Methadone withdrawal starts later than people expect and runs longer than they are told. SAMHSA’s detoxification protocol puts it plainly. Methadone withdrawal typically begins 36 to 48 hours after the last dose, peaks after about 3 days, and gradually subsides over a period of 3 weeks or longer [2]. MedlinePlus gives a similar starting point from a different angle, saying symptoms usually start within 30 hours of the last methadone exposure [1].
Those numbers are methadone’s. They are not heroin’s, and the gap between the two is the single most useful fact on this page. Below: why a long-acting opioid behaves this way, what the symptoms are early and late, what changes the course, why this page publishes no schedule for coming off it, whether any of it is dangerous, and what happens after. Our guide to methadone covers the drug itself.
How Long Methadone Withdrawal Actually Takes
Start with the two published figures, and keep their hedges.
SAMHSA: methadone withdrawal typically begins 36 to 48 hours after the last dose, peaks after about 3 days, and gradually subsides over a period of 3 weeks or longer [2]. MedlinePlus: symptoms usually start within 30 hours of the last methadone exposure [1]. “Typically” and “usually” are the sources’ own words. Neither is a promise about any one person.
Put together, the working shape is this. Nothing much happens on day one. The second day is when it usually arrives. It is worst around day three. Then it tails off over weeks rather than days.
That last part is the bit that catches people out. Three weeks or longer is not a rounding error against a short-acting opioid, and planning a week off work for it is planning for the wrong thing.
Why Methadone Is Different From Short-Acting Opioids
Because it lasts longer in the body, so it leaves more slowly. SAMHSA says every opioid produces similar withdrawal signs and symptoms, with variance in severity, time of onset and duration depending on the agent used, how long it has been used, the daily dose and the interval between doses [2].
Then it gives the contrast in its own two sentences. Heroin withdrawal typically begins 8 to 12 hours after the last heroin dose and subsides within a period of 3 to 5 days [2]. Methadone withdrawal typically begins 36 to 48 hours after the last dose, peaks after about 3 days, and gradually subsides over a period of 3 weeks or longer [2].
Read those side by side. Heroin’s whole course is over before methadone’s has properly started. MedlinePlus reports the same asymmetry at the front end: usually within 12 hours for heroin, usually within 30 hours for methadone [1].
This is why a generic “opioid withdrawal timeline” is worse than useless here. Someone coming off methadone who is told to expect symptoms in the first half-day will conclude, wrongly, that something is going badly when nothing happens. Our general page on opioid withdrawal covers the class; this page is about the one drug in it with the longest clock.
The Symptoms, Early and Late
MedlinePlus splits them in two, and the split is useful because it maps onto the days.
The early symptoms are agitation, anxiety, muscle aches, increased tearing, insomnia, a runny nose, sweating and yawning [1]. They look like a bad case of flu and they feel like dread.
The late symptoms are abdominal cramping, diarrhea, dilated pupils, goosebumps, nausea and vomiting [1]. This is the part people picture, and it is also the part that causes the medical complications in the next section.
MedlinePlus is blunt about the overall experience. These symptoms are very uncomfortable, but they are not life threatening [1]. That sentence has a second half, and it is in the danger section below, because leaving it out is how a page becomes reassuring in the wrong direction.
What Changes the Course
Four things, and SAMHSA names them together. The agent used. How long it has been used. The daily dose. And the interval between doses [2].
Physiological, genetic and psychological factors can also significantly affect how severe intoxication and withdrawal are [2]. That is why two people on the same program have different weeks.
Whether you are tapering or stopping abruptly changes it too. Other substances change it, and so does what else is going on medically. MedlinePlus notes that testing during opioid withdrawal often covers hepatitis C, HIV and tuberculosis, because many people who use opiates also have those conditions [1]. It also says anyone going through opioid detox should be checked for depression and other mental illnesses, and that treating them can reduce the risk of a return to use [1].
Our general guide to withdrawal symptoms covers the pattern across drugs.
Why This Page Publishes No Schedule for Coming Off Methadone
Because there is not one to publish, and printing a plausible-looking one would be worse than printing nothing.
