Methadone is an opioid medication some doctors prescribe to treat pain. The central nervous system depressant is also used to treat opioid use disorder, particularly in patients who have tried to stop using opioids multiple times without success.
Methadone has been used to treat people with heroin addiction in the U.S. for 40-plus years, writes the National Institute on Drug Abuse (NIDA), which says the drug:
The medication is available either through a) certified methadone treatment centers that clients must visit daily to receive their dose or b) a take-home dose that can last for one day or up to one week. Only clients who meet the federal eligibility criteria can take their dose at home. People who have been approved for this arrangement likely have been receiving methadone maintenance for some time.
Unlike other opioids, methadone is long-acting with a significantly longer half-life (15 to 55 hours). A single dose is effective for four to eight hours. Medical professionals use methadone to slowly taper or wean opioid-dependent people off drugs. Adjusting the dosage gradually allows the body to adjust to smaller amounts in its system.
Excessive methadone use is considered abuse, and some recreational use usually means too much overindulging in the potent substance. This practice can create major health problems, addiction, and overdose. Whether used as directed or for non-medicinal purposes, users should take care with methadone use, as the drug is highly addictive, and a dependence on it can happen rapidly. Methadone also can cause heart rate abnormalities and respiratory depression, especially when abused.
Repeated dosing can cause methadone to build up in the liver, which releases the drug slowly over time. This buildup can boost the drug’s potency and prolong the duration of its potential toxicity, Drugs.com says.
The longer one uses methadone, the harder it is to quit. If you have become dependent on methadone and try to stop using it, you may notice that you feel, think, or act differently from when it was in your system.
The drug has some of the most intense, long-lasting symptoms of medications in the opioid family. Its long half-life means it stays in the body longer, which only lengthens the withdrawal period beyond the standard timeline of other opioids.
Several symptoms come at different stages of the withdrawal timeline. In general, opioid withdrawal symptoms often present as the common cold or even the flu. However, people who experience it may notice they have other physical, mental, and emotional symptoms, such as:
Opioid withdrawal is uncomfortable but overall is not known to be fatal. However, some of the symptoms listed above can cause medical complications and be potentially life-threatening, such as a rapid heartbeat and high blood pressure. Symptoms, such as anxiety, depression, and thoughts of suicide can be risky to manage on your own, so seeking professional help to treat these conditions can help.
The stages of methadone withdrawal depend on various factors that are unique to the person going through it. These factors include the size of the last dose, how long it’s used, and the dosage one is used to taking. Age, medical history, drug use history, and mental health history can also shape the timeline. If you use methadone regularly or are dependent on a high dose, your timeline may be different than someone who has only recently become dependent on it.
The drug’s long half-life must be considered, as it is different from most opioids. Some users report feeling withdrawal symptoms eight hours after the drug’s effects wear off. However, with prolonged use, pain relief and withdrawal prevention effects can last up to two days. Following that, users may feel the worst symptoms within the first week before they ease up.
That said, methadone stays in the body for weeks, and symptoms can linger for up to a few weeks after it exits the body. Most symptoms should clear up by the second month, but anxiety and depression can last for years without treatment. These symptoms are known as post-acute withdrawal syndrome, or PAWS. Some people find it helpful to follow a healthy lifestyle and receive ongoing therapy and support to manage this period.
Methadone does share effects with other opioids, but it’s also different in many ways. Its long-lasting and its intense withdrawal effects mean it’s riskier than other opioids, so withdrawing from it on your own is dangerous. Plus, dealing with flu-like symptoms for an extended period could make daily living difficult.
Drug cravings are also another thing to think about during withdrawal. Dealing with them, along with other uncomfortable symptoms, can make it harder to get through withdrawal without relapsing. To withdraw from the drug safely, and avoid cravings that can return at any time, medical detox is recommended. During this time, medical professionals who understand the care needed during this critical period can help keep cravings away to ensure stability is regained.
Chronic methadone users who are battling an addiction to the drug are encouraged to seek professional help at an accredited facility that specializes in drug rehabilitation.
Treatment programs that are designed to meet your specific needs can help you address underlying issues that led to your initial addiction and teach you how to manage cravings and triggers that can potentially lead to relapse. After your treatment is complete, these tools can help you maintain lasting sobriety.
Once you enter a rehabilitation program, an assessment will help professionals determine a placement for you that is along the continuum of care. People with severe substance use disorders may be placed in residential or inpatient treatment, which requires a longer stay at a facility. People in the mild or early stages of addiction may be placed in an outpatient program. If a mental health disorder is uncovered, a treatment program that includes therapies for co-occurring disorders, such as anxiety or depression, among others, is usually recommended.
NIDA asserts that addiction is a complex but treatable disease that affects brain function and behavior. The disease also can change the brain long after substance abuse has ended, which is why relapse is possible. The federal agency recommends that a recovery program lasts at least three months (90 days) to increase the chance of recovering from addiction.
“Part A: Questions and Answers Regarding the History and Evolution of Methadone Treatment of Opioid Addiction in the United States.” Methadone Research Web Guide. National Institute on Drug Abuse. from https://www.drugabuse.gov/sites/default/files/pdf/parta.pdf
(2008). Take Home Regulation Page 4098. National Alliance for Medication Assisted Recovery. from http://www.methadone.org/library/take_home_p4098.html
Methadone – FDA prescribing information, side effects and uses. (n.d.). from https://www.drugs.com/pro/methadone.html
American Society of Addiction Medicine. (2015, May 13) ASAM Continuum. Knowledge Base. What are the ASAM Levels of Care? from https://www.asamcontinuum.org/knowledgebase/what-are-the-asam-levels-of-care/
NIDA. (January, 2018). “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).” National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment