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December 12, 2018

How to Get Off Methadone

When it comes time to discontinue taking methadone, either because you’ve made the decision to get off the drug you’ve taken recreationally, or your treatment team is going to gradually wean you off it after methadone maintenance therapy or long-term 

medication-assisted treatment (MAT), you must be smart and cautious on how you go about getting off methadone. You can’t just go it alone. You need professional methadone withdrawal treatment, medically-supervised drug detox, and therapy.

DANGERS OF QUITTING METHADONE COLD-TURKEY

It is not only ill-advisable to quit taking methadone cold-turkey, it is also extremely dangerous, can be quite painful, and is potentially life-threatening. When you stop taking methadone all at once, symptoms of withdrawal begin almost immediately. While some may be tolerable, the most serious include risk of heart attack, seizures, permanent mental disability, even death.

The abrupt brain changes in chemistry and function resulting from stopping methadone use cold-turkey are extremely hazardous to proper mental functioning. The brain simply cannot handle this kind of assault. Some of the mental disability side effects – including loss of judgment, loss of motor control, depression, increased mood swings, dependency and reduced pain tolerance—may become permanent.

You might survive the initial withdrawal from methadone, only to fall quickly into relapse. It’s not worth the risk when there are safer medical alternatives available, preferably medically-supervised 

methadone detox, withdrawal and therapy at a drug rehab facility with expertise in this area.

METHADONE OVERDOSE DEATHS

Methadone is an opiate narcotic, an extremely potent pain reliever. It also helps reduce certain withdrawal symptoms in those who are addicted to heroin and other opiate drugs while it simultaneously blocks the euphoric effects associated with those drugs.

A 2014 study published in the International Journal of Legal Medicine found that methadone played an important role in drug-related deaths in Hamburg, Germany during the period of 2007 to 2014. Researchers specifically looked at intravenous application of methadone. Their findings indicated it did, with 49 percent of the 114 methadone intoxications ending in death were in individuals under opiate maintenance with methadone. Thirty percent were never in methadone opiate maintenance, and 20 percent were previously in opiate maintenance with methadone, although not at time of death. Researchers concluded that intravenous application of methadone is relevant in methadone-related fatalities among opiate-substituted patients and opiate users not in therapy. They recommended therapists stick to statutory regulations regarding methadone prescribing and only give take-home doses after a minimum of 6 months of successful therapy and when no intravenous methadone use is suspected.

A 2016 study published in European Addiction Research looked at 130 methadone-related overdose deaths in Denmark from 2008 to 2011 in a liberal opiate maintenance treatment program. Sixty-three percent were receiving methadone maintenance treatment, 79 percent had benzodiazepines co-detected, 43 percent had higher prescribed methadone dose than recommended, and 80 percent lacked supervised methadone intake.

WHAT HAPPENS DURING METHADONE WITHDRAWAL?

Since it’s so dangerous to try getting off methadone on your own and medically-supervised withdrawal is highly recommended, what actually happens during methadone withdrawal? This is, no doubt, an issue that greatly concerns you and you’re right to seek the facts. The truth is that you can be effectively weaned off methadone with professional care – although it will take considerable time to do so safely and prevent relapse to opiates. That’s why medication-assisted treatment includes gradual tapering or dosage decrease is coupled with behavioral therapy and other treatments to give you the best possible treatment outcomes. The goal is to make you as comfortable as possible, to minimize withdrawal symptoms and reduce cravings, while also providing you with access to behavioral therapies that will better prepare you to enter recovery.

Symptoms of methadone withdrawal begin to appear about 24-36 hours after your last dose. Detoxing from methadone is safest and most effective when supervised by a physician or treating professionals in an accredited drug rehab facility specializing in opiate addiction detox and treatment. While studies have shown that methadone usually gets eliminated from the body within about a 72-hour timeframe, this process of elimination is generally patient-specific. Traces of methadone will continue to be detected in urine for 3 weeks or longer.

Some of the withdrawal symptoms reportedly feel like the flu, although the more severe symptoms tend to linger for several days. Some symptoms may peak after about the third day, such as cramps, diarrhea, vomiting, severe nausea, goosebumps, mild depression and some drug cravings. When undergoing medically-supervised drug detox from methadone, however, the treatment professionals work diligently to tailor your detox protocol to incorporate the right mix of medications to help minimize discomfort, reduce cravings, and prepare you for further treatment with behavioral therapies and counseling.

A 2016 study published in Psicotherma found that high levels of perceived stress could increase risk of failure during methadone detoxification, recommending clinical intervention on the psychological aspects of stress to improve the effectiveness of methadone withdrawal treatment.

