Methadone Withdrawal

Doctors prescribe methadone to help someone overcome his addiction to opioids. Methadone is one medication used in Drug Replacement Therapy, or DRT, which allows an individual to learn how to live without opioid drugs before going through the detoxification process. After counseling and behavior modification, he weans himself from methadone. Many patients have significant difficulties overcoming methadone withdrawal and spend years participating in DRT.

Definition

Rehabilitation specialists define opioid withdrawal as a normal, predictable consequence of a sudden drop in the level of opioids in the body of a person who is physically dependent on this class of drugs.

Opiate drugs include heroin, codeine, morphine, OxyContin, Dilaudid and methadone.

Withdrawal manifests itself in a variety of overpowering physical symptoms that can last a week or more; psychological symptoms of withdrawal can linger undetected.

Causes

The human body adjusts to the presence of certain substances in the body, including opioids such as methadone. The body can become tolerant of certain chemicals, which means it takes an ever-increasing amount of opioids to cause a euphoric or pain-relieving effect.

With prolonged use, the body may become dependent on the chemical; this means the individual must maintain a certain level of opioids for the body to feel normal. If the level of opioids drops rapidly, the body struggles to maintain its chemical balance. This struggle manifests itself through withdrawal symptoms. If the individual were to take another dose of opioids, his withdrawal symptoms would disappear because his body has regained chemical balance.

Doctors prescribe methadone to treat these withdrawal symptoms. The opioids in methadone "trick" the body into thinking it has gotten another dose of drugs, so the body maintains chemical stability and withdrawal symptoms fade as long as it gets enough methadone.

The opioid component of methadone interacts with the central nervous system in the same way as other opioids, but methadone does not produce the same euphoric effects. The effects of methadone last longer than other opioids. One dose of methadone lasts about 24 hours, as compared to a dose of heroin which may last for only a couple of hours.

The opioid-dependent person will suffer methadone withdrawal symptoms if he stops taking methadone or if he takes insufficient doses.

Facts

About 9 percent of people abuse opiates at some point in their lives.

Withdrawal symptoms are painful and demoralizing, but usually not life threatening

German scientists first synthesized methadone in 1939. The United States Public Health Service hospitals began administering methadone as part of an opioid abstinence program by the 1950s.

Methadone comes as a syrup, injection or tablet. Treatment programs typically administer methadone syrup mixed in fruit juice.

Symptoms

Withdrawal from opioids is typically associated with physical symptoms similar to the flu, but withdrawal also causes psychological symptoms whose demoralizing affects can be just as overpowering as the physical symptoms of withdrawal.

Methadone withdrawal symptoms usually begin 1 to 3 days after the last dose and peak on or about the sixth day but can last longer.

Physical

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

Psychological

Opioid withdrawal has a profound psychological impact on the patient, especially when that opioid is methadone. Psychological symptoms of withdrawal include:

  • Aggression
  • Agitation
  • Cravings
  • Irritability
  • Social Isolation

Possible Complications

Complications of methadone withdrawal are the same as with other opioids. One such complication is aspiration, where the patient vomits and then breathes stomach contents into the lungs. Aspiration may cause fluid in the lungs and lung infection. Extreme vomiting and diarrhea associated with methadone withdrawal may result in dangerous dehydration.

The greatest complication associated with methadone withdrawal is the return to opioid abuse. A person who has used drugs soon after experiencing methadone withdrawal stands a greater risk for overdose because the detoxification process reduces tolerance to opioids; a person who has just gone through methadone withdrawal can overdose on a much smaller dose than they used to take.

Treatment Options

The American Society of Addictive Medicine warns that addiction to methadone or other substances may result in "disability or premature death, especially when left untreated or treated inadequately."

Treatment usually consists of two phases: detoxification and rehabilitation. Detoxification is the process of lowering opioids to non-toxic levels in the patient's body.

Patients take methadone to put off the detoxification phase while they engage in rehabilitation but they will eventually need to detoxify their systems from the effects of methadone and go through methadone withdrawal. By the time the patient reaches a point where he faces methadone withdrawal, he has already participated in some form of rehabilitation for his original opioid addiction. His rehabilitation focused on changing the cognitive and behavioral aspects of opioid addiction. This portion of treatment typically involves behavior modification techniques along with individual, group and family counseling to help the addicted individual learn how to live without the original opioid and, with proper guidance, he applies these same techniques to overcoming methadone.

