Methadone Detox

Methadone detoxification removes toxins accumulated in the body after chronic methadone use. Methadone detoxification ends withdrawal symptoms and brings a drug-dependent person to a drug-free state.

Doctors in the United States typically prescribe methadone to help patients manage a drug problem or as an aid to detoxification from that drug. Methadone temporarily delays withdrawal symptoms or reduces discomfort while the patient weans himself from drugs.

Methadone is a semi-synthetic opioid drug. Drug makers create methadone from extracts of the opium poppy plant. Opioid drugs work with the central nervous system, or CNS, to relieve pain, sedate, relax, and cause a pleasant feeling of euphoria.

Doctors frequently prescribe opioids, such as OxyContin and morphine, to relieve pain caused by an injury, illness, or invasive medical procedure. Most of these patients use opioids for only a short time but many people use these drugs to control long-lasting pain caused by a chronic condition. Today, more than three percent of adults in the U.S. participate in long-term opioid therapy for the treatment of chronic non-cancer pain.

About 5 million Americans use painkillers for non-medical use every year. To use a drug non-medically means to take it to get high or to treat a different condition than the doctor had intended to treat when she wrote the prescription.

Anyone who uses an opioid regularly for longer than a few weeks can become physically dependent on it, whether he takes it for therapeutic reasons or for non-medical uses. When someone takes an opioid for a long time, his body becomes dependent on that drug to feel normal; he becomes opioid-dependent. When opioid levels drop, the opioid-dependent body struggles to regain chemical stability and to cleanse itself of the toxic effects of that drug - doctors refer to this as detoxification. The opioid-dependent person experiences detoxification through unpleasant withdrawal symptoms.

German laboratories first synthesized methadone in 1939 as a pain reliever. Doctors around the world still use methadone as a pain reliever but American physicians usually reserve methadone for the treatment of opioid dependence. According to statistics cited by the Institute of Addiction Medicine, almost 2 million Americans are opioid-dependent.

The United States Public Health Service hospitals began administering methadone as part of an opioid abstinence program by the 1950s. In 1964, doctors developed methadone as a response to an epidemic of heroin use sweeping across New York City. The FDA approved methadone for use in the treatment of opioid dependence in 1972.

About 100,000 Americans use a methadone maintenance program to control the onset of withdrawal symptoms while they participate in rehabilitation to learn how to live without drugs. Once the participant gains the tools he needs to lead a drug-free life, he weans himself from methadone by taking smaller doses each day.

Methadone comes as a syrup, injection or tablet. Treatment programs typically administer methadone syrup mixed in fruit juice. Methadone patients come to the methadone clinic each day to drink a beverage containing. The effects of one dose of methadone last 24 to 36 hours.

Methadone is an opioid, so it mimics the effects of other opioids closely enough to ease withdrawal symptoms. Therapeutic doses of methadone do not get the consumer high. The patient will experience withdrawal symptoms if he stops using methadone suddenly.

Opiate detox symptoms

Withdrawal symptoms start 72 to 96 hours after the last dose of methadone. These symptoms peak in severity on or about the sixth day. Intense withdrawal symptoms may last longer before fading gradually as the body completes the methadone detoxification process.

Physical symptoms of withdrawal include:

  • Abdominal Cramps
  • Backache
  • Diarrhea
  • Difficulty Sleeping
  • Fever, Chills
  • Goose Bumps
  • Joint Aches
  • Loss of Appetite
  • Muscle Spasms
  • Nausea, Vomiting
  • Runny Nose
  • Sneezing
  • Sweating
  • Tears
  • Tremors
  • Weakness
  • Yawning

Methadone detoxification can cause profound psychological symptoms that can interfere with treatment. Psychological symptoms of methadone withdrawal include:

  • Aggression
  • Agitation
  • Cravings
  • Irritability
  • Social Isolation

Unless interrupted, the physical and psychological withdrawal symptoms fade as the body completes methadone detoxification. These symptoms do not return unless the individual returns to a drug-dependent state. Someone might relapse during methadone detoxification or sometime after completing the procedure.

Someone can reduce the severity of these withdrawal symptoms by taking non-opioid drugs, such as using Imodium to relieve diarrhea. Non-opioid drugs do not disrupt methadone detoxification. A person could stop withdrawal symptoms completely by taking more methadone or other opioids but this would reverse the effects of detoxification and return the individual to an opioid-dependent state.

Benefits of Methadone Detoxification

Methadone detoxification ends withdrawal symptoms in a person who has likely been dependent on opioids for months or years. Most patients are eager to free themselves from opioids; detoxification helps these individuals move closer to that goal.

