Detoxing Off Methadone

 

Detoxing off methadone can be a highly uncomfortable, and in rare cases, even fatal process that ideally should be undertaken in the context of medical supervision. Since methadone is an opiate, the detox process can be accompanied by withdrawal symptoms. The severity level and duration of these symptoms depend on a number of factors, including a person’s health and drug use history.

In this article, we will explore the following topics:

• What methadone is
• How methadone is used
• The side effects of methadone
• The stages and side of effects of detoxing off methadone
• Methadone withdrawal management

While it is possible for methadone to be utilized safely and appropriately, it also carries with it the risk of abuse and overdose. If you feel as though you may have developed a problem with methadone, it is critical to know that you can get help detoxing by utilizing resources like an inpatient drug rehab.

What Is Methadone?

Methadone is a legally prescribed medication used in the treatment of addiction to heroin or various other opiate drugs. Since methadone itself is an opiate, it has the potential to be highly addictive, and its excessive use can lead to a person requiring treatment for dependence, even though its main intention is to act as a taper substance for other narcotics.

When taken according to prescribed doses and times, methadone can be an effective and reasonably safe method of recovering from addiction. Despite that and the fact that the drug has been used legally for decades, and continues to be used presently, it is important to be aware of the potential dangers of excessive methadone use, along with the range of treatment options available in case you have a problem.

How Does Methadone Function?

According to the Substance Abuse and Mental Health Services Administration, methadone, “Works by changing how the brain and the nervous system respond to pain.” It diminishes the painful aspects of opiate withdrawal while also creating a block from the potentially pleasurable effects of other opiate substances. These substances can include:

• Heroin
• Morphine
• Codeine
• Oxycodone
• Hydrocodone

Methadone can also take multiple forms. It can be consumed as a pill, liquid, or wafer and should be taken no more than once per day. The pain relief from a single dose can last up to eight hours, and it is also important to note that the substance may remain in the body long after the effects have worn off—giving it a serious potential for overdose if an individual is using it to chase a “high.”

Does Using Methadone Mean Substituting One Addiction For Another?

The short answer to this question is yes, it can. Scientific studies and many addiction treatment experts and administrators disagree on the wisdom of prescribing methadone as a tool for dealing with opiate dependence. Both supporters and critics can make strong arguments for either its continued utility or immediate restriction/prohibition; as such common consensus has not yet been reached.

Supporters of methadone argue that it is only administered under doctor-prescribed and tightly controlled conditions and that it is indeed both safe and effective when used as intended. In addition, the effects of taking the drug are said to differ drastically from heroin or other opiate painkillers in that methadone has an extended-release feature built into the compound that distinguishes it from the “rush” or euphoria of the others.

Heroin and other pain pills are often injected, snorted, or smoked in order to achieve a near-immediate “high.” Since this is quickly followed by a “crash” and a craving for the next high, a cycle can soon develop whereby the user alters his or her behavior in order to secure the drug—a classic sign of addiction. In comparison, it is argued that methadone’s gradual onset creates stable drug levels in the brain, reducing the potential for developing destructive behavioral patterns.

The Downside of Methadone

Critics of methadone may point out the reality that, unfortunately, many people do become addicted to methadone. Indeed, a look at the overdose statistics of opiates in the United States over the past two decades would seem to support that reality. According to the National Institute on Drug abuse, methadone accounted for 3,295 overdose deaths last year alone. While it is lower than the figures for other opiate narcotics such as heroin and fentanyl, the number is not insignificant.

How Do People Get Methadone?

Methadone can only be acquired through a prescription from a certified doctor. However, there are a few distinguishing factors that make the drug different from other prescription medications. Many of these factors exist to impose additional regulations on the distribution and administration of methadone. These factors can include:

• An individual must receive the medication under the supervision of a physician
• After demonstrating a period of stability, the individual may be allowed to take methadone at home; however, they are still subject to monitoring by the responsible physician
• Methadone can only be distributed through an Opiate Treatment Program (OTP) certified by the SAMHSA.

Methadone Safety

Once again, it is essential to remember that methadone should be used exactly as prescribed. This is particularly necessary to observe for those who have been permitted to take methadone outside of an Opiate Treatment Program. The following are a few crucial tips for maximizing safety if currently using methadone:

• Do not use more than prescribed
• Always take it at the specified time
• Do not consume alcohol
• Be cautious about driving or operating heavy machinery
• Call EMS if too much is taken or overdose is suspected
• Take precautions to keep children from access
• Get rid of unused doses by flushing down the toilet

Side Effects of Methadone

Numerous side effects can arise from taking methadone, ranging from mild to severe. Never take methadone without prior consultation with a doctor and full disclosure of your medical history. If serious side effects do occur, contact EMS immediately. Some milder side effects may include:

• A headache
• Weight gain
• Stomach pain
• Dry mouth
• Sore tongue
• Flushing
• Difficulty urinating
• Mood changes
• Vision problems
• Difficulty falling asleep

Serious side effects may include:

• Seizures
• Itching/hives/rash
• Swelling of eyes, face, mouth, tongue, or throat
• Hoarseness
• Difficulty breathing and/or swallowing
• Extreme drowsiness
• Agitation accompanied by hallucinations
• Nausea, weakness, or dizziness
• Fast/pounding heartbeat

Methadone Detox

Since methadone is an opiate, the detox process is often accompanied by withdrawal. Withdrawal from methadone can be both uncomfortable and difficult for an individual to manage—perhaps comparable to a bad case of the flu. Opiate withdrawal is generally not life-threatening, though in rare cases of extreme dehydration, death has been known to occur.

