Methadone Withdrawal

Combating Methadone Withdrawal

When individuals who suffer from substance abuse disorder take advantage of medication options during detox and treatment, they’re afforded a luxury that was once considered lost. They’re able to focus on recovery without chasing heroin and other opiates – all without suffering through the dreaded withdrawal process.

This changes life in a big way for individuals who suffer from opiate abuse disorder, considering that the fear of withdrawal dictated every element of their lives while they were actively using. Medications like Suboxone and methadone aren’t replacements for heroin and other opiates, and they don’t mean you can use them to dodge the symptoms of withdrawal forever.

The Role of Methadone

When you become immersed in the excitement of a life without the daily need to “get well” by any means necessary, it’s easy to forget a couple of important facts.

The first is that medications like methadone and Suboxone lead to physical dependence and require detoxification that includes a period of withdrawal. Additionally, the symptoms associated with methadone withdrawal can sometimes be more intense than more common opiates like heroin.

The uninitiated user may not be familiar with methadone outside of the existence of clinics that dispense this medication. However, methadone has a very storied history regarding substance abuse treatment, with uses reported as early as 1966 to treat heroin addiction. The date of the very first case of synthesis goes back much earlier than that.

What Is Methadone?

Methadone was first synthesized in 1939 as part of an effort to research and develop newer forms of analgesics as part of Hitler’s Four Year Plan for a completely independent Germany. Initially, the medication was created with the intention of eliminating the dependence on imported goods associated with morphine production.

However, the drug would never have the chance to take off in Germany because of the country’s subsequent loss in World War 2. After the war was officially over, any patents belonging to the previous regime were dissolved and sold to the highest bidder.

It wouldn’t take much of a bid in the case of methadone, as the patent was sold for a single dollar. Fast forward to Rockefeller University in 1966, where Mary Jeanne Kreek had been conducting extensive research regarding methadone as a treatment option for heroin.

The Development of Methadone Clinics

Kreek interviewed hundreds of individuals with heroin abuse disorder, and eventually concluded that addiction was a disease and not an issue of morality or a predisposition for criminal behavior. Methadone clinics began opening in small numbers after her groundbreaking research paper was published the same year.

Critics questioned the credibility and effectiveness of methadone, citing that it was just a replacement way of continuing substance abuse. However, Kreek’s response stated that people develop a dependency on many types of medications, and in almost every case, a doctor recommends that patients back off slowly.

She believed that changes took place in the brain after long periods of heroin exposure. Without the need for drug seeking and drug chasing behavior to fight off withdrawal, the brain is able to return to a normal state after enough time.

Kreek found methadone so effective at treating heroin abuse disorder because of its long-acting properties and the fact that dosing was only required once per day. This effectiveness and strength is produced as a result of the half-life of methadone, and the fact that the drug is a full agonist.

Agonist vs Antogonist: Methadone in the Brain

A full agonist binds tightly to the brain’s opioid receptors which produces conformational change the promote the maximum effect. Partial agonists, such as buprenorphine, cause less receptor activation. These medications may be more effective at lower doses, but once increased may plateau, and eventually lead to adverse reaction as they bind tighter and displace other opioids such as heroin and morphine.

The following section outlines the half-life of methadone, and why it makes this medication more efficient at treating opiate abuse disorder by prolonging the onset of methadone withdrawal.

The Half-life of Methadone

The half-life of a substance is the amount of time it takes for the body to eliminate exactly half the concentration of a substance from inside the body. More specifically, it’s the length of time it takes for half of the substance to exit the blood stream.

Substances may be eliminated from the blood but remain present in other areas of the body like the urine, hair, and saliva. The half-life of methadone is approximately 12 hours. However, this doesn’t mean that it takes 24 hours for all traces of methadone to leave the blood.

Instead, you divide the half-life, adding another 12 hours, meaning 75% or 3/4^th of the methadone concentration is expelled within 24 hours. Cut in half again, 1/8^th of the concentration remains, which would take 36 hours for elimination. Reaching 1/16^th concentration would take 48 hours, and finally, nearly all traces would finally be eliminated after 60 hours.

It takes roughly five half-lives for the full concentration of any substance to exit the blood stream. The length of time it takes methadone to exit is what makes it so efficient at treating heroin abuse disorder. One dose per day, even at a low amount, is sufficient enough to keep the symptoms of withdrawal at bay for 24-36 hours.

In fact, it’s not uncommon for clients participating in methadone maintenance to miss one, and even two days without the onset of withdrawal symptoms.

Withdrawal from Methadone

Once all traces of methadone are eliminated from the blood stream (somewhere around 60 hours, depending on concentration), individuals will begin to feel the onset of methadone withdrawal. Methadone withdrawal can be quite deceptive for users that are accustomed to heroin withdrawal.

Normally heroin withdrawal begins after about 12-hours of abstinence. However, because methadone withdrawals can take days to begin, users may think they have avoided the most intense symptoms. However, reality sets in sometime around day three, and withdrawal symptoms begin that can eclipse the severity of other opioid withdrawal.

