Methadone is a medication typically prescribed for opiate addiction. Normally these prescriptions are administered at a methadone clinic, where patients are required to show up daily to receive dosing regimens.
This treatment program is known as methadone maintenance, and the overall goal is for a return to normal life for individuals with opiate abuse disorder. Patients may carry on with their daily lives without constantly chasing opiates to avoid withdrawal symptoms.
In rare cases, methadone prescriptions are used by physicians as a form of pain relief. However, these are normally written in only the most severe cases, such as cancer and other terminal illness.
Regardless of methadone’s use as a maintenance medication, there still comes a time when individuals may want to detox from this medication and become completely substance-free. This requires a period of detox, which can be quite intense in the case of methadone.
A solid plan is required for methadone detox, regardless of an individual’s specific route to accomplish this goal. What options does a user have in terms of methadone detox?
How Can I Detox from Methadone?
Many individuals seeking to abstain from methadone ask the question of how detox is achieved. There are several options in which someone can undergo the process of detoxification.
Two primary environments exist for methadone detox, with two different options for taking the route to achieve this goal. The main environment options are at-home detox and medically-supervised detox. Options for detox are a medical taper and cold turkey.
The specifics surrounding each of these options are heavily dependent on the length and amount of use. Individuals that use methadone as a form of opioid maintenance are likely to have a long history of use.
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Methadone as Opioid Maintenance
When individuals enter a methadone clinic, they are first assessed by a nurse and physician. Each patient is required to complete an intake process, which normally consists of a questionnaire regarding the history of opiate abuse.
After completing the questionnaire, patients will meet with a physician to ensure they are physically capable of receiving methadone maintenance. A decision is made on the strength of the dose to begin the maintenance program.
Physicians use a clinical opiate withdrawal scale to determine the severity of the symptoms a patient experiences. This is why methadone treatment facilities require patients to be in full-blown withdrawal before attending their intake appointment.
Typically, individuals will begin at a dose of around 30 mg. Depending on the clinic, they will be allowed to increase in intervals of 5 mg every day or two days.
During the meeting with the physician, a maximum dose increase is entered into the patient’s chart. Normally, the dose increases are capped somewhere between 70 and 90 mg.
If patients desire to receive doses higher than these levels, they are required to meet with a physician for a second time, where another assessment is made. The physician will either approve or disapprove the request.
During methadone maintenance, patients are required to submit to random urine screening. These urine screenings are turned over to a counselor who will meet with each patient bi-weekly or monthly.
In coordination with counselors, patients will craft a treatment plan. This plan includes establishing goals for dosing amounts and personal and professional goals.
Research suggests that methadone maintenance is fairly successful in treating opiate abuse disorders. It’s important to note that certain substances should be avoided when participating in methadone treatment.
Coffee should be avoided when participating in a methadone program. Heavily caffeinated beverages like coffee can make it difficult for methadone to bind to receptors.
Regular methadone maintenance can be an efficient route of treatment for opiate abuse disorder. However, like any other opioid, failure to maintain a daily regimen results in withdrawal symptoms.
Methadone Withdrawal Symptoms
Methadone withdrawal symptoms are similar to any other opiate or opioid medication. The following symptoms are present during the withdrawal period:
- Frequent yawning
- Watery eyes
- Stomach cramps
- Mood swings
- Sweating/cold chills
Individuals seeking recovery from methadone must decide on an efficient course of action. Cold turkey and tapering are the two primary options in terms of detox.
Cold Turkey Methadone Detox vs. Tapering
Cold turkey methadone detox is the most difficult form of detox from this medication. This entails individuals suddenly abstaining from the drug, leading to sudden withdrawal symptoms. There’s no avoiding the severity of withdrawals during this time because of the sudden shock to the body because of the absence of methadone.
Although a small percentage of individuals may achieve success with cold turkey detoxification, the chances of relapse are high. The symptoms of withdrawal become too intense, and individuals normally find a way to ease withdrawal symptoms by obtaining illegal narcotics.
Tapering is normally far more effective, as it gives the individual’s body a chance to slowly acclimate to the reduction in methadone. A plan is crafted that includes a schedule for slowly decreasing the dosage amount.
A methadone taper normally takes place over several months. It’s important that the user doesn’t decrease too suddenly; otherwise, withdrawal symptoms may become too intense to handle.
Typically cold turkey detox occurs at home in a private setting. There are several risks involved with at-home detox that should be considered before deciding on this course of action.
The severity of withdrawal symptoms is more intense in individuals who participated in methadone maintenance at high doses. It’s not uncommon for patients to reach 150 mg or higher doses.
In these cases, cold turkey detox is strongly discouraged. The risk of negative health effects is quite high in these cases. Listed below are some of the most significant risks associated with cold-turkey withdrawal from methadone in high dosage users.
- Intense body aches will affect the user. Many individuals report that the aches and pains associated with high-dose methadone detox can be unbearable.
- Dangerously high blood pressure and heart rate levels. While opiate and opioid withdrawal aren’t considered deadly, high dosage users have a chance of experiencing potentially deadly scenarios as a result of withdrawal. This includes complications from a heart attack or stroke.
- Complications from dehydration are also dangerous. Many individuals don’t realize they are entering dehydration until it’s too late. However, dehydration symptoms may become quite severe because of the intense vomiting and diarrhea associated with methadone withdrawal.