Methadone detoxification helps patients continue or complete rehabilitation, which frequently offers counseling and behavior modification to help the patient remain drug-free. Detoxification promotes abstinence and reduces the frequency and severity of drug use episodes when they do happen.

Detoxification from methadone improves the patient’s self-esteem and confidence - becoming opioid-free is a very big deal after years of drug abuse. Methadone detoxification helps patients feel like upstanding members of the community, no longer dependent on drugs.

Methadone detoxification frees the patient from daily visits to an approved methadone clinic. It also liberates people to travel without arranging for methadone treatments from an out-of-town clinic.

Types of Detox

More than 21 million people in the United States needed treatment for substance abuse problems in 2011. The National Institute on Drug Abuse, or NIDA, states there were 1.8 million admissions to U.S. treatment centers for help with drug and alcohol abuse during 2008. While alcohol abuse made up for most admissions, opioid accounted for about 20 percent of drug-related admissions. Many of these individuals receive methadone to control opioid dependence.

Only about 10 percent of those who needed help with a drug or alcohol problem received care from a specialty facility, such as a hospital, outpatient clinic, mental health institution or dedicated detoxification facility. Everyone else tried self-detoxification, going to a private physician, getting help from an emergency department, or quitting while in jail or prison.

Each of these is a viable choice as long as it brings the patient to a drug-free state safely and effectively.

Self Detoxification

Many patients try self-detoxification at home by taking a smaller dose each day. It may take the patient weeks or months to reach an opioid-free state through tapering.

Cold turkey

The tapering method works well for some patients but stubborn withdrawal symptoms prevent some people from completing methadone detoxification. These individuals might try “quitting cold turkey” by discontinuing methadone abruptly. Quitting cold turkey causes severe withdrawal symptoms but does bring the patient to an opioid-free state.

The phrase “cold turkey” refers to the skin’s appearance during detoxification: pale, cold, and clammy with goose bumps, much like a plucked and frozen turkey.

Natural remedies

Many individuals seek out natural detoxification remedies, including acupuncture, meditation, yoga and massage. Others use a nutritional approach, consuming only certain herbs, vegetables, fruits, soups and juices to help the body naturally detoxify itself. Ginger and peppermint relieve nausea, for example, while chamomile and cayenne curb diarrhea.

Using medications during methadone detoxification may be unsafe. One well known remedy for opioid withdrawal, known as The Thomas Recipe, calls for a benzodiazepine like Valium or Xanax to relieve symptoms like anxiety and insomnia; these benzodiazepines can interact with methadone in unsafe ways. Other drugs included in The Thomas Recipe, such as Imodium or vitamin B, should not interfere with methadone detoxification.

Medical Detox

Outpatient clinics offer methadone as part of medication-assisted detoxification, sometimes called medical detox, to help patients stop using other drugs. Inpatient facilities use non-opioid drugs to help people complete the detoxification process. Some forms of medication-assisted detoxification are appropriate for those struggling with methadone dependence.

Outpatient
An outpatient clinic that offers methadone maintenance treatments typically helps the patient wean himself from methadone by offering guidance and support. This approach to methadone detoxification is appropriate for patients who have been dependent on opioids longer than one year, need little supervision, and require freedom to work or take care of other responsibilities during the detoxification process.

Rarely, an outpatient clinic will prescribe buprenorphine as an aid to methadone detoxification. Patients start out on a high induction dose of buprenorphine then reduce the daily dosage over the course of several days or weeks during the tapering phase.

Buprenorphine

Most professionals discourage patients from switching from methadone to buprenorphine but a medication change may be necessary for patients who do not tolerate methadone well.

Buprenorphine works like methadone to mimic the effects of another opioid. Buprenorphine is a sublingual medication; the patient places the buprenorphine tablet under her tongue where it dissolves and enters the bloodstream at the appropriate rate. Buprenorphine is available under the brand name, Subutex.

Suboxone

Pharmaceutical companies discourage abuse by adding naloxone to the brand name buprenorphine preparation, Suboxone. When taken sublingually, naloxone does not cause noticeable effects. Intravenous naloxone use, however, neutralizes the effects of buprenorphine so the consumer does not get high. Furthermore, intravenous naloxone use causes withdrawal symptoms in patients dependent on opioids like methadone.

Inpatient
Some patients require inpatient care during methadone detoxification. Inpatient methadone detoxification focuses on lowering methadone levels and reducing the severity withdrawal symptoms.

The physician may administer naltrexone to lower opioid levels and initiate the detoxification process. Physicians will give the patient multiple medications to alleviate a variety of symptoms. She may then give the patient hydroxyzine or promethazine to calm nausea, Loperamide for diarrhea, and clonidine to ease a variety of symptoms including watery eyes, sweating and restlessness.