The duration of methadone withdrawal can be much longer than other opiates as well, with some users reporting acute effects for as long as three and four weeks. In the following section, the most common symptoms of withdrawal are highlighted, as well as an example of the methadone withdrawal timeline.

What are Methadone Withdrawal Symptoms?

Methadone withdrawal symptoms range in severity and differ between users. However, the symptoms listed below are present in some fashion in nearly every case of methadone withdrawal.

• Yawning
• Water eyes
• Fatigue
• Insomnia
• Nausea
• Vomiting
• Muscle aches
• Stomach aches
• Sweating
• Hot flashes
• Cold chills/goosebumps
• Intense cravings
• Anxiety
• Depression
• Increased heart rate
• Elevated blood pressure
• Difficulty concentrating

These side effects are spread out over several stages, taking place over the course of several weeks. An example of the methadone withdrawal timeline is outlined below:

Timeline of Methadone Withdrawal

To make it through detox, you must be prepared to counteract the most severe symptoms of withdrawal. Understanding the methadone withdrawal timeline allows you to come up with a plan for experiencing a more manageable detox.

The First Day

Methadone withdrawal symptoms take longer to kick in than most opiates. During the first and second days, you won’t notice many of the acute symptoms. However, you may still experience more fatigue than normal, and possibly slight irritability.

When you progress into the second and third days, you may develop more anxiety as a response to the onset of withdrawal side effects.

The Second and Third Days

Once you hit the third day, you will probably begin to feel the full effect of methadone withdrawal. You will develop cold chills while simultaneously experiencing heavy periods of sweating. Nausea and muscle aches can become an issue, and you’ll be heavily affected by insomnia.

Restless legs and anxiety make it nearly impossible to sleep, which may make it easier for you to experience paranoia. Depression can be challenging during this period, and it’s important to have a strong support system to avoid relapse.

Most individuals cave during this period because of the intensity of withdrawal symptoms. If you’ve ever experienced full-blown methadone withdrawal, you probably understand the advantages of participating in medically-assisted detox.

Days Four through 10

You may experience the full intensity of methadone withdrawal for up to 10 days. However, after the 10-day point, the most intense symptoms will begin to subside.

The most difficult challenge after the 10-day mark is depression and intense cravings. Although the worst of the physical symptoms are normally over, the mental side effects continue for quite some time.

Days 10+

Well after the 10-day mark and into the months following detox, post-acute withdrawal symptoms may further the potential for depression. However, it’s important that you don’t allow yourself to get discouraged or feel like you’re going through an isolated case that will last forever.

The brain needs time to recover and return to a normalized way of thinking, processing feelings, and associating normal activities with feelings of joy and happiness. Don’t give up hope – the longer you have clean time under your belt, the easier things get from the mental side of things.

Making the decision to participate in medically-assisted detox gives you access to professional medical care, as well as access to medications that can help with the uncomfortable feelings of methadone withdrawal.

Medications to Assist Methadone Detox

During medically-assisted detox, clients will experience pain, discomfort, and other challenges in several areas of the body. Nausea, muscle aches, high blood pressure, insomnia, and restless legs can all be difficult to handle when they exist individually, during separate and unrelated events.

When these challenges exist simultaneously during detox, the situation becomes almost unbearable. The following medications may be provided during medically-assisted detox to give clients some type of relief during this incredibly difficult process:

• Buspirone for anxiety management
• Benzodiazepines for anxiety and depression if symptoms become particularly intense
• Muscle relaxers for muscle aches
• Promethazine for stomach issues and nausea
• Lucemyra (Lofexidine Hydrochloride), also marketed as clonidine, for blood pressure and anxiety

Tapers and the Proper Scheduling of Methadone Withdrawal

It’s important to remember that all medication options should only be considered for short-term relief. Some of these options have the potential to become habit-forming and should only be taken under a doctor’s care.

Some clients may find a methadone taper to be more appropriate. A methadone taper is the gradual decrease of a client’s daily dose over a more extended period. This will significantly decrease the severity of withdrawal symptoms and avoid some of the challenges from the sudden change in the body.

After detox, clients must be aware of therapy as a component of methadone detox. This is included in inpatient treatment for opioids.

Inpatient Treatment for Opioids

Inpatient treatment will focus on all of the mental challenges associated with substance abuse disorder. Meetings with mental health professionals will provide exercises and assistance for coping with behaviors and emotions associated with substance abuse.

Underlying mental health challenges may also be addressed with dual-diagnosis treatment. All of these elements will prepare clients for life after treatment to avoid the pitfalls of relapse. The final element is attention to aftercare for continuing long-term recovery.

Establishing Foundation for Long-term Recovery at Pathfinders

After graduating treatment, clients must remain active in various forms of aftercare services. These services include continued appointments with mental health professionals, attending peer recovery groups, and maintain a solid support system.

At Pathfinders Recovery Centers, we believe that substance abuse disorder can be treated with a mix of group exercises, one-on-one mental health services, and behavioral and mood therapy. Every client is different, and find out how we can craft your individual treatment plan by contacting one of our admissions specialists.