Methadone Withdrawal and Detox
Methadone is a synthetic analgesic painkiller, used primarily to treat heroin addiction. Since the 1990s however, methadone has been administered more frequently to manage chronic pain. It can be taken in pill, powder or liquid form and can also be injected intravenously in some cases. Since this substance binds to the same opioid receptors as heroin and narcotic painkillers, it can also be extremely addictive and habit-forming. Methadone is listed by the Drug Enforcement Agency as a Schedule II drug, meaning it has a medical use in addition to a significant potential for abuse. While methadone can assist with your overall quality of life (because of how effective it is in treating heroin and prescription medicine addictions), it also has a high potential for causing dependence.
Methadone dependence and addiction is one of the most widespread impacts of using the drug. If you suddenly quit, you could experience withdrawal symptoms, particularly if you’ve been using long-term. The detox and withdrawal symptoms associated with methadone abuse may not be as severe as other opioids, but they can last for a much longer period. Drug addiction treatment centres utilise doctors and experienced therapists to develop customised treatment plans to overcome addiction. The right treatment programme can give you the best chance of a successful detox and recovery from methadone addiction.
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What Is Methadone Withdrawal?
Methadone can be highly addictive physically, especially if you are taking it in high doses. The medication is typically used in the treatment of opiate addictions, and could result in the trading of one addiction for another. With consistent and prolonged usage, you can build up a tolerance to methadone. This means you would need to take higher doses of the drug to achieve the desired effects. As soon as your body becomes reliant on methadone to function normally, you can be said to be dependent on the drug.
Methadone withdrawal is what occurs when your body has to relearn how to function in the absence of the substance. As your body attempts to re-establish normal functions or regain homeostasis, unpleasant withdrawal symptoms occur, which make recovery a challenging experience.
Withdrawing from methadone can result in adverse symptoms, which is why it’s recommended to undergo detox in a controlled medical environment. Medical detox can be found at a number of inpatient and outpatient treatment programmes, where withdrawal symptoms can be reduced in severity. Methadone withdrawal is different for everyone. Therefore, the duration of withdrawal and the accompanying symptoms will depend on different factors, including the length and severity of your addiction. In addition, your body chemistry and tolerance level will also influence your symptoms and the duration of withdrawal.
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Causes of Methadone Withdrawal
When methadone is consumed, the effects it produces in the brain and body are similar to that of other opioids. As the drug travels through your bloodstream, it attaches to certain specialised locations known as mu-opioid receptors and simultaneously activates neural processes that control feelings of pleasure and reward. When you take opioids like methadone without a legitimate need for pain relief, these rewarding feelings (similar to those naturally provided during eating or
sexual activity), can increase your chances of developing a compulsive need to abuse methadone. When usage becomes chronic, you begin to experience less of a ‘high’ in terms of the pain-relieving effect and any accompanying pleasurable sensations, when stimulated by methadone. As a result of this heightened tolerance, you may consume even more methadone to try to attain the initial effects.
Developing tolerance to methadone is a normal and expected aspect of prolonged use of the drug. With long-term usage, your brain becomes desensitised to the effects of methadone, and also becomes dependent on the drug to function normally. At this stage, reducing intake or quitting too quickly can trigger withdrawal, and you’ll need to continue to prevent the onset of distressing withdrawal symptoms.
There are significant risks associated with methadone abuse and undergoing withdrawal. So, if you are addicted to this substance, it’s best to seek treatment from a professional to help you quit safely. Medical detox – especially at the first stage of withdrawal – can help to increase your comfort and manage any complications that may occur in the process.
Phases of Methadone Withdrawal
As long as medical replacement therapy is not offered during detox, you can expect methadone withdrawal to follow these basic stages:
Phase 1 – Early Symptoms: Following your last methadone dose, withdrawal symptoms may not normally begin for about 8 to 30 hours. At the first stage, methadone withdrawal symptoms mimic a cold or flu and include: excessive yawning, watery eyes, sweating, involuntary twitching, anxiety, restlessness, agitation, irritability, dilated pupils, and fatigue. The first phase can last two to three days, with most of the physical symptoms gradually dissipating with the continual of withdrawal into the next phase. However, your psychological symptoms may either increase or change.
Phase 2 – Peak Symptoms: Between three to four days, methadone withdrawal symptoms can be expected to peak. You may continue to yawn excessively. However, most of the initial symptoms may have morphed into others. Those that appear at the second phase include: stomach pain, diarrhoea, nausea or vomiting, insomnia, increased sensitivity to pain, depression, intense cravings, cramping and restless legs syndrome. During this phase, relapse is highly possible if you are attempting to withdraw from methadone on your own.