It is important to note that pregnant women should not undergo withdrawal from opiates, as it is possible for the process to cause miscarriage or premature delivery. It is strongly recommended that women who are both pregnant and dependent on opiates instead participate in a continued methadone maintenance treatment under the supervision of a licensed physician.

Opiate Withdrawal Syndrome

Methadone can be classified as a long-acting opiate, which means that symptoms of withdrawal tend to occur later than withdrawal from heroin or other opiate painkillers. Symptoms may generally begin around 12 to 48-hours after last use and may last up to 20-days. Symptoms can include the following:

• Nausea and vomiting
• Anxiety
• Insomnia
• Hot and cold flushes
• Perspiration
• Muscle cramps
• Watery discharge from eyes and nose
• Diarrhea

Stages of Methadone Withdrawal

Similar to the withdrawal process of other substances, methadone withdrawal tends to occur in three commonly observed stages. These stages can be described as follows, though the severity and duration of specific side effects may vary widely according to the health of the client and their usage history:

Stage 1.            

Symptoms tend to appear within the first 30 hours of last use. Initially, those symptoms may be characterized in the mild to moderate range. Intensity may escalate quickly, however.

Stage 2.            

Acute withdrawal, the peak of intensity, often will occur between the 24- and 72-hour mark from last use. The most intense symptoms generally subside within a 7 to 14-day period.

Stage 3.

After acute withdrawal symptoms subside, Post-Acute Withdrawal symptoms begin to set in and may last for months or even years.

An unfortunate reality of detoxing off methadone is that withdrawal symptoms may last for an extended period in what is known as Post-Acute Withdrawal Syndrome (PAWS). As the body attempts to recover from the lingering effects of opiate use, it may take some time for the brain chemistry to regain optimal functioning and stabilize at healthy levels. In certain instances, extreme opiate use may cause lingering effects that never disappear. Common symptoms associated PAWS may include:

• Depression
• Cravings
• Anxiety
• Mood swings

Observation and Monitoring

During all stages of the early detox process, clients should be monitored regularly for signs and symptoms of discomfort and any potentially serious complications. Ideally, staff will be able to check on a client three to four times per day and ask him or her questions about the severity of withdrawal.

A helpful tool in the diagnosis of a client’s withdrawal severity is the Clinical Opiate Withdrawal Scale (COWS), along with its shortened version, the Short Opiate Withdrawal Scale (SOWS). These sets of questions allow a client to accurately describe their symptoms, thereby making it possible for supervising staff to accurately assess the client and strategize about the appropriate level of necessary care.

Managing Mild Opiate Withdrawal

During stages one and two of methadone withdrawal, clients should drink in excess of 2-3 liters of water each day in order to replace fluid loss as a result of sweating, vomiting, or diarrhea. It can also be helpful to administer Vitamin B and Vitamin C supplements to ensure the body has the nutrients it needs to function during this stressful time period.

In most cases, supportive care and treatment of individual symptoms may be sufficient in managing a client suffering from mild opiate withdrawal. It may remain necessary, however, for the supervising staff to continue providing close monitoring and regular assessments to determine whether the client’s symptoms have intensified.

Managing Moderate To Severe Opiate Withdrawal

As opiate withdrawal tends to rarely be life-threatening, the function of additional care beyond that which was already stated usually exists only to help alleviate the additional distress caused by more severe levels of withdrawal. In some instances, it may be necessary to implement a Medically-Assisted Treatment (MAT) plan using one of the following medications:

• Clonidine
• Buprenorphine
• Codeine phosphate

Follow-Up Care

The onset of Post-Acute Withdrawal Syndrome (PAWS) following the earlier stages of acute withdrawal can present a serious roadblock to any individual attempting to successfully recover from excessive opiate use. As this phase can be characterized by a generally reduced sense of wellbeing and intense cravings for opiates, the risk of relapse during this period can be particularly high.

To reduce the risk of relapse, it is strongly recommended that a client participates in psychosocial interventions, such as an inpatient or outpatient treatment program, group or individual therapy, or extended involvement in a 12-step group. These options have each been proven to significantly improve success rates in achieving lasting sobriety.

Opiate-dependent clients who have undergone withdrawal should be aware that their tolerance has substantially decreased as a result of the detox process, and they are therefore at heightened risk of overdose. If they use opiates, they should use a decreased amount to diminish risk.

Conclusion

While it may be possible for the prescribed and supervised use of methadone to present a safe, effective option for the treatment of opiate addiction, it is important to remember that methadone can be highly addictive and therefore dangerous.

The detox process for methadone (and accompanying withdrawal) carries with it a similar potential for adverse side effects seen with other opiates such as heroin or narcotic painkillers. As such, if you are deciding to quit methadone, it may be necessary to utilize a licensed treatment program that specializes in opiate detoxes. If you have a problem with methadone, it is critical that you get help. Make the call today.

Articles

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4. Withdrawal Management. NCBI.gov