Methadone Withdrawal: Symptoms, Timeline, and Detox

Methadone is a synthetic, long-acting opioid that has successfully helped treat people with opioid use disorders for decades. Over time, when taking methadone as prescribed, you will develop a physiological dependence on it, which means you may experience methadone withdrawal symptoms if you miss a dose or abruptly lower your dose. This is normal and can be treated by your provider. However, because methadone is an opioid, some people may misuse it. Misusing methadone can speed up the development of dependence and increase the severity of methadone withdrawal symptoms. If you misuse methadone or are addicted to it, you may need professional detox services to manage your withdrawal.1

In this article:

What is Methadone Misuse?

While methadone has proven helpful for countless people in recovery from opioid addiction, some people may misuse it to get high. Methadone misuse occurs when you take this medication in any other way than prescribed by your doctor, including:

  • Taking higher doses than prescribed
  • Taking more frequent doses than prescribed
  • Mixing methadone with alcohol or other substances
  • Taking it in a way other than prescribed, such as crushing it up and snorting it or injecting it

Methadone Withdrawal Symptoms

Methadone withdrawal can resemble the symptoms of withdrawal from other opioids. Ranging from mild to moderate to severe, you may experience any or all the following:4

  • Urges and cravings that vary in intensity
  • Sleep disturbances such as insomnia and nightmares
  • Heart rate and blood pressure increases
  • Flu-like symptoms include chills, fever, aches, runny nose, and watery eyes
  • Digestive issues like nausea, vomiting, diarrhea, and constipation
  • Concentration and focus problems
  • Mental health symptoms such as anxiety, depression, and mood swings
  • Irritability and easily agitated

If you are taking your methadone as directed by your doctor, you are likely dependent on your medication. That means you may experience some of these withdrawal symptoms if you miss a dose or suddenly reduce your dose. Talk to your doctor if you experience methadone withdrawal symptoms and want to adjust your methadone treatment dose.

But if you misuse methadone or have an addiction to this opioid, your withdrawal symptoms will likely be much more severe and distressing and may require medical oversight in a detox facility or hospital setting.

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Methadone Withdrawal Timeline: How Long Does Methadone Withdrawal Last?

The length and severity of methadone withdrawal depend on many factors, including your age, weight, gender, how long you have been misusing methadone, and the amount you use.3

Also, methadone is a long-acting opioid, which means its effects come on more slowly and last longer than other opioids like heroin or oxycodone. Because of this, the withdrawal timeline is likely to be longer than short-acting opioids.5

Days 1-2

Because methadone is long-acting, methadone withdrawal symptoms may take up to 30 hours to appear.5 Typically, the first symptoms feel like an extreme version of the flu. Typical reports include chills, fever, sweats, and aches and pains all over the body. Cravings, nausea, and vomiting are also common early in withdrawal.

Days 3-7

Methadone withdrawal symptoms continue for several days and sometimes a whole week before they begin to ease. Your flu-like symptoms may continue during this time, but you may also have trouble focusing, sleeping, and controlling mood swings.

Protracted Methadone Withdrawal

Protracted withdrawal or post-acute withdrawal syndrome (PAWS) refers to a set of symptoms that persists after acute methadone withdrawal has resolved. These symptoms may last for weeks or months after quitting methadone.6

Protracted withdrawal can happen with all prescription and illicit drugs, but the symptoms are different. For protracted methadone withdrawal, signs appearing at the earliest, in the sixth week after abstinence, may include:6

  • Extreme fatigue
  • Cravings
  • Anxiety and depression
  • Dysphoria
  • Palpitations
  • Hypomania
  • Insomnia

Some symptoms can linger for as long as nine months, including:6

  • Feeling tired when you think you should have energy
  • Being unable to fall asleep or stay asleep
  • Experiencing blood pressure irregularities
  • Palpitating heart beats
  • Breathing problems
  • Fluctuating body temperatures

Rebound Phenomenon

While your body is trying to rebalance itself and heal from long-term methadone use or misuse, an unusual occurrence called the rebound effect or rebound phenomenon can happen in some during withdrawal. This event is marked by a return of your original symptoms, only more intense and severe than before. Rebound events occur more with drugs that lead to tolerance and dependence, such as methadone.6

For example, if you were taking methadone for chronic pain, you may see a return of pain symptoms and withdrawal symptoms. Fortunately, they are reversible, and you will stabilize after a few days. You can avoid the rebound phenomenon by working with a medical team for withdrawal.

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How to Avoid Methadone Withdrawal

Methadone, even when prescribed, is an opioid that can lead to dependence. If you suddenly quit taking methadone, you will experience unpleasant withdrawal symptoms. This is why you shouldn’t suddenly stop taking methadone without your doctor’s assistance.

The first step to stopping methadone is consulting with your prescribing doctor. Together, you can create a plan to ease you off methadone using a gradual tapering program. Specific topics of discussion can help your doctor design an individualized tapering plan for you.