Phase 3 – Decreasing Symptoms: By the time you reach the third phase (in about 10 days), the worst of your methadone withdrawal symptoms will have subsided. You may still feel tired, depressed and anxious, but such feelings will lessen in time. Also, your physical symptoms like yawning, abdominal pain and runny nose, will reduce. Feelings of cravings will commonly continue for weeks, but other symptoms will normally disappear, unless you develop post-acute withdrawal syndrome (PAWS), which is possible with heavy use of methadone over an extremely long period of time.
Methadone Withdrawal Symptoms: What to Expect
Methadone is released into the body at a slower rate than other opioid drugs, so you may not feel withdrawal symptoms for a few days. Typically, methadone withdrawal symptoms take as long as 30 hours to appear after your last dose. The symptoms which occur are similar to those of other opiates like heroin and morphine, but can be lower in intensity. Usually, the symptoms are moderate and flu-like, and may include: muscle aches and pains, nausea and vomiting, fever, chills, anxiety, paranoia, sweating, cravings, paranoia, diarrhoea, rapid heartbeats, irritability, stomach cramps, depression, insomnia and hallucinations.
If your addiction to methadone is more severe, you will likely experience more serious withdrawal symptoms. Also, if you are addicted to multiple substances, withdrawal for you could be more intense and longer in duration.
Quitting methadone ‘cold turkey’ will result in harsher withdrawal symptoms. Doctors recommend a slow tapering off methadone usage to create a more bearable withdrawal process. When you decide to quit using methadone, it’s essential to get help from a doctor or an addiction treatment programme. You can negate methadone tolerance in as little as three days, increasing the possibility of overdosing in relapse, which often occurs when you try to overcome a methadone addiction on your own. This means your body is still dependent on the drug, but cannot tolerate the regular dosage. Symptoms of methadone overdose include blue-tinted lips or fingernails, slow heartbeat, depressed breathing, clammy skin, inability to wake up, coma and even death.
Timeline of Methadone Withdrawal
Methadone withdrawal symptoms generally appear within 24-30 hours of your last dose. However, it can take as long as 15-60 hours before the substance is completely cleared from your system. Withdrawal can therefore take several days to take hold, with the symptoms lasting three to six weeks. The process can also take much longer with a more severe addiction. The first two weeks are usually the most difficult, with uncomfortable flu-like physical symptoms and mentally draining psychological effects. However, you can expect your symptoms to fade over the next few weeks. The timeline of methadone withdrawal will generally go as follows:
First 24 hours – within a day of your last methadone dose, you can expect to begin experiencing initial (early) symptoms of withdrawal.
Days 2 to 10 – methadone cravings will be strong over the next week or so. You may experience paranoia, insomnia and hallucinations, in addition to anxiety and irritability. Flu-like symptoms may persist, but can be expected to improve after about one week.
Days 11 to 21 – at this stage, many of your physical symptoms will have begun to disappear. You could still experience powerful cravings, and depression may also be apparent.
Day 22 onwards – any remaining symptoms at this stage will typically be mild. Depression may still occur intermittently for months as your body readjusts to functioning without methadone.
Methadone Detox Process
The detox process begins by stopping or reducing the intake of methadone and/or replacing it with cross-acting agents. The main aim of drug detoxification is to help you achieve a sober and drug-free state. The methadone detox process can be completed at either an inpatient or outpatient setting, although an inpatient detox centre is often recommended for this type of treatment.
In drug detox centres, licensed clinicians help you to withdraw from methadone by substituting it with cross-acting drugs like benzodiazepines. This drug is preferred for treatment, because of its long elimination half-life, long-acting metabolites, and availability in low-potency doses. Another method used to help you reduce withdrawal symptoms is to gradually taper your regular dosage, which in turns lessens the physical and psychological influence of methadone.
In some cases, methadone detox involves the use of other medications such as buprenorphine. This partial opioid medication is commonly prescribed by doctors and other care providers during transitioning from a methadone dependency. Suboxone is one of the available types of buprenorphine. When detoxing with suboxone, your experience might be noticeably better than simply tapering off methadone. The main reason for this is that both buprenorphine and suboxone bind to the same opioid receptors as other opiates. They can be used to effectively avoid the effects of quitting methadone ‘cold turkey’.