Detoxification

Some addicted individuals attempt self-detoxification to free themselves from dependence on methadone. Self-detoxification is the process of going through withdrawal alone, without the help of trained professionals or medicines to ease physical and psychological symptoms. Powerful withdrawal symptoms often drive these individuals back to using opioids.

Some methadone patients develop a homemade treatment plan to ease withdrawal symptoms. One such home remedy is the Thomas Recipe, in which individuals use medicine such as Xanax to ease anxiety, drugs to stop diarrhea along with vitamins, supplements and hot baths to reduce methadone withdrawal symptoms.

While the Thomas Recipe relieves the physical symptoms associated with methadone detoxification, it does not protect the individual from dangerous complications, nor does it address the psychological symptoms that cause many people to relapse to opioid abuse.

Overdose

The biggest risk to recovery is relapse to methadone use or opioid abuse, potentially leading to fatal overdose. The detoxification process reduces tolerance to opioids; there is a greater risk for overdose immediately following methadone withdrawal. A person can potentially overdose on a lesser dose of methadone than he used to take before going through the withdrawal process.

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.

Overdose is a serious, life threatening medical emergency. If you think you or someone you know has overdosed on methadone or any other medication, contact poison control center at 1-800-222-1222 or go to the nearest hospital.

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

While the patient is in the emergency department, doctors and nurses administer naloxone or other drugs to drop methadone to non-toxic levels quickly. Nurses will establish an airway to help the patient breathe, start intravenous fluids and pump excess methadone from the stomach. They will also perform other emergency, life-saving treatments such as CPR as necessary to save the patient's life.

Once the individual is out of mortal danger, he can resume behavioral modification.

Drug Replacement Therapy

After the individual changes the behaviors associated with addiction, he must wean himself from methadone. Harvard Medical School cites estimates that 25 percent of methadone DRT patients eventually abstain, another 25 percent continues to take the drug and 50 percent go on and off methadone.

Methadone is just one type of Medically-Assisted Treatment, or MAT, in which physicians administer drugs to lower opioid levels and reduce withdrawal symptoms. Standard detoxification and rapid detox are other types of MAT.

Research shows MAT such as methadone and rapid detox has many benefits, including:

  • Improved Survival Rates
  • Increased Retention in Treatment
  • Decreased Illicit Opioid Use
  • Decreased Risk for Hepatitis and HIV
  • Decreased Criminal Activities
  • Increased Employment
  • Improved Birth Outcomes for Pregnant Women Battling Addiction

Inpatient detoxification is another form of MAT in which doctors administer naloxone to lower opioid levels along with other medications to relieve the resulting withdrawal symptoms. While inpatient standard detoxification reduces severity and duration of methadone withdrawal symptoms somewhat, the patient must still suffer demoralizing and debilitating psychological symptoms associated with methadone withdrawal.

Rapid Detox is the most humane and efficient way to detoxify the body from methadone dependence. During rapid detox, board certified anesthesiologists administer sedatives and anesthesia along with the usual detoxification medications. The patient dozes in a pleasant "twilight sleep" and awakens refreshed, unaffected by methadone withdrawal symptoms or psychological complications associated with the detoxification process.

Rehabilitation

Successful recovery from dependence on methadone often includes continuing rehabilitation and behavior modification. Opioid dependence and methadone treatment is complex process that affects brain function and behavior. Individual, family and group counseling, along with other behavioral therapy are a large part of successful methadone treatments. While no single therapy works for everyone, treatment does needs to be readily available to be effective.

The most effective treatment must attend to the complex and multiple needs of the individual, and not just focus on his methadone abuse. Many drug-addicted individuals also have other mental disorders that prevent or slow the recovery process.

Methadone is an important element of treatment for many patients, especially when therapists combine methadone with counseling and other behavioral therapies. Methadone is only one aspect of treatment for opioid dependence and, by itself, does little to change long-term drug abuse.