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Methadone Withdrawal

Methadone has been used for decades to treat addiction to opioids, particularly heroin. It’s an opioid itself, originally discovered in the late 1930s and used to treat pain. It was soon found that the high created by methadone wasn’t as intense as that of morphine. It also stayed in the system for much longer, lasting around 24 hours after administration.

In the 1960s, as heroin abuse began to become a serious problem, medical professionals started using methadone to treat addiction to the dangerous street drug. To those addicted to heroin who already possess a high tolerance to opioids, the high caused by methadone is not substantial, but the drug reduces or eliminates cravings for heroin as well as withdrawal symptoms that appear when an addicted person stops taking heroin.

Today, there are many specialized methadone clinics in which doctors administer the medication to addicted individuals as part of a treatment program. Typically, the goal is to gradually reduce the dose given until methadone is no longer needed to get through the day.

Methadone Overdose


Because methadone has a high overdose potential, it’s highly restricted in these programs. Only a specially licensed professional is allowed to administer the drug. This kept methadone mostly off the black market for a long time. However, it’s recently become more popular to prescribe methadone for certain types of chronic pain because the nature of this particular opioid makes it more effective for neuropathic pain. Unfortunately, more prescriptions of opioids given out means more potential for people to obtain the drug illegally, abuse it, and become addicted.

That’s what is happening to many people across the US. In 2009, the Centers for Disease Control and Prevention’s National Center for Health Statisticsissued a special report warning that overdose deaths related to methadone had tripled since 1999. Because overdose is virtually impossible when being treated via a methadone clinic, these deaths likely resulted from methadone obtained via prescriptions for chronic pain treatment.

Part of addiction to most drugs is the physical tolerance that causes withdrawal symptoms when an addicted person stops taking the substance. These symptoms are generally very unpleasant and can even be dangerous, though this is not usually the case with opioids. Still, opioid withdrawal, including from methadone, is known to be so distressing due to both physical and psychological symptoms that it can in and of itself be a deterrent to attempting to get clean.

Withdrawal Symptoms and Timeline

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Withdrawal is most intense when a person stops taking an addictive substance all at once, commonly called “going cold turkey.” However, individuals addicted to powerful opioids like heroin, Vicodin, or fentanyl may still experience mild symptoms when their dose of methadone is reduced. Due to the fact that methadone is typically tapered off anyway, someone who obtains methadone illegally and becomes addicted to it will likely be advised to get off the drug in this fashion under the supervision of a medical professional. This process can take a few months up to a year or more depending on the severity of the addiction.

Mild symptoms from methadone withdrawal include:

  • Runny nose
  • Headache
  • Body aches
  • Nausea
  • Sleepiness
  • Sweating
  • Restlessness
  • Anxiety and depression
  • Muscle tension
  • Mood swings
  • Malaise
  • Irritability

Severe methadone withdrawal symptoms can include:

  • Vomiting
  • Diarrhea
  • Fever
  • Insomnia
  • Fatigue
  • Dizziness
  • Confusion
  • Muscle pain

M_MatinIn some cases, it may be better for an addicted person to stop taking methadone all at once. This can produce new, more severe withdrawal symptoms as well as increase the severity of the milder symptoms. This cold-turkey process is also often forced upon people who are arrested and put into jail in spite of the known effects of this withdrawal. One study found that nearly half of all inmates addicted to opioids and on methadone treatment were denied their doses of the medication while behind bars.

When it comes to cold-turkey detox, the length of time that symptoms last often depends on how long the person has been using it, how heavy the abuse was, and personal factors like overall health, body mass, and genetics. It also depends on which symptoms are being referenced.

In general, methadone withdrawal follows a timeline that looks something like this:

  • Day 1: Methadone stays in a person’s system for much longer than most drugs, so an addicted person might not feel anything during the first 24 hours. Once the drug leaves, individuals can begin to feel achy, develop a fever, and get chills, as though they’re coming down with the flu.
  • Days 2-10: Peak withdrawal will last for around a week, often spiking at day four after the last dose was taken. Flu-like symptoms will intensify and come to include psychological symptoms, such as depression, anxiety, irritability, and in severe cases, paranoia and hallucinations. Insomnia frequently also becomes an issue, and afflicted persons often report severe fatigue, restlessness, and a general intense feeling of unease and discomfort. Cravings for the drug also tend to be their strongest at this point.
  • Days 11-21: Physical withdrawal symptoms begin to fade and cravings usually start to calm down after the first several days. However, strong cravings may persist or occasionally reappear for the next week or two, and psychological symptoms can continue. Depression is the most common of these as people feel they can’t achieve any feeling of pleasure without the drug.
  • Days 22 and beyond: Some symptoms may linger, but they should be mild at this point. Depression may continue to be a problem but can be treated with medication, daily activities, nutrition, therapy, etc.

In rare cases, emotional symptoms and an inability to feel pleasure (anhedonia) may persist for months or even years. This could point to a serious alteration of the brain caused by long-term methadone abuse that needs a lot of time to correct itself, or it could be permanent. In the vast majority of cases, however, the recovering person can achieve a feeling of normalcy without the drug and go on to live a happy, healthy life.

Medically Assisted Detox


Medical-doctor-working-with-he-88692314Because methadone is already a medication used to treat opioid addiction, the only other drug treatment a doctor might recommended for someone addicted to methadone is buprenorphine. This is a much newer medication developed to be an alternative to methadone. It’s a semisynthetic opioid that produces a lesser high that drugs like heroin but also has a much lower risk of overdose than methadone – a necessary change due to the fact that methadone has been found to account for one in three prescription painkiller deaths in the US. However, since a methadone user might still experience a high on buprenorphine, a medical professional is more likely to recommend tapering off the dose of methadone or going off the drug all at once.

Even without a medication that directly treats methadone addiction, withdrawal doesn’t have to be a terrible ordeal. Many treatment centers offer medically assisted detox – a treatment service in which a client can stay in a hospital setting during the worst of the withdrawal symptoms so that each symptom can be treated by medical professionals. Most or all of the symptoms experienced during methadone withdrawal can be treated with simple medications, making the process much more comfortable.

Clients may be put on a preliminary regimen of nonaddictive antidepressants so they have time to begin working properly before detox begins. Other symptoms can be treated with non-opioid painkillers, anti-nausea medications, and sedatives. The goal is to make withdrawal as easy as possible.

To maximize the effectiveness of treatment and decrease the chances of relapse (and another round of detox), it’s important than addicted persons attend a comprehensive rehabilitation program. Many addiction treatment centers have both inpatient and outpatient options in which clients can learn about their illness, attend therapy, and gain the tools necessary to transition back to life without drug abuse.

Inpatient treatment refers to the residential programs typically portrayed in the media in which clients stay for 24 hours per day at the treatment facility, living and sleeping there for a few weeks to several months. The advantage of this is the complete lack of temptation; intoxicants are not allowed unless they are prescribed and administered by a medical professional. It can also be helpful to get away from old environments that may contain stressors and craving triggers.

The downside is that some people cannot afford to miss weeks or months of work, or they may have children to take care of. Outpatient rehab allows these individuals to stay at home most of the time and come in a few times per week for the same therapy, support, and skill-building available in inpatient rehab.

After this, it’s equally important to engage in aftercare and work toward a healthy lifestyle that creates joy and pleasure without the help of intoxicants. The most important thing in recovery is to focus on taking care of oneself and improving and maintaining life satisfaction.

About The Contributor
Editorial Staff
Editorial Staff, American Addiction Centers
The editorial staff of Oxford Treatment Center is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed... Read More