In addition to being incredibly uncomfortable, attempting a home detox can also be dangerous. Methadone is a drug that requires careful control and regulation by experienced healthcare professionals, to prevent accidental overdose or other severe consequences that can occur by taking the wrong dose. Similarly, detoxing from methadone or any opioid substance without help can result in terribly uncomfortable withdrawal symptoms. Along with nausea, vomiting, diarrhoea, sweating and other physical withdrawal symptoms, you can also experience psychological symptoms like depression, suicidal thoughts, anxiety and paranoia. Methadone is one of the most difficult drugs to detox from, especially on your own. This is because it has a longer half-life than many other opiates. Therefore, your body takes longer to be totally free of methadone, as it occupies your opiate receptors for a lengthier period of time.
If choosing to home detox, you can increase your chances of success by tapering on-schedule and in a coordinated manner, following a planned tapering calendar. Keeping a calendar can make the difference between suffering miserably during detox, and being aware and functional for your acute detox stage. However, if you’ve been using methadone for a long time (such as 10 to 20 years), home detox is a significant decision and one you should first discuss with your doctor, pain management specialist or whoever is managing your care.
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Medically supervised methadone withdrawal detox
When you’re ready to overcome your methadone addiction, you can benefit a lot from a medically supervised detox. It is carried out by trained staff and can improve your safety and offer you better symptom relief to prevent you from relapsing.
The normal treatment with detox begins by gradually reducing the dose of methadone via a weaning or tapering process. You might be switched to clonidine at this stage, or simply continue to receive lower doses of methadone. During the final weeks, you may experience more severe withdrawal symptoms, which serve to encourage relapse. This is why supervised detox – such as can be found in an inpatient environment – is recommended as a way to help you maintain abstinence.
Additionally, if you’re seeking a speedier detox, there are options available, such as rapid and ultra rapid detoxification programmes. Such methods involve the use of naltrexone or another type of opioid antagonist to initiate withdrawal, while the symptoms that occur in the process are treated using medications like clonidine and benzodiazepines. This type of medical detox reduces the period from weeks to days, even though the risks of additional side effects make this method unproven and constantly debated. After methadone withdrawal detox, you should seek ongoing treatment for substance abuse, as detox alone is not regarded as comprehensive treatment to achieve long-term recovery.
Medications used during methadone detox
When it comes to drug addiction and treatment, methadone presents a unique problem; it is a major treatment medication for treating addiction to heroin and other opiates, as it alleviates withdrawal symptoms, but in many cases methadone itself becomes addictive. During methadone detox, some withdrawal medications can help, including:
Clonidine: This drug is effectively used to reduce emotional symptoms in the methadone detox and withdrawal process. It contributes significantly to reducing anxiety and agitation, and is also highly beneficial for certain physical symptoms like aches and runny nose.
Buprenorphine/Suboxone: Synthetic opioids that can reduce the length of withdrawal and lessen the symptoms that appear in the process. Both work well together to increase your comfort during withdrawal, and can reduce the risk for dependencies in the future.
Naltrexone: May be prescribed after your treatment to help you reduce the potential for relapse. It functions by reducing cravings and blocking off the effects of opioids.
Zofran: It is used in treating and preventing symptoms like nausea and vomiting, which are common during withdrawal. It also helps you to prevent dehydration, which can happen as a result of excessive vomiting.
Baclofen : This drug targets muscle pain and spasms and helps you to cope with them. It also increases your level of comfort during the process.
Treatment for Withdrawal
Methadone withdrawal treatment prevents symptoms resulting from abrupt cessation of the drug. It is the first phase of rehabilitation treatment for substance abuse. Substance withdrawal centres provide inpatient or outpatient treatment, aimed at eliminating your physical cravings for methadone, so that you can move on to psychological rehabilitation treatment, involving intensive counselling.
At some point during the process of your addiction disorder, you can reach the stage where you are mentally and psychologically ready to quit. In such a state, you may attempt to stop taking methadone, only to discover that it is physically challenging. This is not a sign of weakness; it is simply an effect that methadone and other addictive drugs can have. They make your brain become used to the presence of the drug you’ve been consuming on a daily basis. Withdrawal symptoms can therefore manifest when the drug is no longer present. They can be so unpleasant that you may return to using methadone.
This is where treatment for withdrawal comes in. Programmes designed to treat addictions to opioids such as methadone take care of your physical need for drugs and the effects they produce as part of an overall, intensive rehabilitation programme. Such programmes are either administered on an outpatient or inpatient basis, depending on your scale of addiction. Their treatment mainly involves substituting your drug of abuse with safer medications that target the same receptors and neurotransmitters, affected by methadone and other mind-altering drugs.
