid, tablet, or wafer form to be ingested orally (swallowed by mouth). It also can be used as a painkiller, although since its analgesic properties wear off much faster than its central nervous system (CNS) depressant effects, it is not generally a first-line option for pain relief.
Methadone increases levels of dopamine in the brain and binds to its opioid receptors. When dopamine levels increase, mood improves. A person is liable to feel mellow, relaxed, and happy when taking methadone, and this can make it a target for abuse.
Recreational use of methadone can include snorting, smoking, or injecting the drug. Since some of the methadone’s activity wears off faster than the drug itself, it can also seem like the drug isn’t working as desired, encouraging a person to take additional doses. Any misuse of methadone is considered abuse. The U.S. Drug Enforcement Administration (DEA) publishes that nearly 2.5 million Americans reported abusing methadone at least once in their lifetime as of a 2012 national survey.
Methadone use and misuse can cause drug dependence, which can lead to difficult withdrawal symptoms when the drug processes out of the body. It is not a drug that should be stopped cold turkey. Instead, medical detox is the optimal format for allowing the drug to process slowly out of the body, often with the aid of medications or a tapering schedule.
What Is Methadone?
What Is Methadone?
Methadone is an opioid medication used during medication-assisted treatment (MAT) to help people reduce or quit their use of opioids, such as heroin or fentanyl. The drug has been used for decades to treat individuals addicted to these drugs. When used as prescribed, it’s considered safe and effective. It allows people to recover from their opioid use disorder, giving them the ability to reclaim their lives.
For methadone to work, the individual must participate in a comprehensive medication-assisted treatment (MAT) program that includes social support and counseling. Despite its benefits, it can be an addictive drug when misused because it’s an opioid.
How Does Methadone Work?
How Does Methadone Work?
Methadone works by changing how the brain and nervous system respond to pain. Methadone will lessen the symptoms of opioid withdrawal and block the euphoria associated with morphine, heroin, and codeine, as well as semi-synthetic opioids like hydrocodone and oxycodone. It comes in pill form, liquid, and wafers. It’s taken once a day, and the pain relief from the drug lasts anywhere from four to eight hours after the last dose. It’s proven effective in higher doses, especially for heroin users, and keeps them in treatment programs longer.
Is Methadone Safe to Use?
Is Methadone Safe to Use?
Since methadone can be addictive, it must be used exactly as the doctor prescribes it. It’s particularly important for those who take methadone at home and not under the supervision of a medical professional. Methadone is tailored for the person in question and should never be shared or given to others. The individual must share their complete health history with medical professionals to ensure the safe use of methadone.
Despite its ability to assist opioid addicts in overcoming their affliction, methadone itself is an opioid, meaning it can be addictive and cause withdrawal symptoms. Since it’s a longer-lasting opioid, it remains in your system much longer than other opiates. This means withdrawal symptoms can be even more severe and take longer to present themselves. Below, we’ll provide a timeline of methadone withdrawal and what you can expect.
Detox Timeline
Methadone is considered a long-acting opioid drug. This means it remains active in the body for a day or more. Once methadone stops being active, withdrawal symptoms begin. Methadone withdrawal generally starts within 30 hours of the last dose of the drug.
- One to three days after the last dose of methadone, early withdrawal symptoms begin. These include agitation, restlessness, insomnia, sweating, muscle aches, yawning, runny nose, watery eyes, and anxiety.
- Three to five days after stopping use, additional side effects of withdrawal kick in, such as racing heart rate, elevated blood pressure, cravings, stomach cramps, diarrhea, nausea, vomiting, goosebumps, and dilated pupils. Withdrawal symptoms usually peak during this period.
- Five to 10 days after the last dose of methadone, withdrawal symptoms will begin to dissipate. Cognitive difficulties, trouble feeling pleasure, and general malaise are common.
- One week to a month after stopping use, short-term memory problems, problems concentrating, depression, anxiety, sleep issues, and cravings may continue but will lessen with time.
An Individual Process
Many factors can influence the detox timeline and affect the intensity of withdrawal symptoms, how long they persist, and if there will be any other complications. Withdrawal is highly individual, and no two people will experience it in the same way.
The significance, duration, and timeline can be influenced by biological, environmental, and genetic factors. Environmental aspects, including stability of home life and stress levels, can influence the healing process. The more stressed a person is, the more intense withdrawal is liable to be and the greater the odds for relapse.
A person’s metabolism is also going to play a role in how long it takes methadone to process out of the body. The faster methadone is metabolized, the sooner withdrawal starts. Age, gender, and even race can affect metabolism.
Opioid tolerance is another major factor in metabolism. The journal Pharmacy & Therapeutics publishes that methadone’s half-life is as short as 24 hours in someone tolerant to opioids, and in someone who is not tolerant, the drug’s half-life is as long as 55 hours. Tolerance is something that occurs when a person takes an opioid drug regularly, and the brain requires larger doses for it to be effective. Drug tolerance can often lead to escalating dosage and then to drug dependence. Genetics can influence a person’s level of dependence, as personal or family history of addiction can be related to genes.
The more dependent a person is on methadone, the longer and more significant withdrawal can be. Methadone dependence is also related to the following:
- How long methadone has been used
- Dosages took each time
- The method by which methadone is taken (ingestion, smoking, snorting, or injection)
- If other drugs or alcohol are taken in combination with methadone
One of the biggest risks during withdrawal is the possibility of relapse and potentially life-threatening overdose. When a person takes methadone regularly, their brain and body get used to certain amounts of the drug. When use is stopped, even for a short time, tolerance can drop. If a person then starts taking methadone again in the amounts they used to before, the body will no longer be able to metabolize it as quickly, and a toxic overdose can result.