Federal rules say who decides [3]. Under the federal opioid use disorder treatment standards, a certified opioid treatment program has to keep procedures ensuring that patients who choose to come off medication for opioid use disorder can do so with informed consent [3]. The regulation’s own words for the rate are “a mutually agreed-upon rate that minimizes taper-related risks”, and it requires the consent to be documented in the clinical record by the treating practitioner [3]. Read what that says. The rate is agreed between a patient and a practitioner, in writing, case by case. It is not a number a website can supply.
The same regulation says an opioid treatment program must provide adequate medical, counseling, vocational, educational and other screening, assessment and treatment services to meet patient needs, with the combination and frequency tailored to the individual patient and to a care plan created through shared decision making between the patient and the clinical team [3]. It also requires that methadone be administered or dispensed only in oral form [3].
Those standards govern certified opioid treatment programs [3]. Not every methadone prescription comes from one. MedlinePlus lists methadone among the narcotic pain relievers, and opioids are drugs used to treat pain [1]. If yours was written for pain, the person to ask about coming off it is the prescriber who wrote it.
So the honest version of “how do I taper” is: ask the program you are enrolled with, ask for the plan in writing, and ask what happens if a step is harder than expected. MedlinePlus describes the general mechanism without numbers, saying that after a period of maintenance the dose may be decreased slowly over a long time, which helps reduce the intensity of withdrawal symptoms [1]. It also notes that some people stay on methadone for years [1].
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Opioid withdrawal treatment in Washington
The Recovery Village Ridgefield is our campus in Ridgefield, Washington, and its own page cards medical detox, inpatient treatment, partial hospitalization programming, intensive outpatient programming, dual diagnosis treatment and medically-assisted treatment. Its medication card says that for severe opioid or alcohol use disorders, approved medications may be beneficial when medically appropriate, and admissions is the place to confirm what that means for someone currently enrolled with an opioid treatment program.
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The Recovery Village Ridgefield is part of our family of treatment centers. See the Recovery Village Ridgefield campus.
Is Methadone Withdrawal Dangerous?
Both halves of the answer have to be said together, so here they are together.
The first half. SAMHSA states that unlike alcohol and sedative withdrawal, uncomplicated opioid withdrawal is not life-threatening [2]. MedlinePlus agrees: withdrawal from opiates is painful, but usually not life threatening [1].
The second half, from the same two pages. SAMHSA adds that rarely, severe gastrointestinal symptoms such as vomiting or diarrhea can lead to dehydration or electrolyte imbalance, and that underlying cardiac illness can be made worse [2]. MedlinePlus lists the complications as vomiting and breathing stomach contents into the lungs, which is called aspiration and can cause a lung infection, and dehydration with electrolyte disturbance [1].
Then the risk that dwarfs all of those. MedlinePlus: the biggest complication is returning to using the drug. Most opioid overdose deaths occur in people who have just detoxed. Withdrawal reduces the person’s tolerance, so someone who has just gone through it can overdose on a much smaller dose than they used to take [1].
That is the reason this page exists. The week you feel proudest of is the week the amount you used to take can kill you.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Why a Supervised Setting Helps
Because the two things most likely to go wrong are both things somebody else has to notice.
MedlinePlus is direct about going it alone. Withdrawal from opiates or opioids on your own can be very hard and may be dangerous [1]. It lists three settings: at home with medication and a strong support system, which it calls difficult and says should be done very slowly; a facility set up for detox; and a regular hospital if symptoms are severe [1].
What a supervised setting adds is fluids, medication for the symptoms, someone watching for aspiration and dehydration, and the screening MedlinePlus describes — the physical exam, the medical history, the blood and urine testing, and the checks for other conditions [1]. It also adds the handover. Nobody walks out of a supervised detox with no plan for the next day, which is exactly when tolerance is lowest.
Our guide to medical detox sets out what happens inside it, and our guide to the levels of care explains the five treatment levels that follow.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Medicines Used During Opioid Withdrawal
MedlinePlus describes four, and it describes what each medicine is for rather than what a person does with it [1]. No amounts appear on this page, and a prescriber is the only source for those.
