Methadone is often used to help treat opioid dependence, but it can also cause withdrawal symptoms.
Replacing a drug your body has become dependent on with a prescription medication is a part of recovery known as medication-assisted treatment.
By using one drug to replace another, you can often treat withdrawal symptoms, dependency cravings, and habit-forming effects in the brain.
Methadone is a common choice for medication-assisted treatment. Even though it can be habit-forming, when used correctly, it can help you overcome more intense drug dependencies.
Methadone is an opioid medication that’s used to treat severe pain. It’s also commonly used to treat dependence to other opioids, like oxycodone and heroin.
Your doctor may prescribe methadone if you need relief from chronic (long-term) pain, or if no other pain medications have made a difference.
Like all opioids, methadone’s origins can be traced back to opium, a product of the poppy plant.
Used for thousands of years as a form of pain relief, opium eventually gave rise to commercial medications, like morphine and fentanyl.
All opioids work by binding to certain nerve receptors in the brain, spinal cord, and other areas of the body. These receptors, called opioid receptors, are linked to the body’s pain and stress response.
When you take an opioid medication like methadone, the drug binds to those nerve receptors and blocks pain signals.
Many opioid medications also create a feeling of calm and sometimes euphoria, which is part of the reason they can lead to dependence.
While methadone can cause dependence, it’s long-acting effects are what also help prevent physical withdrawal.
If your body has become dependent on another opioid medication, your healthcare team may prescribe methadone to help you break that cycle of dependency.
Methadone, like other opioids, is labeled a Schedule II drug by the Drug Enforcement Administration (DEA), meaning it has a high chance of leading to drug dependency.
Even when using methadone as directed by a healthcare professional, your body can develop a tolerance.
Over time, you may need higher doses to feel the same levels of pain relief. This can make self-dosing tempting. Tolerance can lead to dependence.
When your body is dependent on a medication, your body can’t function normally without it. If you take a lower dose or try to stop taking the medication, you’ll likely experience withdrawal symptoms.
The best way to avoid methadone withdrawal is to try to take the medication exactly as prescribed. However, be mindful that even correct long-term use can result in withdrawal symptoms.
If you do develop methadone dependence, gradually tapering off the medication can cause less severe symptoms.
Methadone works by targeting opioid receptors in your brain and throughout your body.
Without medication, these opioid receptors are there to bind with your body’s natural feel-good chemicals, known as endorphins.
When you’re experiencing extreme pain, however, you may need more relief than your body can provide. Opioid medications can make up the difference.
Methadone works by specifically targeting a type of opioid receptor known as a mu receptor. A
Many opioids, like heroin, bind to mu receptors and create the euphoric effect the body recognizes as a reward.
This is part of the reason these substances can cause dependence. Your brain feels rewarded, and your pain goes away.
When it comes to methadone, however, you’ll still get the pain relief, but with less euphoric-type reward triggers in the brain. This is because more consistent drug levels act on the mu receptors than short-acting drugs like morphine, oxycodone, and heroin.
More than just nerve receptors
Binding to mu receptors isn’t the only mode of action methadone has in your body.
This fat-soluble drug slows gastric emptying, which means you experience the effects of methadone over a longer period of time compared with other opioids.
Pain relief can start as quickly as 30 minutes after taking a dose. In most cases, some form of methadone remains in the body for up to 3 days.
In addition to slowing gastric emptying, methadone distributes widely into tissue. With long-term use, this tissue saturation can help keep levels of methadone consistent throughout the body.
Symptoms of methadone withdrawal may be less severe and take longer to set in than withdrawal symptoms of other opioids.
Withdrawal symptoms can feel like the flu and remain severe for several days. Some symptoms may include:
- fever and chills
- watery eyes and runny nose
- vomiting and diarrhea
- muscle and body aches
- tremors and shaking
- excessive yawning
- trouble sleeping
- loss of appetite
- irregular heartbeat
Psychological symptoms are also possible and may last for months or years, such as:
- drug cravings
Methadone withdrawal can look different from person to person. How long or short your withdrawal process is can depend on a number of factors, including your:
- weight and height
- severity of dependence
- overall health
- length of methadone tapering schedule
Methadone is a long-acting opioid and can last in the body for several days. The general timeline of methadone withdrawal can look like:
- days 1 to 2: symptoms often begin 12 to 48 hours after the last dose
- days 3 to 8: symptoms peak, cravings are strong, and psychological symptoms — like anxiety and irritability — may show up
- days 9 to 15: symptoms begin to subside, though some psychological symptoms may remain
- days 15+: psychological symptoms continue for months, and in some cases, up to 2 years or longer
The amount of time your healthcare team takes to taper you off methadone can influence your withdrawal process and how long symptoms are present.
