Bottles of methadone used by a doctor to treat addiction

Methadone is a potent opioid that is used as a painkiller as well as for the treatment of addiction to other opioids. Methadone has a more gradual mode of action than many other opioids and does not produce euphoric effects. This allows for the use of methadone during detoxification from other opioids and in the treatment of opioid addiction. However, prolonged use of methadone during the treatment of chronic pain or opioid addiction leads to the development of physical dependence on the drug. Furthermore, methadone has a potential for abuse, and misuse of the drug can lead to dependence and addiction.

Discontinuation of methadone use after the development of dependence results in severe withdrawal symptoms that can lead to a relapse. The symptoms of methadone withdrawal are usually not life-threatening but are difficult to cope with due to their unpleasantness. These withdrawal symptoms arise after 30-48 hours after discontinuation of drug use and persist for about three weeks. Some symptoms of methadone withdrawal may persist for several weeks after discontinuation of methadone use.

When Does Methadone Withdrawal Begin?

Methadone is a long-acting opioid, i.e., it has a longer half-life (24-36 hours) than other opioids like heroin (6 minutes) or oxycodone (5 hours). In other words, methadone persists for a longer time in the body relative to other opioids. As a consequence, the symptoms of methadone withdrawal emerge later relative to short-acting opioids (onset:12-24 hours, duration: 4-10 days) and last for a longer duration. The symptoms of methadone withdrawal appear between 30-48 hours after discontinuation of methadone use. However, in certain cases, these withdrawal symptoms may emerge up to 72 hours after abstinence.

Methadone Withdrawal Symptoms Timeline

The symptoms of methadone withdrawal emerge between 30 to 72 hours after abstinence from drug use and may persist for around three weeks after onset. Besides these primary withdrawal symptoms, certain symptoms of methadone withdrawal may continue beyond this acute phase and may persist for several months. These withdrawal symptoms that persist beyond the acute phase are referred to as the symptoms of protracted withdrawal.

  • Acute withdrawal period: The symptoms of methadone withdrawal tend to appear between 30 to 72 hours after abstinence and peak after the first three days of onset of withdrawal symptoms. These symptoms then gradually decrease in intensity over the subsequent three weeks (or longer). The symptoms of methadone withdrawal observed during this period are referred to as acute withdrawal symptoms. The symptoms during this period include nausea, diarrhea, insomnia, anxiety, agitation, muscle and bone pain, excessive sweating, nasal discharge and dilated pupils.
  • Protracted withdrawal: Some of the symptoms of methadone withdrawal persist for several months beyond the acute withdrawal phase of 3 weeks. These symptoms may persist for up to 6 months and are collectively referred to as the post-acute withdrawal syndrome. The symptoms experienced during this post-acute or prolonged withdrawal phase include anxiety, irritability, depressed mood, fatigue and sleep disturbances.

How Long Does Methadone Withdrawal Symptoms Last?

The symptoms of methadone withdrawal tend to occur within the first 72 hours of discontinuation of drug use and may persist for up to 3 weeks after discontinuation of drug use. Some of the symptoms of methadone withdrawal may persist beyond this acute phase and may be experienced up to 6 months after abstinence.

Factors Affecting Methadone Withdrawal Duration

The severity and duration of methadone withdrawal symptoms vary depending upon the drug use history of the individual. Severe dependence on methadone is associated with more intense withdrawal symptoms that persist for longer. Factors that determine the severity of dependence on methadone, such as the dose, frequency and duration of drug use, also similarly impact the intensity and duration of withdrawal symptoms. Furthermore, polysubstance abuse can also result in more severe withdrawal symptoms.

Besides the severity of dependence on methadone, the physiological characteristics of an individual also tend to determine the severity and duration of methadone withdrawal symptoms. Thus, variables that influence physiological characteristics such as genetics, environmental factors, lifestyle choices and age tend to influence the duration of withdrawal.

Tapering Off Methadone to Reduce Withdrawal

Abrupt discontinuation of methadone use, such as quitting methadone use cold-turkey, can result in very severe withdrawal symptoms that are associated with relapse. Hence, the methadone dosage should be very gradually tapered to avoid such adverse withdrawal symptoms. It is advisable to devise a tapering schedule with the help of a physician to avoid the onset of withdrawal symptoms due to a rapid decrease in dosage. The tapering schedule is tailored according to the needs of the individual, taking into account factors such as the severity of methadone dependence, abuse of other substances, as well as the individual’s physiological and psychological state.

If you or a loved one are dependent on or are addicted to opioids like methadone, Orlando Recovery Center can help. The Orlando Recovery Center provides evidence-based detoxification and rehabilitation services for substance use disorders delivered by experienced and accredited professionals.

 

Sources

Kharasch, Evan D. “Opioid Half-lives and Hemlines: The Long and Short of Fashion.” Anesthesiology, May 2015. Accessed October 31, 2019.

World Health Organization. “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” 2009. Accessed October 31, 2019.

Elsevier. “Opioid Withdrawal: Clinical Key.” 2017. Accessed October 31, 2019.

Substance Abuse and Mental Health Services Administration.”Treatment Improvement Protocols: Detoxification and Substance Abuse Treatment, Physical Detoxification Services for Withdrawal From Specific Substances.” 2006. Accessed October 31, 2019.