Inpatient methadone detoxification is appropriate for anyone who:

  • Has suffered an overdose
  • Has an underlying condition that makes self-detoxification or outpatient care unsafe
  • Is at risk for severe withdrawal symptoms or complications
  • Has a documented history of not engaging in or benefiting from less restrictive programs
  • Has psychiatric problems that impair his ability to participate in self-detoxification or outpatient methadone detoxification, such as depression with suicidal thoughts or acute psychosis
  • Might pose a danger to herself or to others

Rapid Opiate Detox

Rapid detox is a safe, effective procedure that cleanses the body of the toxic effects of methadone and brings the patient to a drug-free state in the most comfortable way possible. Rapid detox doctors sedate and anesthetize patients before giving the usual detoxification and anti-withdrawal drugs. Rapid detox patients doze in a comfortable “twilight sleep” during methadone detoxification, unaware of the withdrawal symptoms that may have prevented success in the past. Rapid detox patients awaken a few hours later, renewed and refreshed.

Our detox center: Who we are and what we do

We are a group of board-certified anesthesiologists and other professionals dedicated to providing compassionate and effective care. We have helped thousands of people reach a drug-free state since opening the doors of our comfortable and fully accredited hospital more than a decade ago.

We prescreen all of our patients for any underlying illnesses that may complicate methadone detoxification. We then create a personalized treatment plan that may include rapid detox. After reaching a methadone-free state, out patients may continue recovery in our qualified aftercare facility.

Detox Comparisons

Self-detoxification is the least expensive and most private but it is associated with most risk for complications, especially relapse due to uncontrolled withdrawal symptoms.

Many patients respond more favorably to methadone detoxification with the help of the same outpatient clinic that helped them with methadone maintenance treatment than with the aid of strangers in an inpatient facility.

Inpatient care provides the closest patient monitoring along with the greatest protection from withdrawal symptoms and complications. Inpatient detoxification brings the patient to a methadone-free state in a relatively short time - the average length of stay for inpatient detoxification is 4 days, compared with an average of 197 days for outpatient detoxification.

Rapid detox is the most humane and efficient approach to methadone detoxification, providing relief to patients who have likely struggled with drug dependence for months or years. Rapid detox brings the patient to a drug-free state in hours rather than days or months and detox frees the patient from the uncomfortable and demoralizing withdrawal symptoms that interfere with recovery.

Detox Possible Complications

Methadone detoxification is not usually a life-threatening procedure but patients may develop dangerous complications that may become fatal. Pre-existing medical conditions and co-existing substance abuse problems increase the risk for complications.

The primary complication associated with methadone detoxification is relapse. Only about a quarter of all methadone users eventually abstain from drug abuse. Another 25 percent of methadone users remain on this drug for the rest of their lives. About half of all methadone users struggle with relapse, going on and off methadone forever.

Relapse increases the risk for overdose. The detoxification process reduces the body’s tolerance of methadone, making the individual more sensitive to the effects of methadone. This reduced tolerance and increased sensitivity means it is possible for someone to overdose on a smaller amount of methadone than he took before experiencing even moderate withdrawal symptoms.

Prescription painkiller overdose kill more than 15,500 people every year in the United States, and nearly one-third of those overdoses included methadone. The number of opioid poisoning deaths has risen for several years; as compared to other opioids, methadone has had the largest relative increase. The Centers for Disease Control and Prevention, or CDC, shows methadone-related poisoning deaths in the United States skyrocketed 468 percent between 1999 and 2005. By 2009, there were 5.5 times as many deaths associated with methadone as there were in 1999.

Each day, 14 people in the United States die from an overdose involving methadone. Some of these deaths are associated with abuse and relapse during methadone treatment for opioid dependence. Others are associated with the use of methadone as a pain reliever; methadone sales account for about 2 percent of the prescription painkiller market in the United States.

Anyone who has possibly taken a methadone overdose should seek emergency medical care immediately.

Overdose symptoms include:

  • Extreme drowsiness
  • Pinpoint pupils
  • Nausea
  • Vomiting
  • Diarrhea
  • Confusion
  • Ringing in the ears
  • Cold, clammy skin
  • Muscle weakness
  • Fainting
  • Weak pulse
  • Slow heart rate
  • Coma
  • Blue lips
  • Shallow breathing or no breathing

Self Detox Possible Complications

Severe withdrawal symptoms and underlying medical conditions can complicate self-detoxification. Extreme or prolonged vomiting or diarrhea can cause dehydration and imbalances in sodium, potassium, and other electrolytes. Methadone detoxification can increase blood pressure and pulse, which may worsen some types of heart conditions.

Outpatient Care Possible Complications

Patients may be unable to complete methadone detoxification because they require more supervision than is offered through outpatient care. These individuals may struggle to complete methadone detoxification for months or years.

