Opioid drugs like methadone disrupt natural brain chemistry and the movement of neurotransmitters throughout the central nervous system. As the brain becomes accustomed to methadone’s involvement and interference, it may no longer work the same way when the drug is no longer active in the bloodstream. This means that regions of the brain that are affected – areas involved in short-term memory and learning functions, impulse control, mood regulation, and those related to feelings of pleasure and happiness – may not function as they once did without the drug.
Withdrawal symptoms are common side effects when methadone is no longer active in the bloodstream after regular use has created dependence. The National Library of Medicine (NLM) publishes that methadone withdrawal symptoms typically start within 30 hours of the last dose.
Methadone withdrawal symptoms may include:
- Anhedonia (trouble feeling pleasure)
- Muscle aches
- Joint, bone, and back pain
- Stomach cramps
- Dilated pupils
- Hypertension (high blood pressure)
- Tearing up
- Tachycardia (irregular heart rate)
- Mental confusion
- Difficulties concentrating
- Appetite loss
- Chills and goosebumps
Detox is the process of allowing toxins like methadone to dissipate from the brain and body. The duration of detox and the severity of the withdrawal symptoms are variable and highly personal. In general, someone who abuses methadone in high amounts for a long period of time will suffer from a more intense and prolonged withdrawal syndrome than a more occasional user. The more significantly dependent a person is on methadone, the more difficult and longer withdrawal will likely be.
Dependence is influenced not only by the amount, duration, and method of abuse, but also by any polydrug abuse and by the presence of any co-occurring mental health or medical disorders. Biological factors as well as environmental ones also play a part in the methadone detox timeline. For these reasons, a detailed assessment is often done prior to admission into a methadone detox program in order to design and implement the most optimal treatment methods.
Methadone and other opioid drugs have significant withdrawal syndromes that are best managed through a specialized detox program that is staffed by trained professionals.
What to Expect with Methadone Detox
Methadone withdrawal symptoms typically start later than those of other opioid drugs and may be less severe, although they may also last longer, the National Highway Traffic Safety Association (NHTSA) publishes. Symptoms of withdrawal generally begin when a drug stops being active in the bloodstream. Since methadone has a long half-life, around 24 hours for someone who is opioid-tolerant per the journal Pharmacy &Therapeutics (P&T), withdrawal symptoms usually won’t begin for up to a day or two after taking the last dose of the drug. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), acute methadone withdrawal can last between two and three weeks on average.
Emotional lows and intense cravings during methadone withdrawal may encourage a person to return to using methadone. This can be highly dangerous, as relapse, especially after any period of abstinence, may lead to a potentially life-threatening overdose. In 2014, more than 14,000 Americans died from a fatal prescription opioid overdose, and methadone is one of the most common drugs involved in these deaths, the Centers for Disease Control and Prevention (CDC) reports.
In order to manage cravings and withdrawal symptoms, methadone is generally tapered off during detox instead of stopped “cold turkey.” This method allows the body time to process the drug out of its system without shocking it suddenly. Opioid receptors remain filled with lower levels of methadone that can be slowly reduced over a set period of time. A detox program will typically set up a tapering schedule that is tailored to the individual. As published by Pain Treatment Topics, a sample methadone taper during detox may follow this format:
- Determine the level of methadone currently in the system upon admission.
- Decrease methadone dosage 20-50 percent per day until down to 30 mg/day.
- Keep decreasing dosage by 5 mg/day every 3-5 days until down to 10 mg/day.
- Decrease dosage 2.5 mg/day every 3-5 days until down to zero.
Medical detox is considered the safest method of detox for an opioid drug, as it is provided by trained professionals in a specialized facility designed to ensure client safety and security.
Managing Methadone Withdrawal
A medical detox program can help to smooth out the bulk of the withdrawal symptoms and aid in physical stabilization. In addition to a tapering schedule, the American Pain Society publishes that other medications, like clonidine, ondansetron, Phenergan, hyoscyamine, hydroxyzine, fluids, and over-the-counter analgesics, like acetaminophen or ibuprofen, are useful during detox to manage methadone withdrawal symptoms. These medications target and ease specific side effects of withdrawal.
Buprenorphine, another long-acting opioid agonist that is FDA-approved to treat opioid dependence per the White House Office of National Drug Control Policy (ONDCP), may be used in place of methadone during medical detox. Buprenorphine is only a partial opioid agonist instead of a full agonist like methadone; therefore, it will not produce the same mind-altering effects that methadone does. It also has a “ceiling effect,” meaning that after a set amount is taken, the drug will no longer have any effect. These properties make buprenorphine less likely to be abused and possibly desirable over methadone during detox. It can also be used in a tapering schedule under close medical supervision.
With medical detox, individuals are provided the security of 24/7 medical monitoring of vital signs. If any complications or issues arise, treatment providers are on hand to offer immediate care.
Mental health support and encouragement are also important during detox as the emotional side effects of methadone withdrawal can be intense. A calm, quiet, and supportive environment can go a long way during this time. Medical detox can also address any nutritional deficiencies that methadone use may have created and help to rectify them with balanced and healthy meals at regular intervals. Vitamin and mineral supplements as well as plenty of fluids to promote rehydration are beneficial as well. Supportive and pharmacological methods can decrease withdrawal symptoms, thus impacting the duration of withdrawal. Co-occurring mental health or medical disorders can also be cared for during medical detox in an integrated fashion.
The overarching goal of detox is to help an individual reach a stable physical level, so they may enter into a complete addiction treatment program with a strong foundation. Medical detox can help individuals to achieve this, while also helping to prevent relapse and shortening the overall withdrawal timeline.