Methadone Withdrawal and Treatment

Methadone is a synthetic, long-acting opioid medication that may be prescribed to help manage symptoms of opioid withdrawal and treat opioid use disorder (OUD).¹ Methadone is one of two opioid agonist medications approved for OUD treatment, and has been used in treating opioid addiction for over 40 years.³

When taken as prescribed, methadone is effective and safe as a treatment medication for opioid use disorder (MOUD).¹ However, it is possible to misuse methadone,⁴ such as taking more than prescribed, in a way other than prescribed, or with the intent to get high.⁵ Understanding what methadone is, how it can be used to aid recovery, and how misuse could lead to addiction can help you achieve and maintain recovery.

What is Methadone?

Methadone, like many other opioid medications, was initially prescribed for pain management but has since been approved and primarily used for treating opioid addiction.⁶ In OUD treatment, methadone can be used to reduce opioid cravings, mitigate withdrawal symptoms, and blunt the effects of any other opioids misused while on treatment.⁴

Several studies show that methadone can be effective in treating opioid use disorder when taken as prescribed.⁷ When compared with patients who received a placebo and psychosocial treatment, those who were prescribed methadone (combined with psychosocial treatment) were more likely to experience reduced rates of opioid use, infectious disease transmission, and crime.⁷ Additionally, those taking methadone as part of a medication treatment program were 4.44 times more likely to stay in treatment.⁷

Like other opioid agonists, methadone produces its effects by activating opioid receptors throughout the brain; however, relative to many other opioids, the onset and duration of methadone’s effects develop over a slower or more gradual timeframe.³ This means that a person with an OUD is unlikely to experience a rewarding euphoria or high from taking methadone at the dose prescribed to them.³

Opioid Withdrawal Symptoms

Although methadone may be used to manage withdrawal from other opioids like heroin or prescription pain relievers, it is still possible for people to experience methadone withdrawal symptoms if they abruptly stop using methadone after a period of sustained use.

Symptoms of methadone withdrawal are similar to many opioid withdrawal symptoms and may include:^{2, 8}

• Low or sad mood.
• Insomnia.
• Anxiety.
• Fast heart rate.
• High blood pressure and/or high body temperature.
• Increased breathing rate.
• Muscle and bone pain.
• Muscle spasm.
• Runny nose.
• Watery eyes.
• Nausea or vomiting.
• Diarrhea.
• Fever.
• Sweating.
• Chills.
• Goosebumps.
• Yawning.
• Dilated pupils.

How Long Does Opioid Withdrawal Last?

Exactly when opioid withdrawal occurs and how long it lasts depends on several factors including the type of opioid used, how long it was used, and the dose used.² Withdrawal symptoms typically last for 3–5 days for short-acting opioids like heroin and 3 weeks or more for relatively long-acting opioids like methadone.²

Opioid Withdrawal Timeline

For short-acting opioids, symptoms can appear as early as 6–12 hours after a person’s last dose, peak within 1–3 days, and slowly lessen over 3–7 days.^{2, 8} Withdrawal symptoms associated with a longer-acting opioid like methadone may develop relatively more slowly—first emerging within 2–4 days after the last dose. ⁸ Methadone withdrawal may peak in severity around day 3 and typically subsides over a 3-week period. ²

Opioid Detox

A supervised opioid detox may be an initial step of more comprehensive treatment for OUD.⁹ Medical detox and withdrawal management occurs under the supervision of a medical provider who may prescribe methadone or buprenorphine (another opioid agonist medication commonly used to treat opioid withdrawal) for a brief period to help reduce and manage opioid withdrawal symptoms.⁴

Because a person may experience unpleasant withdrawal symptoms, the Substance Abuse and Mental Health Services Administration advises against attempts to manage significant opioid withdrawal symptoms without medication.²  If someone is considering detoxing, people are encouraged to talk with their primary care physician or another medical professional rather than attempting to detox on their own without medical support and withdrawal symptom management.

Methadone Rehab and Treatment

Though medical detox for opioid withdrawal management is an important start to recovery, it’s not a replacement for more comprehensive treatment for opioid use disorder.¹¹ Because of this, detox is often followed by more formal assessment and referral to or continuation with additional addiction treatment efforts. An important component of any professional detox program entails readying a patient for such additional, more comprehensive substance use disorder rehabilitation. ^{10, 11} Common settings of care and continued treatment elements may include:

• Inpatient or residential: Inpatient treatment involves a patient temporarily living at a facility while receiving 24/7 addiction treatment.. As part of treatment, patients may participate in individual or group behavioral therapy and counseling to change beliefs about and behavioral patterns related to substance use.^{9, 10} Inpatient treatment lengths vary, but can range anywhere from several weeks to months, as needed.
• Outpatient: Outpatient treatment programs allow patients to live at home while still receiving treatment for opioid addiction. Various types and intensity of outpatient care may be available to you based on your needs, with may offering a similar range of services as their inpatient/residential counterparts.⁹ Methadone maintenance treatment may be administered on an outpatient basis, with a patient going to a specialized opioid treatment clinic to receive supervised methadone doses.³
• Aftercare: A plan for continued care will commonly be made prior to completion of treatment. With various outlets of addiction aftercare available, these programs can help promote continued sobriety and reduce relapse risk by providing ongoing recovery support after completion of a treatment program.¹⁰

If you or someone you care about is struggling with methadone misuse or opioid addiction, there are resources available to you. Speaking with your primary care physician is usually a good place to start as they can provide appropriate referrals. If you are already involved in a methadone treatment program and are concerned you may be misusing methadone, talk to your provider. You can also contact American Addiction Centers (AAC) by calling the AAC addiction helpline, and our team can connect you with opioid treatment programs near you. Don’t delay the care you need, contact us today at .