Patients may suffer drug interactions when taking methadone with other medications, especially the benzodiazepines doctors prescribe to treat certain psychiatric conditions. Case studies of patients in methadone maintenance programs suggest about one-third of methadone patients use benzodiazepines.

Inpatient Detox Possible Complications

Inpatient methadone detoxification provides great protection from severe withdrawal symptoms and complications but patients may still face obstacles during inpatient care. This is especially true for patients withdrawing simultaneously from methadone and benzodiazepines or alcohol, sedatives, or anti-anxiety drugs.

Rapid Detox Possible Complications

Rarely patients suffer an allergic reaction to the drugs used in medical treatments such as rapid detox. The sedatives used in the procedure may complicate breathing, blood pressure, and heart rate in some patients. Any patient receiving anesthesia may develop bruising, swelling, or an infection at the injection site.

Detox Myths

Self Detox Myths

Myth: Methadone detoxification is easier than quitting other opioids
Fact: Some people find methadone detoxification to be as difficult as or more difficult than discontinuing other opioids.

Myth: The benzodiazepines used in The Thomas Recipe make self-detoxification from methadone safe.
Fact: Combining benzodiazepines and methadone may have fatal consequences. Statistics suggest benzodiazepine use is associated with more than 63 percent of the deaths associated with methadone.

Outpatient Detox Myths

Myth: It is cheaper to force methadone users to “dry out” in jail than to keep them on methadone until they are able to complete the detoxification process.
Fact: One year of methadone costs an average of $4,700 per patient while 12 months of incarceration runs around $24,000 per inmate.

Myth: Methadone detoxification causes permanent bone rot.
Fact: Methadone detoxification causes withdrawal symptoms, including bone ache. This symptom fades in time.

Inpatient Detox Myths

Myth: Treating a methadone patient in an inpatient setting is a waste of a good hospital bed since there is no cure for addiction.
Fact: Drug addiction is a chronic illness and produces relapse rates similar to other chronic conditions, such as high blood pressure, diabetes or asthma - ranging from 40 to 60 percent.

Myth: Communities cannot afford to spend money on drug treatment programs in this bad economy.
Fact: A community can expect a return between $4 and $7 in reduced drug-related crime rates, criminal justice costs and theft for every dollar spent on drug treatment. Add in healthcare costs associated with dependence and the savings rise to $12 gained for every dollar spent.

Rapid Detox Myths

Myth: Rapid detox is appropriate for only people trying to stop using “real” drugs like OxyContin and is not right for the treatment of methadone dependence.
Fact: Rapid detox is appropriate for methadone detoxification.

Myth: Someone could be dependent on methadone for years - it must take weeks or months to cleanse the body of the toxins accumulated during that time.
Fact: It takes a reputable expert one to two hours to perform rapid detox, which cleanses the body of methadone toxins.

Detox and Pregnancy
Women who are opioid-dependent face a higher risk for certain medical disorders, including anemia, blood infections, heart disease, depression and other mental disorders, hepatitis, pneumonia and gestational diabetes, or widely fluctuating blood sugar levels during pregnancy. Opioid-dependent women are at higher risk for contracting and spreading infectious diseases, including sexually transmitted diseases, HIV/AIDS and tuberculosis.

Opioid dependence increases risk for complications to the mother and fetus during pregnancy, labor and delivery. Complications can include hemorrhage, inflammation of the membrane surrounding the baby, separation of the tissue between the mother and baby, slowed fetal growth, premature labor and delivery, spontaneous abortion, fetal death. Methadone reduces these complications and is currently the currently only approved treatment plan for pregnant women, although a study published in the New England Journal of Medicine calls buprenorphine “an acceptable treatment for opioid dependence in pregnant women.”

Detoxification is unsafe for pregnant women. As long as she tolerates the drug, a pregnant woman should remain on methadone throughout the duration of her pregnancy. A woman who does not tolerate methadone during pregnancy may switch to buprenorphine.

Using opioids, including methadone, regularly during pregnancy may result in neonatal abstinence syndrome, or NAS. A baby born with NAS suffers withdrawal symptoms during the first weeks or months of life. NAS babies also suffer from low birth weight, seizures, breathing problems, feeding difficulties and death. Babies born to women taking methadone during pregnancy will remain under close hospital observation for signs of NAS for 72 hours after delivery.

What is the best method to detox from methadone?
Each person has different needs when it comes to methadone detoxification, so no single treatment approach is right for everyone. When determining the best method of methadone detoxification, the individual should assess the severity of his dependence, the likelihood of severe withdrawal symptoms or complications, and his ability to abstain from drugs then choose the least restrictive form of treatment that is still likely to bring him to a methadone-free state in a safe and effective way.