The intensity of methadone withdrawal is considered more severe than other opiates and opioids. Several rumors attempt to justify this severity, most of which are false.
Some of the rumors include the assumption that methadone has an extremely long half-life. While the half-life is longer than heroin and other substances, it’s not astronomically high. The average half-life of methadone is somewhere between 10 and 12 hours.
Another common rumor is that methadone becomes deposited inside a user’s bones or bone marrow. This is completely false, with no medical evidence giving any credibility to this rumor.
Individuals seeking to make a choice on the best course of action for detox should understand the elements of the methadone withdrawal timeline.
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Methadone Withdrawal Timeline
The methadone withdrawal timeline is somewhat different than most other opiates and opioids. Withdrawal periods are substantially longer and often considered more intense. Below is an example of the methadone withdrawal timeline.
Methadone withdrawal symptoms normally begin two to four days after a patient’s last use. In other opiates, this normally begins 24-hours after the last ingestion.
The most intense symptoms begin somewhere around day seven and will persist for as long as 14 days. Average opiates normally have a withdrawal timeline that persists only for around five to seven days.
Acute withdrawal symptoms of methadone are considered more intense than other opiate medications. There is also a marked risk for experiencing post-acute withdrawal from methadone.
Post-acute withdrawal occurs months, and sometimes years, after individuals complete detox. Because of how methadone rewires the receptors in the brain, it takes a significant amount of time for things to return to normal.
The symptoms of post-acute withdrawal include:
- Random cravings
- Difficulty concentrating
- Anger issues
There are multiple remedies that bring relief to the symptoms of post-acute withdrawal.
What Happens After Detox from Methadone?
After detox, individuals may suffer from the side effects of post-acute withdrawal. The following activities may provide relief from the most intense symptoms.
- Talk therapy
- Group meetings
Medication-assisted treatment exists as a potential option before the period of post-acute withdrawal begins. Even though methadone is considered a form of medication-assisted treatment, other prescriptions can be effective in combatting methadone detox.
Suboxone vs. Methadone vs. Vivitrol
Suboxone may be used in place of methadone to allow a gradual taper. However, per recommendations from the manufacturer of Suboxone, abstinence from methadone must be achieved for a period of five to seven days.
At this point, Suboxone is used as a means to control cravings. If this is seriously considered as a potential course of action, Vivitrol may be a better option.
Vivitrol is a once-per-month injection used to control the cravings associated with opioid use and post-acute withdrawal. The active ingredient in Vivitrol is naltrexone, which is not habit-forming.
Because of the non-habit-forming properties, individuals aren’t substituting one addiction for another. This will eliminate the need for future maintenance programs to prevent withdrawal symptoms.
Although methadone is difficult to detox from, it’s not impossible. The right elements must come together for a person to experience long-term recovery from methadone dependence.
Long-term Recovery from Methadone Dependence
Long-term recovery from methadone dependence is possible when the right course of action is taken. Normally, users that simply wake up and decide to quit methadone cold turkey have a significant chance of failure.
Although this is an admirable goal and shows an initiative to move toward recovery, more planning has to be put into this goal. Successful and long-term recovery begins with choosing the most effective form of detox.
1. Choosing the Right Method of Detox
Normally, an inpatient rehab program is the best course of action to engage in a medically assisted detox. This form of detox is often the best choice when it comes to avoiding the most severe symptoms of withdrawal. It’s also the safest.
During medically-assisted detox, clients are provided access to 24/7 monitoring by medical professionals. This provides the opportunity to receive several benefits that are only available in a medical setting.
- IV to avoid dehydration. It’s important that individuals stay well-hydrated during detox to avoid complications of dehydration.
- Support from doctors and nurses during the detox period
- Access to prescription medications that provide relief from the most severe withdrawal symptoms. Patients may receive a short-term regimen of muscle relaxers, stomach medications, blood-pressure medications, or antianxiety options.
While all of the medication options provide relief, it’s important to know that these aren’t permanent solutions. These should only be used as a temporary remedy for withdrawal symptoms.
Another benefit of medically-assisted detox is the immediate transfer to an inpatient rehab facility. Any downtime between detox and rehab may present an increased risk for relapse. It’s vital that individuals obtain professional treatment services immediately after detox.
While medically-assisted detox may provide the physical relief patients need during withdrawal, the right treatment program will provide the education and mental health services needed for long-term recovery. After the treatment program, the most important element of long-term recovery is having the appropriate sober support systems and aftercare services.
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Sober Support and Aftercare
Certain parts of methadone maintenance programs provide vital elements needed for recovery. This includes regular meetings with a counselor and group meetings. These should never be discontinued just because detox is achieved and an individual graduates treatment.
Mental health services should be a permanent dynamic in the lives of individuals recovering from any substance abuse disorder. Additionally, group meetings can provide the right type of peer engagement to promote long-term recovery.
At Icarus Behavioral Health, we refer to outside detox facilities and have all of the elements in place to efficiently treat individuals seeking methadone support past this point. We also have well-trained staff ready to accept clients into inpatient treatment programs once detox is complete.
If you have any questions regarding our services, contact one of our admissions specialists. They’d be happy to guide you in the right direction and help you begin steps toward recovery.