Methadone Withdrawal Symptoms and Timeline: What to Expect and How to Detox Safely

When determining the duration and intensity of your methadone withdrawal, you need to consider several variables, such as:

• The typical length of time for methadone withdrawal.
• How long you have been using methadone.
• Your overall physical health, including mental health.

Methadone Withdrawal Symptoms

Methadone withdrawal may produce similar physical and psychological symptoms to flu-like symptoms. Some common physical symptoms of methadone withdrawal are:

• Muscle and joint pain, including sweating and chills, or feeling tired and achy all over.
• Nausea, vomiting, diarrhea, and stomach cramps.
• A running nose, watery eyes, yawning, and sneezing.
• Restlessness, tremors, and inability to sleep.

Symptoms experienced by individual people during their methadone withdrawal may differ in severity based on:

• The dosage of methadone used and for how long.
• Individual health status (i.e., overall health, metabolism)

Methadone withdrawal can produce emotional and cognitive effects (processes that deal with knowledge, awareness, and thinking), in addition to the physical impacts. Common psychological symptoms that may be experienced during methadone withdrawal include:

• Anxiety, panic attacks, irritability, and mood swings.
• A low level of motivation to do various activities, including exercise and work, may be accompanied by depression or a lack of general desire for life.
• Cravings for methadone or related opioids (e.g., codeine, hydrocodone).
• Inability to concentrate and brain fog; these emotional symptoms may be intensified if you don’t sleep at all.

Some of the symptoms experienced during methadone withdrawal will require immediate medical attention, such as:

• Symptoms of dehydration, such as persistent vomiting or diarrhea, confusion, dizziness; or fainting [1].
• Chest pain, rapid heartbeats, or extreme shortness of breath.
• Thoughts of suicide

Methadone Withdrawal Timeline

Typical Timeline

Most individuals will experience methadone withdrawal symptoms approximately 1-2 days after they stop taking their last dose. The first week following the previous dose of methadone is the timeframe during which withdrawal symptoms are typically at their peak [1]. However, some individuals may also have prolonged withdrawal symptoms, such as sleep disturbances, for several weeks or even longer.

What Are the Stages of Methadone Withdrawal? A Stage-By-Stage Representation of What You Will Experience During Withdrawal.

Early withdrawal: Days 1-2. Anxiety, restlessness, yawning, sleep difficulty, and early cravings

Peak withdrawal: Days 3-.7 You may have muscle and/or joint pain, GI issues, increased sweating, chills, significant cravings for opioids, and mood disturbances

Late withdrawal: weeks 2-later. You may have symptoms that are improving gradually; you may experience lingering emotional and sleep issues

Protracted Withdrawal Symptoms: For weeks or months after your last methadone dose, you may experience ongoing insomnia, low-level depression, increased anxiety, and/or occasional cravings

The severity and type of methadone withdrawal symptoms will vary among individuals and not follow a specific pattern.

Factors Influencing the Length of Methadone Withdrawal

Many factors influence the duration of methadone withdrawal, including:

• The level of methadone taken and how long it was used.
• The individual’s metabolism and overall health.
• Whether the individual has any co-occurring mental health issues, such as depression or PTSD.
• Whether a gradual methadone taper is used versus stopping abruptly [2].
• Use of other substances like alcohol, benzodiazepines, or stimulants.

How Can Methadone Withdrawal Be Managed Safely?

The Safest Starting Point: Clinician-Guided Plan

Stopping methadone cold turkey is generally not recommended. Abrupt discontinuation often leads to more severe withdrawal symptoms and a higher risk of relapse. A clinician-guided plan allows for careful dose adjustments, monitoring, and support for managing substance use disorder.

Two common approaches include:

• A gradual methadone taper to slowly reduce dependence and minimize withdrawal symptoms.
• Medically supervised withdrawal or detox with continuous monitoring and symptom management [2].

Medication-assisted treatment is recognized as an evidence-based standard of care, meaning current research and clinical practice guidelines support it.

Medical Detox: What Monitoring and Support Typically Includes

Medical detoxification is when healthcare professionals help patients manage withdrawal symptoms safely using medication and other interventions. During the detox process, healthcare professionals are often available to provide assistance and support to patients to help them deal with the immediate effects of withdrawal using various forms of medication, in addition to providing emotional support to patients who may be experiencing anxiety or distress. To support this process, healthcare providers may assist with the following:

• Monitor for vital signs and ensure the patient is stable overall.
• Provide IV fluids/electrolytes.
• Provide medications to assist with nausea, diarrhea, muscle pain, anxiety, and sleep disturbance [3].
• Provide emotional distress support/evaluating the patient’s emotional health.
• Continue planning for the next step, including residential treatment options, intensive outpatient programs, and/or individualized therapy.

These services are designed to ensure patient safety and comfort during detoxification.

Examples of Medications that May Be Utilized during a Methadone Detox

During the course of treatment for methadone withdrawal, clinicians may utilize medications that provide symptomatic relief for the patient. These medications can include:

• Clonidine and lofexidine (alpha-2 agonists) are used to reduce autonomic symptoms of withdrawal [4].
• Medications used to treat nausea and diarrhea, and reduce pain.
• Careful transitioning from methadone to other medications to treat opioid use disorders when appropriate.

The use of all medications should occur under the supervision of a clinician and will be based on the individual needs of the patient.

Examples of Support Strategies Helpful in Enhancing Patient Safety and Comfort

In addition to the provision of medical care, the use of other types of supporting strategies may be beneficial for the patient during the detoxification process:

• Maintaining hydration status through the ongoing use of fluids and eliminating the use of diuretics.
• Implementing sleep hygiene practices, which means maintaining habits that help the patient get adequate, high-quality sleep.
• Consuming foods low in fat and high in nutrients that are gentle on the gastrointestinal tract and provide reduced GI symptoms during detoxification [3].
• Using supportive family members as part of an ongoing family support program.
• Creating a relapse prevention plan and utilizing ongoing therapy/counseling programs.

The combination of each of these approaches will support both the physical healing process and the recovery process.

Differences Between Methadone Withdrawal and Other Types of Opioid Withdrawal

Methadone withdrawal has a longer duration than withdrawal when compared to the withdrawal from other opioids. While individuals often experience several hours of intense withdrawal symptoms while withdrawing from short-acting opioids, many individuals may take days for full withdrawal from methadone [5]. Because of this lengthy process, individuals withdrawing from methadone will require additional professional support during the detoxification period compared to those withdrawing from shorter-acting opioid drugs.

Discovery Institute’s Detoxification and Treatment Services

Discovery Institute is located in Marlboro, NJ, and offers individualized treatment plans to assist those experiencing methadone withdrawal symptoms. The institute’s program includes supervised medical detoxification and residential treatment programs; an intensive outpatient treatment program, and a variety of therapy programs to assist with relapse prevention and family support. The Discovery Institute supports patients in safely transitioning to the next step of recovery from methadone withdrawal.