What Is Methadone Withdrawal?
Methadone is a medication that is prescribed to manage opioid addiction. Methadone itself can be addictive, and people who take methadone over a period of time can become physically dependent on it.1 Approximately 4.3 million people reported using opioids like methadone for non-medical purposes in 2014.2
When a person abruptly stops or attempts to sharply reduce methadone use, they may experience a variety of withdrawal symptoms. Methadone detox and addiction treatment programs can help ensure a safe withdrawal process.
This article will discuss:
- Methadone withdrawal symptoms.
- Withdrawal timeline.
- Causes of withdrawal.
- Treatment for withdrawal.
A person can experience some methadone withdrawal symptoms even if they have been taking the drug for a short time and taking it as prescribed.
However, in general, methadone withdrawal will be much more likely, and the symptoms more intense, in those who have been using or misusing the drug for an extended period of time.
The following is a list of typical methadone withdrawal symptoms:2
- Strong cravings for methadone
- Aches in the muscles or bones
- Stomach cramping or pain
- Dilated pupils
- Excessive yawning
- Goose bumps
- Runny nose
- Tearing eyes
Some of the biggest risks associated with withdrawal are relapse and potential overdose. Abstinence during the detox process can lower a person’s tolerance. If the person then relapses and uses the same amount they were accustomed to, they may overdose more easily.2
In addition, anxiety and irritability can lead to changes in a person’s mental health status, and some people may become depressed or suicidal.2
A person who is suffering from diarrhea may become dehydrated. If the person is vomiting, they may also aspirate (breathe vomit into the lungs), which can lead to infection.2
Methadone is a long-acting opioid, and withdrawal symptoms generally appear around 30 hours after the last dose.2 Acute methadone withdrawal can last for about 2–3 weeks, with symptoms improving gradually around the 10th day of withdrawal.3
According to the typical methadone withdrawal timeline, when an individual is in the early withdrawal stage, symptoms can include agitation or anxiety, muscle aches, tearing eyes, runny nose, inability to sleep, and excessive yawning. As withdrawal progresses, they may have symptoms such as stomach cramps, nausea, vomiting, goose bumps, and dilated pupils.2
Some people may experience a protracted withdrawal period, or post-acute withdrawal syndrome, in which withdrawal symptoms may persist for weeks or months.3
Protracted withdrawal can include emotional symptoms such as anxiety, depression, and continued irritability. Physical symptoms of post-acute withdrawal can include fatigue. Cognitive symptoms, such as having difficulty focusing on a task, may also occur.3
Causes of Withdrawal
Regular methadone use leads to the development of tolerance to the effects of the drug. The brain and the body become desensitized to the effects of methadone and, over time, the person requires more of the drug to cause the desired effects.2
A person who builds tolerance can develop a physical dependence on the drug due to increasing drug use. Once an individual is physically dependent on methadone, they will need to continue to take the drug to prevent withdrawal symptoms, which occur when use is abruptly stopped or drastically decreased.2
Treatment for Withdrawal
Methadone withdrawal is not life-threatening. But since it is often painful and includes strong cravings for the drug, a safe, structured environment can help prevent relapse. Detox facilities can also provide medication-assisted treatment that can ease withdrawal symptoms. Further, support from other recovering peers and trained staff can help to facilitate the process of recovery from addiction.
Methadone withdrawal treatment methods can include:
- Detox: Detox occurs in a medically supervised setting. Staff are on hand around the clock to ensure comfort and safety, and many programs use medication-assisted treatment to reduce the discomfort of withdrawal symptoms. Methadone detox centers are not a substitute for treatment, however. Further treatment is often necessary to ensure sobriety after completing detox.5
- Inpatient treatment: Inpatient methadone withdrawal treatment takes place in a residential facility where patients remain for varying periods of time based on the severity of the addiction and the person’s readiness to reintegrate into society. Inpatient programs generally last for 28–30 days, though treatment can be extended for as long as 90 days, if needed. Group therapy sessions, individual therapy sessions, medication-assisted treatment, and if necessary, medical and psychiatric treatment are provided.
- Outpatient treatment: Outpatient recovery programs allow people to live at home and continue to work, go to school, and take care of responsibilities at home while in treatment. Outpatient treatment facilities also provide therapy in both group and individual sessions, as well as psychiatric treatment if needed.
- Partial hospitalization: Partial hospitalization is a relatively intensive form of outpatient treatment. These programs provide a highly structured environment where therapy is provided in group settings, as well as individual counseling sessions, 5 days a week for several hours. People in partial hospitalization programs are able to return home while receiving treatment.
Medications for Withdrawal
A number of medications can be used to treat and reduce methadone withdrawal symptoms as well as assist in maintaining long-term sobriety. The following medications can be used:
- Buprenorphine is a medication that can manage withdrawal. It is a synthetic opioid that reduces or eliminates the symptoms of withdrawal, and it can also reduce the length of time needed to detox from methadone.2,5 Buprenorphine and naloxone combinations (Suboxone) work in a similar way to buprenorphine, but the naloxone blocks any effects from additional opioid use and reduces the risk of misuse.2,5
- Clonidine can reduce feelings of anxiety and agitation, as well as help treat the physical symptoms of withdrawal, such as runny nose, sweating, goose bumps, cramping, and muscle aches.2
- Zofran (ondansetron) is used to reduce nausea, and it can help prevent dehydration and electrolyte imbalance from nausea and vomiting.6 Diarrhea and vomiting can also be treated with medications such as Imodium (loperamide) or Compazine (prochlorperazine), as well as hydrating fluids.
- Baclofen can help reduce the pain from muscle aches and spasms associated with methadone withdrawal.7
- Naltrexone can help prevent relapse during and after treatment.2 It blocks the effects of opioids and reduces cravings for methadone or other opioids.5 This medication is available in pill form, or it can be delivered as a monthly injection (Vivitrol).2, 5
- Benzodiazepines or non-addictive prescriptions such as trazodone can treat insomnia and anxiety. Benzodiazepines are addictive, however, and medications with a lower risk of abuse are generally preferred in the treatment of methadone withdrawal.
- Mayo Clinic. (2016). Methadone (oral route).
- U.S. National Library of Medicine. (2016). Opiate and opioid withdrawal.
- Substance Abuse and Mental Health Services. (2010). Protracted Withdrawal.
- Substance Abuse and Mental Health Services. (2006). What every individual needs to know about methadone maintenance.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd edition).
- U.S. Food and Drug Administration. (2015). Ondansetron (marketed as Zofran) Information.
- U.S. National Library of Medicine. (2010). Baclofen Oral.
- Drug Enforcement Administration. (2014). Methadone.