Methadone is a synthetic opioid agonist with a long half-life. The drug binds to the same opioid receptors in the brain as other opioid narcotics, including heroin and OxyContin. However, for people with an opioid tolerance, methadone does not induce the same euphoric effects; instead, the drug helps people attempting to overcome a narcotic dependence or addiction by reducing cravings and withdrawal symptoms.
Methadone was first used to treat people struggling with opioid addiction in the 1960s in the US. It has been an integral part of maintenance therapy for people with narcotic addiction for several decades.
How Is Methadone Prescribed and Abused?
Because it is inexpensive and commonly found in generic form, methadone has recently been used to treat patients struggling with chronic pain. This treatment is most effective in patients who are “opioid naïve,” meaning they do not have an existing tolerance to narcotics. The long-acting properties of methadone make it an attractive prescription for low-income or elderly patients who need help with chronic pain conditions, since methadone can bind to the opioid receptors for at least eight hours.
Unfortunately, for people who are opioid naïve, or who combine methadone with other central nervous system depressants, like alcohol, benzodiazepines, or other opioids, the drug can induce a relaxed, narcotic euphoria or enhance the euphoria associated with other drugs. Methadone has long been a useful maintenance therapy, used under medical supervision, but it has also become a target for abuse and addiction due to its potency. The Centers for Disease Control (CDC) reports that methadone was involved in one-third of prescription opioid overdose deaths in 2009. About 5,000 people die annually in an overdose incident involving methadone.
Methadone Withdrawal Symptoms
Methadone was designed to bind to the opioid receptors in the brain for a long time, so the drug’s half-life is anywhere between eight and 59 hours, depending on the size of the dose. At typical doses given as maintenance therapy, methadone lasts 24-36 hours in the body. However, the analgesic effects may last 12 hours or less, so the person may begin struggling with cravings or mild withdrawal symptoms after that point. Since methadone is still active in the body, if the person takes other narcotics like heroin, they are more likely to experience an overdose because of the combination of opioid agonists.
Typical methadone withdrawal symptoms are like those of other opioid drugs, but can be more drawn out as methadone takes longer to exit the body. Symptoms include:
- Nervousness or anxiety
- Irritability or mood swings
- Cold or flu-like symptoms
- Excessive yawning
- Body chills
- Muscle and joint pain
- Widened pupils
- Physical weakness
- Exhaustion or fatigue
- Nausea or vomiting
- Abdominal cramps
- runny nose
Generally, methadone withdrawal symptoms begin within 30 hours after the last dose. Although the symptoms of withdrawal can last for longer, due to the length of the drug’s half-life, the most intense methadone withdrawal symptoms last for 1-2 weeks, like with most other opioids. Without medical oversight or maintenance therapy, withdrawal symptoms can be intense, and that can lead to relapse.
Methadone Withdrawal Timeline
Like other opiates, methadone withdrawal symptoms can be grouped into three categories: early, peak, and late. Here is the overview of what occurs during each stage.
- Early stage: This is the initial stage of withdrawal, which starts as the last dose begins to wear off. For methadone, this is about 30 hours later. Symptoms associated with the early stage will feel like a cold or the flu; runny nose, chills, sweating, shivering, goosebumps, and tearing or watery eyes can all be mistaken as an illness. Other symptoms include aches and pains, especially in the back and legs; restlessness and anxiety; and insomnia. These may feel mild at first, but increase in intensity over several hours.
- Peak symptoms: For most opioid drugs, withdrawal symptoms become the most intense within 1-3 days after the last dose; however, since methadone is a longer-acting narcotic, symptoms will peak after about one week. Emotional symptoms, especially agitation and anxiety, often feel the worst; physical symptoms include abdominal pain, nausea, vomiting, and diarrhea. These pass after a few days though, and the person begins to experience relief from withdrawal symptoms.
- Late stage: The majority of methadone withdrawal symptoms should pass after two weeks. Individuals may experience some insomnia, anxiety, and cravings for the drug after this point, but aches, pain, nausea, and appetite changes will usually be gone. If the person develops post-acute withdrawal syndrome, however, they could experience mild withdrawal symptoms for several months.
Physical Complications from Methadone Withdrawal
Post-acute withdrawal syndrome (PAWS) is more likely to affect people who have struggled with methadone abuse for a long time or at high doses. Some experts say it is more likely to occur in people who struggle with methadone addiction, compared to other opioids, because methadone is so long-acting. PAWS is an extended experience of withdrawal symptoms, especially cravings, mood swings, and general aches and pains. With a doctor’s oversight, PAWS can be managed or avoided.
Can Medical Detox Help Methadone Addiction?
Getting medical oversight to gradually taper off methadone means that the individual can be in maintenance therapy for a year or more. Some people who use methadone as a maintenance therapy remain in these programs for several years. However, as long as the maintenance therapy stabilizes mental and physical health, and helps the person focus on treatment through a rehabilitation program, then it is considered useful.
A doctor may also switch the individual to a different maintenance therapy, such as buprenorphine. This medication was approved for use as a maintenance therapy by the Food and Drug Administration (FDA) in 2002, and it can be used as a replacement option for opioid narcotics, including methadone. A physician does not have to require their patient to go to a specific clinic to receive their dose of buprenorphine: instead, the patient can come into a doctor’s office and receive the dose there. This allows for more flexibility and greater treatment options for more people. The goal of buprenorphine treatment is specifically to taper the person’s physical dependence until their body no longer relies on the drug.
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