How Long Does Withdrawal From Methadone Last?

Methadone is a medication used to treat chronic pain and symptoms of opioid withdrawal. However, stopping methadone can result in withdrawal symptoms that last up to 14 days, with some people experiencing symptoms for months.

If you're concerned about methadone withdrawal, it can be helpful to know what to expect. Read on to learn more about withdrawal signs and symptoms, as well as their timeline.

What Is Methadone?

Physicians prescribe methadone for two reasons. One is to treat stubborn cases of severe chronic pain. It can also be used as medication-assisted treatment (MAT) for opioid addiction.

When used correctly, methadone allows people to quit heroin and prescription painkillers without going into withdrawal. At a “maintenance dose,” it prevents withdrawal symptoms without causing a high or leading to sedation. People often take this drug for at least 12 months, with some individuals taking it for years.

Methadone is effective for most people, preventing innumerable overdose deaths each year. Its primary drawback is the prolonged withdrawal syndrome it can cause.

Overview of Methadone Withdrawal

Everyone’s experience getting off methadone is different. Some people find methadone withdrawal less intense than they expected. Others think it’s worse than withdrawing from a short-acting opioid like heroin. 

If you have opioid use disorder, you probably know what to expect from opioid withdrawal. Feeling like you have a terrible flu, vomiting, diarrhea, sweating, and insomnia are all common. With a short-acting opioid, these withdrawal symptoms can be intense but typically peak within a couple of days and begin to resolve. 

Quitting methadone can be a long and frustrating process, even for people without an opioid dependence. If you are using methadone to manage chronic pain, you may still be physically dependent on it and experience withdrawal symptoms when you try to quit or reduce your dose.

Methadone Withdrawal Timeline

Because methadone is a long-acting opioid, the drug can remain active between 8 and 59 hours. This means that withdrawal comes on more slowly and lasts longer. Your symptoms may start mild and become more severe over the course of a few days. Once they reach peak severity, your symptoms will begin to resolve.

Acute methadone withdrawal symptoms can last up to 14 days, but many people experience post-acute withdrawal for months after their last dose. These lingering psychological symptoms leave many people feeling uncomfortable in their own skin, dissatisfied with their decision to quit methadone, and frustrated about their lack of progress. 

Signs and Symptoms of Methadone Withdrawal 

Your experience with methadone withdrawal can depend on a variety of factors, including your past experiences and expectations. Some people go into it thinking it’s going to be a nightmare, but it turns out to be milder than anticipated. Others think it will be easy and find that it requires a greater commitment than they thought.

Common methadone withdrawal symptoms include:

• Agitation
• Anxiety or restlessness 
• Excessive sweating
• Flu-like feeling
• Gastrointestinal issues (nausea, vomiting, diarrhea)
• High blood pressure
• Insomnia
• Muscle cramps and pain
• Pain in the joints
• Runny nose
• Yawning

Methadone withdrawal symptoms vary from mild to moderate. To get a better idea of the scale, you can check out the Clinical Opiate Withdrawal Scale (COWS) that physicians use to diagnose their patients.

Post-Acute Withdrawal Syndrome

Post-acute or protracted withdrawal can begin in the weeks following your detox. These symptoms are most common in people who have been misusing opioids over a long period of time.

Opioids affect the way your brain works, flooding it with neurotransmitters. After you detox, your brain is operating with depleted stores of neurotransmitters. It can take up to six months for your brain to return to normal. 

During that time, you may experience symptoms such as:

• A low tolerance for stress (short fuse) 
• Depression
• Irritability or agitation 
• Low energy levels 
• Problems with memory or concentration
• The inability to experience pleasure from anything 
  
• Trouble sleeping
  

These symptoms may come and go over several weeks or months. They can be highly frustrating for both people in recovery and their loved ones. It helps to remember that these symptoms are temporary and should resolve within the year.

Coping and Relief for Methadone Withdrawal

The best way to cope with methadone withdrawal is to avoid skipping doses or trying to quit abruptly. Even if you are frustrated and tired of going to a clinic or pharmacy every day for a supervised dose, it is best to avoid abrupt cessation. Instead, talk to your prescribing physician about tapering. 

Tapering methadone means gradually taking smaller doses over several weeks or months. Although tapering is considered the best way of detoxing from methadone, it can still be challenging. You may still experience withdrawal symptoms each time your dose is cut. By working closely with a physician, you can extend your taper timeline and reduce your dose by smaller increments if necessary. 

The WHO acknowledges that this is only a general recommendation and that the taper schedule should be tailored to each individual’s needs. So, dose reductions can occur once a week, once every two weeks, or less often.

Sometimes one dose reduction is harder than the others and uncomfortable withdrawal symptoms occur. When this happens, your doctor can pause the taper at that level and wait several weeks before reducing the dose again.  

Medications for Withdrawal Symptoms

If you are experiencing withdrawal symptoms when you reduce your dose, your physician may recommend treating your symptoms with other medications. The American Society for Addiction Medicine recommends that physicians consider prescribing the following medications:

• Clonidine, a hypertension drug regularly used off-label to treat opioid withdrawal symptoms and is available as a pill or a transdermal patch
• Loperamide to treat diarrhea 
• Ondansetron to treat nausea and vomiting
• Benzodiazepines to treat short-term anxiety
• OTC pain relievers, like Tylenol or Advil, to treat aches and pain 

Another option is Lucemyra (lofexidine hydrochloride). Lucemyra is a medication that is similar to clonidine and approved by the FDA in 2018 to treat the symptoms of opioid withdrawal. It is the first non-opioid medication clinically proven to do so. Lucemyra works by reducing the release of norepinephrine, a neurotransmitter that researchers believe plays a role in opioid withdrawal symptoms. 

If you are experiencing insomnia or disordered sleeping, your physician may prescribe something to help you sleep. They might prescribe trazodone, for instance, or suggest an OTC antihistamine like Benadryl to help you get some rest.

Warnings About Methadone Withdrawal

Opioid withdrawal is rarely dangerous for healthy adults, but some people need to be more cautious than others. Most notably, pregnant women.  

If you are currently using methadone or other opioids, it is best to continue with methadone until the end of your pregnancy. Methadone is proven safe and effective for use during pregnancy. It does not cause birth defects or pregnancy complications. However, it is possible that your child will be born with an opioid dependence, which means they will need to detox.  

It’s important to keep in touch with both an obstetrician (OBGYN) and an opioid use disorder specialist throughout your pregnancy. Pregnancy affects how your body metabolizes methadone, so your dose may need adjusting as your pregnancy advances.  

Although the laws about opioid abuse during pregnancy do differ among the states, methadone is safe and legal. You should not run into any problems when you seek treatment. 

You should also talk to your care providers about your plans after giving birth. Breastfeeding is generally considered safe during methadone treatment. If you want to stop taking methadone, your physician will talk to you about an appropriate tapering timeline. They may advise waiting until your body feels back to normal. 

Long-Term Treatment for Opioid Addiction

It is not unusual for people with opioid use disorders to go on and off methadone over the course of several months or years. Detoxing from methadone is a great step, but it doesn’t mean that you’ve beaten your addiction. Proper treatment takes a multifaceted approach that combines medication management with psychotherapy and social support.

The primary goal of long-term treatment is to prevent relapse. Relapse rates among people with opioid use disorders are very high. Research shows that roughly three in four people who complete opioid detoxification relapse within two to three years.

These numbers aren’t pretty, but don’t let them scare or discourage you. Relapse is a part of the recovery process. Knowing the odds will help you understand the value of ongoing treatment. 

Naltrexone

Naltrexone is what’s known as an opioid antagonist (similar to the naloxone in Suboxone). Naltrexone binds to the opioid receptors and acts like a blockade, preventing other opioids from binding to those same receptors. This means that even if you relapse and use an opioid, you won’t get high (but you can overdose). Knowing that using an opioid won’t get you high should discourage you from impulsively relapsing. 

Naltrexone is available with a prescription and can be taken as a daily pill or a monthly injection. Because naltrexone can bring on instantaneous withdrawal, you shouldn’t start using it until all the methadone is out of your system. This can take as long as 14 days.

Therapy

When it comes to therapy, you have a variety of options. Most methadone clinics offer some sort of counseling, so that’s a good place to start.

Once you have tapered down, you might want to find something more convenient, like a therapist in private practice or at a local community health clinic. You can also look into group therapy sessions, which are often held at hospitals and other addiction treatment facilities.

Social Support

Finally, social support is a key aspect of relapse prevention. Many people find support at local 12-step meetings, such as Narcotics Anonymous.

Resources for Opioid Use Disorder

To find more information about Narcotics Anonymous (NA) meetings in your area, check out their website. You can find a meeting near you with their searchable directory. 

If your loved one is trying to recover from opioid addiction, you may want to consider a support group for friends and family, such as Nar-Anon.