Topics include the following:6

  • Social factors that will affect you during tapering
  • Physical and psychological factors that will affect you during tapering
  • Fear you may have regarding tapering
  • Expectations while tapering
  • Dosing strategies for tapering off methadone

Managing Methadone Withdrawal in a Medical Detox Program

If you are misusing methadone and are ready to quit, the safest and most effective way is with the help of a professional detox program. Withdrawal symptoms can become unmanageable when trying to stop using on your own. But a medical detox program, which provides 24/7 medical care and oversight, can ease your methadone withdrawal symptoms and cravings.7

There are many benefits to entering a medical detox program for methadone withdrawal, including:7

  • Treatment planning by a team consisting of doctors, nurses, technicians, and therapists
  • Prescription medication to alleviate withdrawal symptoms and cravings
  • Ancillary medicines to treat physical symptoms, including anxiety, nausea, vomiting, sleep, and muscle cramps
  • Vital sign monitoring around the clock
  • Access to a licensed therapist
  • Peer support

Methadone Tapering

To manage methadone withdrawal, doctors may choose to taper you off the substance rather than substitute another medication for methadone. Drug tapering can be done using four methods, defined by the speed of withdrawal.8

Slowest Taper

The taper schedule recommended for long-acting opioids, such as methadone, is the slowest taper. Your doctor will adjust your medicine by between 2% and 10% every four to six weeks. This gives your body more than enough time to adapt to the smaller dose without producing withdrawal symptoms.

Slow Taper

Slow methadone tapers happen every four weeks, with your doctor adjusting the amount of methadone you receive by 5% to 20%. This is the most popular tapering regimen, possibly because it can be implemented on an outpatient basis.

Fast Taper

Those wanting to get off methadone quickly may agree to a fast-tapering schedule. Every week your dose is reduced by 10% to 20%. Fast tapers work best when monitored on an inpatient basis due to the likelihood methadone withdrawal symptoms will reappear. When this happens, your doctor may reintroduce methadone to provide stabilization.

Ultra-Fast Taper

Also completed in an inpatient setting, ultra-fast methadone tapering happens daily. The first day involves dropping the dose by 20% to 50%, then 10% to 20% on the days following.

Find a Detox Program

When searching for a detox program to help you overcome methadone addiction or dependence, some specific criteria may help you finalize your decision. Look for the following:9

  • Specialized treatment for groups, including LGBTQ+ individuals, veterans, men-only, or women-only
  • Transition to inpatient or outpatient rehabilitation is easy and extends medication management
  • Assessment to determine if your methadone use disorder is mild, moderate, or severe
  • Interventions ranging from brief to long-term, such as motivational interviewing to behavioral therapies
  • Education on methadone and how it affects your brain and body
  • Therapies for support, including 12-step facilitation and family therapies
  • Treatment using modern technological programs for each stage of recovery
  • Treatment using alternative and holistic methods to heal the whole person

If you are ready to quit using methadone, it is highly recommended that you detox in a medically supervised program. Admission to a program begins with a screening and assessment with a treatment provider.

Give us a call at 800-530-0431Who Answers? to speak to a treatment support specialist about finding a methadone detox program that’s right for you. We are available 24/7.

Resources

  1. West-Ward Pharmaceutical Corporation. (2018). Dolophine.
  2. Substance Abuse and Mental Health Services Administration. (2022). Methadone.
  3. National Institute on Drug Abuse. (2020). The Brain & the Actions of Cocaine, Opioids, and Marijuana.
  4. Sharma, B., Bruner, A., Barnett, G., & Fishman, M. (2016). Opioid Use Disorders. Child and Adolescent Psychiatric Clinics of North America, 25(3), 473-487.
  5. S. Department of Health and Human Services. (n.d.). Opioid Withdrawal Support. Indian Health Services.
  6. Lerner, A., & Klein, M. (2019). Dependence, Withdrawal, and Rebound of CNS drugs: An Update and Regulatory Considerations for New Drugs Development. Brain Communications, 1(1), fcz025.
  7. Department of Health and Human Services. (2016). Chapter 4, Early Intervention, Treatment, and Management of Substance Use. Substance Abuse and Mental Health Services Administration (U.S.). Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Washington (D.C.): U.S.
  8. Henry, S. G., Paterniti, D. A., Feng, B., Losif, A. M., Kravitz, R. L., Weinberg, G., Cowan, P., & Verba, S. (2019). Patients’ Experience With Opioid Tapering: A Conceptual Model With Recommendations for Clinicians. The Journal of Pain, 20(2), 181-191.
  9. Pergolizzi, J. V., Varrassi, G., Paladini, A., & LeQuang, J. (2019). Stopping or Decreasing Opioid Therapy in Patients on Chronic Opioid Therapy. Pain and Therapy, 8(2), 163-176.

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