Even though detox is not pleasant, you can be as comfortable as possible throughout the process, with the help of trained medical staff. Attempting treatment for withdrawal on your own may seem easier, but it only makes the process more painful and rarely results in long-term recovery. The best thing you can do for yourself in withdrawal is to choose a medical treatment that not only relieves your pain, but also provides you with a chance to reclaim a happy and fulfilling life alongside your loved ones.
Withdrawing from methadone: treatment methods and options
Generally, methadone withdrawal is not life-threatening. However, since it is usually painful and strong methadone cravings tend to occur, a safe and structured environment can help you deal with the symptoms and prevent relapse. In addition, detox facilities can offer medication-assisted treatment that can ease the overall process for you. Also, having the support of trained staff and other recovering peers can contribute to improving the recovery process. Treatment methods and options for methadone withdrawal treatment include: detox, inpatient treatment, outpatient treatment and partial hospitalisation. Methadone detox centres are generally not meant to act as a substitute for addiction treatment centres. The best way to ensure your abstinence after completing detox is to undergo further treatment.
Inpatient methadone treatment occurs in a residential centre, where you can remain for varying lengths of time, depending on the severity of your addiction, as well as your willingness to reintegrate into society. This method of treatment incorporates the use of individual therapy sessions, group therapy sessions, medication-assisted treatment, and (where necessary) medical and psychiatric treatment.
Outpatient treatment for methadone withdrawal allows you to live at home and continue with your responsibilities at work or school, whilst undergoing treatment. These types of programmes also offer individual and group therapy sessions, in addition to psychiatric treatment, as needed. Partial hospitalisation treatment is a form of outpatient treatment, but on a more intensive level. Therapy here is provided in the form of individual counselling sessions, as well as group sessions, for several hours over five days each week. In partial hospitalisation programmes, you can return home while undergoing treatment.
Drug treatment for withdrawal
Your doctor can administer treatments to ease your withdrawal symptoms, making it much more likely that you’ll make a complete recovery. Unfortunately, the use of drugs for methadone withdrawal will be limited, because the substance itself is used in helping to end opioid dependence.
Buprenorphine, clonidine and naloxone are drugs used as treatments during withdrawal, shortening the duration and helping to relieve your symptoms. Buprenorphine is a synthetic opioid that is used to manage withdrawal. It can reduce the length of time you’ll spend detoxing from methadone and also reduces and eliminates withdrawal symptoms. A combination of naloxone and buprenorphine (Suboxone) works in a similar way to buprenorphine, with the naloxone element reducing the risks of misuse and overdose by blocking all the effects from using more opioids.
Clonidine is normally used as a blood pressure medication, and has proven to be effective in treating a number of methadone withdrawal symptoms. However, it is ineffective with symptoms such as nausea, aches, diarrhoea and sleep problems. Prescription sleep aids and other over-the-counter options may be used instead. Also, Benzodiazepines are used in treating anxiety and insomnia. However, Benzodiazepines can be addictive and medications with a lower risk of abuse – such as the non-addictive, prescription trazodone – are preferred options for treating methadone withdrawal. After you’ve completed withdrawal, naltrexone may be prescribed by your doctor to minimise cravings and discourage future opioid use. This drug works like other opioid antagonists to block the effects of opioids in your body, and can be offered as a pill or monthly injection (Vivitrol).
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Guided methadone therapy
As a result of the risk of abuse and overdose, you need to be registered in a government programme to have access to guided methadone therapy. This involves the close supervision of your methadone intake by a doctor, to ensure your withdrawal process is both effective and safe. Therapy continues until your body stops showing signs of needing methadone in order to function properly. Guided methadone therapy can be successfully employed in some instances to help the process of tapering off the substance.
This is an effective method, because it tends to have a low impact on your overall wellbeing. For instance, you may feel less medicated and more normalised with such controlled intake, as compared to your regular patterns of usage.
With guided methadone therapy, there are inherent benefits, including the possibility of a reduced likelihood you will overdose. Also, your dependence problems may be positively affected, because a doctor is in charge of dosing with this method. In addition, there are guidelines for the use of methadone therapy, which are put in place by federal government to ensure your safety.