Signs of Methadone Withdrawal

When you’re in withdrawal from methadone, you may experience many of the same withdrawal symptoms as coming off heroin. According to Drugs.com, these may include:

  • Anxiety
  • Body aches
  • Chills
  • Confusion
  • Constipation
  • Cramps
  • Cravings
  • Depression
  • Diarrhea
  • Difficulty concentrating
  • Hot flashes
  • Increased blood pressure, heart rate, respiratory rate
  • Insomnia and sleep difficulties
  • Nausea
  • Restlessness
  • Sweating
  • Vision problems
  • Vomiting
  • Weakness

WHAT HAPPENS DURING METHADONE MAINTENANCE TREATMENT?

The goal of methadone maintenance is to improve the health and quality of life of those who are addicted to opiates. Each individual undergoing treatment for opiate addiction has a unique set of contributing factors to be considered in preparing a safe and effective treatment program tailored to meet their needs. This is true in methadone maintenance and in gradually discontinuing methadone use entirely.

A 2018 study published in Neuropsychopharmacology noted that while methadone maintenance is an effective treatment for opioid use disorder (OUD), many individuals undergoing methadone maintenance therapy continued to struggle with chronic relapse. Using functional near-infrared spectroscopy (fNIRS), researchers found data providing preliminary evidence of the technology’s value as an objective measure of the treatment outcomes at outpatient methadone clinics. Researchers also found that depressive symptoms and drug cravings were associated with those undergoing methadone maintenance.   

As to why individuals stay in opiate maintenance treatment, a 2014 study published in Substance Use and Misuse found that the long-term maintenance treatment helped them improve social functioning and increased survival rates as a result of reducing infection rates and drug-induced mortality. Researchers noted that patients, on average, consider it more difficult to detox from opiate maintenance treatment than from heroin. 

A 2016 study published in Harm Reduction Journal found an increase in dosage in opiate-dependent clients in methadone maintenance treatment (MMT) with methadone and levomethadone, and noted this could be interpreted as development of tolerance. Researchers said this data may be relevant for long-term MMT and that physicians and staff should be vigilant for signs of decreasing MMT efficiency (such as craving symptoms or relapse), which may indicate tolerance is a contributing factor.

WHAT HAPPENS DURING METHADONE ADDICTION TREATMENT?

Tapering off methadone in a trusted drug rehab facility may involve the use of a different form of MAT that uses suboxone or clonidine. These medications may be the preferred route to gradually wean you off methadone and help ease your transition to recovery from methadone dependence and addiction. Careful adjustment of methadone doses during early treatment are critical, as methadone levels accumulate over the first several days of dosing. There have been some deaths in early treatment as a result of the cumulative effects of methadone.

In addition, those who are undergoing medically supervised methadone withdrawal after a period of methadone maintenance treatment for opiate addiction have a high risk for relapse. Indeed, studies have shown that up to 80 percent of those who suddenly discontinue methadone maintenance therapy will relapse and return to opiate abuse within 3 years. Abruptly discontinuing methadone could bring on opiate withdrawal symptoms, which further increase relapse risk. It’s important to choose an accredited drug rehab facility that has expertise in methadone withdrawal, medically-supervised drug detox, uses the latest evidence-based MAT combined with behavioral therapies.

A crucial part of getting off methadone is the emotional support you receive in support groups. Indeed, group support is considered an essential part of long-term recovery from opiate addiction, including addiction to methadone or transitioning from methadone maintenance therapy to gradual cessation of use. Knowing that you are in the company of others who are also recovering methadone users helps you realize you’re not alone, that others know what you’re going through and are willing to share their stories of recovery. This helps motivate you to stick with your recovery program, make sound relapse prevention plans, and prepare yourself physically, psychologically and emotionally for recovery.

For more about methadone, detox, withdrawal and recovery, check out these articles:

Alternative Methods for Managing Pain Without Opiates

Dangers of Drug Detox at Home and Quitting Cold Turkey

Do I Need Methadone Rehab?

Methadone Detox – Withdrawal Symptoms and Timeline

How Does Methadone Make You Feel?

Dangers of Long-Term Suboxone Treatment

Why Medication-Assisted Treatment is Important for Opiate Addicts in Early Treatment

Probuphine: The New Implant for Opiate Addiction

 

Sources:

European Addiction Research. “Methadone-Related Overdose Deaths in a Liberal Opioid Maintenance Treatment Programme.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27246839

Harm Reduction Journal. “Opioid tolerance in methadone maintenance treatment: comparison of methadone and levomethadone in long-term treatment.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754801/

International Journal of Legal Medicine. “Intravenous methadone application as a serious risk factor for an overdose death: methadone-related fatalities in Hamburg from 2007 to 2012.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24859230/

National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” “Opioid Addiction.” “Methadone.” Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies

National Institute on Drug Abuse. “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” “Preface.” Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/preface

Neuropsychopharmacology. “Prefrontal cortex Response to Drug cues, craving, and current depressive symptoms are associated with treatment outcomes in methadone-maintained patients.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30375498

Psicotherma. “Perceived stress related to methadone withdrawal.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27246839

Substance Abuse and Mental Health Services Administration. “Methadone.” Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone

Substance Use and Misuse. “Why do patients stay in opioid maintenance treatment?” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24328842

 

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