Withdrawal in some form can occur anytime you expose your body to a substance for a long period of time.
Without any substances, your body operates in a natural state known as homeostasis.
In homeostasis, hormones, neurotransmitters, and processes in your body are all working together to keep a state of balance.
Introducing a substance like methadone throws off that balance. There’s suddenly a new chemical the body has to adjust to. It does this by initiating counter-regulatory processes to find a new balance that incorporates the drug.
That new balance might mean extra hormones or a decrease in neurotransmitters, or certain processes might stop completely.
If this happens, your body is now dependent on the substance to play its part in the balance. If you stop taking that substance, your body may suddenly be out of balance again.
Your body will let you know by generating a number of uncomfortable, often severe symptoms.
You may either have to resupply the substance or let your body go through the withdrawal process while it creates a natural state of balance again.
You can also experience withdrawal symptoms if you’re taking a substance that may interact with methadone, such as buprenorphine or naloxone.
If you’re taking methadone, consider talking with a healthcare professional about possible interactions before you start a new medication.
If you have discomfort after suddenly stopping methadone or decreasing your dose, you may be experiencing withdrawal.
While there’s no definitive withdrawal test, your healthcare team may check a urine sample to rule out any other drug interactions that may be causing your symptoms.
You may also be asked to participate in the Subjective Opioid Withdrawal Scale (SOWS) assessment to determine the presence and severity of your discomfort.
You’ll be asked questions about 11 commonly seen symptoms of opioid withdrawal. Each symptom will be scored from mild to severe. These symptoms include:
- muscle and body aches
- nausea or vomiting
- runny nose or runny eyes
- low mood
- sweating, piloerection (body hairs standing on end), or dilated pupils
Based on your answers, your healthcare team will determine what form of therapy may be appropriate for your needs.
If you’re experiencing methadone withdrawal, your healthcare team may reevaluate your taper schedule. You may need to slightly increase the dose again to relieve intense withdrawal symptoms.
In some cases, your healthcare team may prescribe other medications to help combat the symptoms of withdrawal.
You may be prescribed anti-nausea medications or medications to help ease anxiety and irritability. Buprenorphine, clonidine, and naloxone are all medications that can help relieve symptoms.
Guided methadone therapy might also be helpful. In this type of therapy, a team of healthcare professionals will closely monitor you as you’re tapered slowly off the medication in a safe and controlled way.
Therapy typically continues until your body doesn’t need methadone at all.
You may also find some relief at home by:
- drinking plenty of water
- being physically active
- participating in support groups, such as Narcotics Anonymous
- staying active with distracting hobbies
Methadone withdrawal can feel overwhelming at times.
Keeping in regular contact with your healthcare team, if you have one, can help make the process more tolerable. They can let you know if what you’re feeling is expected.
While methadone withdrawal itself is not considered life threatening, if left untreated, some symptoms may cause serious health issues.
Lack of sleep, irregular heartbeat, and dehydration are just a few of the symptoms of methadone withdrawal that can turn severe if not treated immediately.
When using methadone, you may experience side effects of the medication, even during a withdrawal period.
These can include:
- weight gain
- stomach pain
- dry mouth
- sore tongue
- difficulty urinating
- mood changes
- vision problems
- trouble sleeping
- eye swelling
- difficulty breathing
- digestive issues
- sexual dysfunction
Whether you’ve been prescribed methadone for opioid dependency or for pain relief, withdrawal symptoms can occur as you taper off this medication.
If you or a loved one is experiencing methadone withdrawal, consider reaching out to a trusted healthcare professional who can help determine whether treatment is necessary. They can help you come up with a plan that works best for you.
If you need immediate help, you can call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for treatment referral and information 24/7.
You can also find more resources and helpful information by visiting the following pages:
- Treating Opioid Withdrawal: What Are My Options?
- What Are the Symptoms of Opioid Withdrawal?
- What Are the Signs and Symptoms of Opioid Use Disorder?
If you don’t have access to a mental health professional, here’s how you can find support.