Live a Sober Life Again
Resuming your daily life after addiction, detox and treatment is a process of transition that requires commitment and several changes. If you’ve recently got clean or are working towards recovery, there are proactive ways to improve your chances of successfully living a drug-free life again. One of the first things to do is to find sober friends. Staying in touch with your old drug-using friends can only do you more harm at this stage, even if they claim to support your new abstinence. Being around them might stimulate your own memories of abusing methadone, which could lead to cravings. Your abstinence, health and happiness are worth a lot, so as long as they continue substance abuse, you should avoid them completely.
Your life may have revolved around getting ‘high’ and compulsively seeking your next methadone fix when you were an addict. With more time on your hands now (and a vacuum having been created by the absence of addiction), you can do something more engaging, productive and enjoyable. Sober living doesn’t have to be boring. Find a new hobby – one you completely enjoy – and immerse yourself in it. You can also offer to volunteer or register for training that will help advance your career. Support groups like Narcotics Anonymous also offer useful help and practical methods you can employ to maintain your abstinence in the future.
After detox and treatment, every day of your life is a step in the right direction. Even if you happen to relapse, you should learn from it, make the necessary changes and keep moving forward. Relapse should never be an excuse to use drugs, but a reason to reject further usage and continue your recovery with pride. However, relapse can be prevented by keeping several things in mind. Some treatment centres prescribe medications that you need during recovery to keep cravings at bay and deal with any lingering symptoms (such as depression, anxiety disorders and other psychological conditions). In addition, you may have a dual diagnosis, which makes it important to remember to take your medication, even on days when you feel ‘cured’.
Additionally, keeping the lines of communication open between you and your treatment providers is key to preventing relapse. This means when you feel intense cravings, you should let your doctor know as soon as possible. Your treatment providers can also equip you with behavioural-based interventions, aimed at helping you replace drug-related mindsets and attitudes with healthy coping strategies for handling your day-to-day-life. Such interventions typically make use of support groups, psychotherapy and group therapy, where you can discuss your difficulties and get guidance for developing relapse prevention techniques.
Find a Treatment Centre
If you are struggling with methadone abuse and addiction, the risks and consequences of your substance abuse disorder increase with every day that you’re not in treatment, getting the help you need. Addiction robs you of your friends, family, loved ones, health and happiness. With the right treatment, you can reclaim all of these. The best thing you can do is to call for help as soon as possible. If you make that call now, you can speak with an experienced addiction counsellor, who can help find the best treatment centre for you.
Without the crippling weight of daily withdrawal sickness, you have the chance to approach your recovery and grab the opportunities that await you. Don’t wait until it’s too late. Begin your journey to a drug-free lifestyle today.
Frequently Asked Questions
How long does methadone withdrawal last?
Methadone can take from 15 to 60 hours to completely leave the body. Methadone withdrawal generally lasts three to six weeks, but for people with severe addictions, it is an even longer process.
Are there any home remedies for getting clean safely?
There are home remedies that can help your ongoing detoxification, with water being one of them. Using hot water can provide immediate relief from restless legs syndrome, muscle spasms, tension, body aches and anxiety. Simply being fully submerged in water – or even swimming – can improve your mood and offer you some other therapeutic benefits.
How long does it take to detox from methadone?
Methadone detox commonly takes about a week, when you are slowly tapered off the drug in a detox clinic. However, the specific duration will depend on how long you’ve been receiving methadone maintenance treatment.
Can you die from methadone withdrawal?
The withdrawal process involved in most opiate detoxifications isn’t necessarily life-threatening, but methadone is an exception to this. If you’ve used methadone in large quantities for a long period of time, quitting can cause severe breathing difficulties, seizures or heart problems.
Can medications help?
Methadone is a medication mainly used to treat addiction to other opiates, but if you have become addicted to it, other medications can help, such as clonidine, naltrexone, buprenorphine, baclofen and Zofran.
What is methadone withdrawal?
This refers to the physical and psychological symptoms that occur after you quit or reduce intake of methadone.
Is methadone withdrawal dangerous?
Unlike other opiates, ‘cold turkey’ methadone withdrawal – especially if the substance has been used in high doses for a long time – can lead to dangerous effects like seizures, breathing difficulties and heart problems.
Can I find help?
If you’ve become addicted to methadone (either by using it as a painkiller or as treatment for heroin withdrawal), you should seek medical help. A doctor can work with you to create a plan for tapering that will help to overcome this condition.
Are there ways to prevent or reduce withdrawal symptoms?
One effective drug that can be used to achieve this is buprenorphine, which can shorten the duration of your detox period and reduce withdrawal symptoms.
Call our admissions line 24 hours a day to get help.