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Methadone is a long-acting, synthetic opiate that was first synthesized by German scientists in the mid-20th century. Methadone is considered a chemical derivative of morphine and was popularized over the decades due to its potent painkilling properties and easy accessibility. The methadone clinics that spread throughout American cities in the 1970s helped cement the drug’s reputation as a major player in the pharmaceutical industry and increase its popularity on the street. Despite methadone’s Schedule 11, highly addictive status, illicit sales and distribution continue to surge. In fact, according to the Centers for Disease Control and Prevention (CDC), although methadone currently represents a mere two percent of US opiate painkiller prescriptions—it is responsible for approximately one-third of accidental overdose deaths.
Although methadone is successfully used as a transitional drug to treat user’s suffering from addiction to other opiates such as heroin, it has been deemed the most unpredictable and deadly of all opiates by numerous experts. Methadone’s volatile chemical composition, highly addictive nature, and “preferred drug” status in 33 states are part of a monstrous epidemic that has taken society by storm—spawning a culture of overdose, crime, disease, death, and mental illness.
Habitual methadone use inevitably leads to the development of tolerance for the drug and, ultimately, addiction. Like other opiates, methadone works through a chemical binding process in the central nervous system (CNS) and brain. This binding process—combined with an artificial increase in neurotransmitters such as dopamine and serotonin—helps immediately reduce the sensation of pain and creates what many users describe as a euphoric, dreamlike state.
Over time, a user’s body and mind become desensitized to methadone’s potent effects and they require more frequent use of the drug in higher doses in order to sustain the same benefits. This vicious cycle sets the stage for a backlash effect which occurs in the form of various withdrawal symptoms that appear whenever there is a decrease or abrupt cessation in use. Methadone’s potency is such that even in cases of casual recreational use or occasional experimentation, a user can quickly progress to full-blown addiction—in which case more severe withdrawal symptoms are virtually guaranteed.
Although not typically life-threatening—methadone withdrawal is considered extremely serious. In most cases, methadone withdrawal requires professional medical management and ongoing psychiatric evaluation. In the early detox and withdrawal stages of methadone addiction, trained doctors and licensed clinicians work together to help determine a client’s individual treatment requirements using a variety of tools such as the Clinical Opiate Withdrawal Scale (COWS). These tools help quantify and evaluate the severity of symptoms and provide the basis for implementing safe and effective pharmacological and therapeutic interventions. Initial methadone withdrawal symptoms may include, but are not limited to the following:
Exact timelines for methadone withdrawal are difficult to establish due to the drug’s unpredictable reaction with individual biochemistry. Methadone features a long half-life of approximately 8-60 hours, which is the primary reason why it is so beneficial to those detoxing from heroin and other opiate addictions. However, this extended effect creates an element of unpredictability and danger when it comes to the withdrawal process.
During withdrawal, symptoms generally appear within 30 hours following dosage. In many users, initial symptoms are mild to moderate, but the intensity can quickly escalate depending upon aggravating factors such as the presence of other potent substances in the system or co-occurring mental health disorders. Methadone withdrawal is typically broken down into two distinct stages:
Methadone, like other illicit or legitimately prescribed opiates, can have a dramatic effect on brain health and cognitive function. Chronic use almost always results in long-term damage and may create permanent structural changes—all of which are negative. Many of these changes are reversible with early intervention and proper treatment. The protracted symptoms of methadone withdrawal may mimic early-onset symptoms, but occur with less frequency and intensity. These long-term withdrawal symptoms frequently include:
Modern pharmaceutical advancements have created a variety of highly effective methadone treatment options. In addition to whatever medications may be used to treat co-occurring mental disorders or physical health issues, the following Food and Drug Administration (FDA) approved medications are considered the nucleus of safe, effective treatment in many methadone treatment facilities:
Although sometimes done despite prevailing medical wisdom, quitting methadone abruptly (cold turkey) is extremely dangerous and increases the likelihood of precipitated withdrawal—the rapid acceleration and intensification of withdrawal symptoms. Quitting cold turkey does not give the methadone-dependent body sufficient time to readjust and may result in a number of harsh, debilitating symptoms. Generally speaking, quitting “cold turkey” and self-administered treatment are not recommended and should never be performed under any circumstances.
Methadone withdrawal is often a long and arduous journey that entails many challenges and includes many set-backs. Those in long-term methadone recovery can attest to the fact that withdrawal is a marathon, not a sprint, and is best approached methodically under ongoing professional guidance. If you or someone you love is suffering from methadone addiction, call a substance abuse professional today. A wide range of treatment options are available to help and, as evidence clearly indicates, early intervention is critical to achieving optimal outcomes.
For more about methadone addiction and recovery, check out these related articles:
Sources:
Journal of Addictive Diseases. Maintenance Medication for Opiate Addiction: The Foundation of Recovery. July, 2012.
Western Journal of Medicine. Use of methadone. Jan, 2000.
Journal of Neurosciences in Rural Practice. Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Jan, 2012.
Journal of Addiction Medicine. Transferring Patients from Methadone to Buprenorphine : The Feasibility and Evaluation of Practice Guidelines. May, 2018.
The Journal of the European Psychiatry Association. Methadone withdrawal psychosis—case report. March, 2016.