Methadone Withdrawal Symptoms
Methadone Withdrawal Symptoms
Despite it being used for medical reasons, when you stop using methadone, you’ll likely experience withdrawal symptoms. Getting through methadone withdrawal is a tough experience because it’s typically the drug that helps you overcome withdrawal symptoms from other opioids. You must discuss the risks and benefits associated with methadone treatment with your doctor to determine if it’s worth it for you. They’ll help you to decide whether long-term therapy with methadone is right for you or if you should stop.
As mentioned earlier, you’ll likely experience withdrawal symptoms around 30 hours after your last dose. These include:
- Watery eyes
- Anxiety
- Restlessness
- Tiredness
- Sweating
- Runny nose
- Trouble sleeping
- Yawning
The initial onset of symptoms will feel like the flu. However, unlike the flu, withdrawal symptoms will remain severe for several days. Most symptoms, which should peak around three days, include:
- Vomiting
- Severe nausea
- Goosebumps
- Muscle aches and pain
- Cramps
- Depression
- Diarrhea
- Cravings for methadone
The symptoms will be at their worst during the first week, while some symptoms will persist longer than a week. These include trouble sleeping, anxiety, low energy levels, and depression.
Withdrawal is extremely uncomfortable, and the risk of returning to other opiates is high. For this reason, some people discuss staying on methadone treatment at lower doses if they can. Once a person is stable at a lower dose, the doctor will attempt to taper you from the drug again. Each person will experience withdrawal differently, based on the amount they were taking and other factors. For that reason, you must speak with your doctor about what to expect. Below, we’ll discuss safe tapering from methadone.
Despite it being used for medical reasons, when you stop using methadone, you’ll likely experience withdrawal symptoms. Getting through methadone withdrawal is a tough experience because it’s typically the drug that helps you overcome withdrawal symptoms from other opioids. You must discuss the risks and benefits associated with methadone treatment with your doctor to determine if it’s worth it for you. They’ll help you to decide whether long-term therapy with methadone is right for you or if you should stop.
As mentioned earlier, you’ll likely experience withdrawal symptoms around 30 hours after your last dose. These include:
- Watery eyes
- Anxiety
- Restlessness
- Tiredness
- Sweating
- Runny nose
- Trouble sleeping
- Yawning
The initial onset of symptoms will feel like the flu. However, unlike the flu, withdrawal symptoms will remain severe for several days. Most symptoms, which should peak around three days, include:
- Vomiting
- Severe nausea
- Goosebumps
- Muscle aches and pain
- Cramps
- Depression
- Diarrhea
- Cravings for methadone
The symptoms will be at their worst during the first week, while some symptoms will persist longer than a week. These include trouble sleeping, anxiety, low energy levels, and depression.
Withdrawal is extremely uncomfortable, and the risk of returning to other opiates is high. For this reason, some people discuss staying on methadone treatment at lower doses if they can. Once a person is stable at a lower dose, the doctor will attempt to taper you from the drug again. Each person will experience withdrawal differently, based on the amount they were taking and other factors. For that reason, you must speak with your doctor about what to expect. Below, we’ll discuss safe tapering from methadone.
Safe Tapering
Because of the potential for complications and differences from person to person, medical detox is the safest course of action for methadone withdrawal. A medical detox program will provide a calm and stable place where the focus is on healing and recovery. Health care professionals can monitor vital signs and determine the best methods for allowing the drug to process out of the brain safely. This is often accomplished through a controlled taper.
While specifics will vary from person to person, on average, the methadone dosage can be lowered between 10 percent and 50 percent at tailored intervals. For some people, the dose may be lowered daily; for others, it may be lowered every two weeks.
During detox, the goal is to keep the brain as balanced as possible. While it is slowly weaned off methadone, its chemical makeup is regulated. This allows the brain to start producing, moving, and reabsorbing neurotransmitters like dopamine on its own without the interaction of methadone. In this way, the brain isn’t shocked by the sudden processing out of methadone, which can leave a major imbalance in its wake.
Dosages may need to be adjusted during medical detox to ensure stability remains and that withdrawal symptoms are minimal. Methadone may also be replaced with the partial opioid agonist buprenorphine during detox. Other medications can be helpful to address specific withdrawal symptoms.
Choosing a Detox Program
A medical detox program can help to minimize withdrawal symptoms and shorten the duration of withdrawal. Below are some tips on what to look for in a detox program:
- A stable and secure environment that is staffed with highly trained professionals 24/7
- Licensed staff members and a credentialed center
- Integrated treatment for co-occurring disorders so all issues are addressed simultaneously
- Teams of professionals work together to design and implement a recovery plan that suits the needs and sensitivities of the individual and the family
- Options for holistic and adjunctive therapies in addition to traditional approaches, such as acupuncture, yoga, massage therapy, chiropractic care, and meditation
- Medication management
- Holistic care that promotes whole-body healing, including nutrition planning and fitness programs
- A program for relapse prevention, stress management, and coping skills
- A full continuum of care
Medical detox programs are generally about five to seven days in duration, though this can vary according to the individual. Methadone withdrawal can be managed through medical detox, and it should be followed by a complete addiction treatment program to sustain long-term recovery.