Methadone itself relieves withdrawal symptoms and helps with detox, and it is also used as a long-term maintenance medicine for opioid dependence [1].
Buprenorphine treats withdrawal from opioids and can shorten the length of detox [1]. It may also be used for long-term maintenance, like methadone [1]. It is often combined with naloxone, which helps prevent dependence and misuse [1]. Moving between methadone and buprenorphine is a prescriber’s decision and it has to be timed by the prescriber, because starting the second too soon while the first is still active can bring on withdrawal rather than relieve it.
Clonidine reduces anxiety, agitation, muscle aches, sweating, a runny nose and cramping during withdrawal [1]. MedlinePlus is careful to add that it does not reduce cravings [1].
Naltrexone can help prevent a return to use, and comes as a pill or an injection [1]. MedlinePlus warns that it can bring on sudden and severe withdrawal if it is taken while opioids are still in the system [1].
One more sentence from the same page is worth reading twice. People who go through withdrawal over and over should be treated with long-term methadone or buprenorphine maintenance [1]. Our pages on medication-assisted treatment and methadone treatment cover what that involves.
What Happens After Detox
Treatment does, and the distinction is not a technicality. SAMHSA defines detoxification as a set of interventions aimed at managing acute intoxication and withdrawal, built from evaluation, stabilization and fostering the patient’s entry into treatment [4]. It then says a detox program is not designed to resolve the longstanding psychological, social and behavioral problems tied to alcohol and drug use, and that detoxification is not substance abuse treatment and rehabilitation [4].
MedlinePlus says the same thing in one line: most people need long-term treatment after detox [1]. It lists outpatient counseling, intensive outpatient treatment and inpatient treatment among the options [1]. NIDA adds the consequence of skipping it. Detox alone, without treatment after it, generally leads to a return to drug use [5].
If that happens, NIDA’s position is that it does not mean treatment has failed [5]. It means speaking to a doctor about resuming treatment, modifying it, or trying another one [5]. Our guides to inpatient rehab and outpatient rehab describe both settings.
The practical side is worth settling early. Our page on how long rehab takes covers length of stay, and our guides to insurance coverage and how much rehab costs cover the money. Our guide to the admissions process sets out what a facility needs before it can give you a date, and our treatment center directory has a map you can browse by state.
Frequently Asked Questions
How long does methadone withdrawal last? Longer than most opioids. SAMHSA says methadone withdrawal typically begins 36 to 48 hours after the last dose, peaks after about 3 days, and gradually subsides over a period of 3 weeks or longer. Keep the word “typically”, because it is the source’s own. Milder or lingering effects can run past that for some people, and how long depends on the dose, the duration of use and the interval between doses.
When does methadone withdrawal start? Later than you would expect from a short-acting opioid. SAMHSA puts the start at 36 to 48 hours after the last dose. MedlinePlus says symptoms usually start within 30 hours of the last methadone exposure, against usually within 12 hours for heroin. So a quiet first day is normal here and is not a sign that something has gone wrong.
Can I come off methadone at home? Not on your own judgment. MedlinePlus says withdrawal from opioids on your own can be very hard and may be dangerous, and that the at-home route is difficult and should be done very slowly. Federal rules put the taper rate in the hands of you and your treating practitioner together, by informed consent, documented in your record. If someone is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
What medications are used during opioid withdrawal? MedlinePlus names four and what each does. Methadone relieves withdrawal symptoms and is also used for long-term maintenance. Buprenorphine treats withdrawal and can shorten detox, and is often combined with naloxone. Clonidine eases anxiety, aches, sweating and cramping but does not reduce cravings. Naltrexone helps prevent a return to use, and can cause sudden severe withdrawal if opioids are still in the system.
What comes after detox? Treatment. SAMHSA states that detoxification is not substance abuse treatment and rehabilitation, and that a detox program is not designed to resolve the longstanding psychological, social and behavioral problems involved. MedlinePlus says most people need long-term treatment after detox, and lists outpatient counseling, intensive outpatient treatment and inpatient treatment. NIDA adds that detox alone generally leads to a return to drug use.
Sources
- U.S. National Library of Medicine. Opiate and Opioid Withdrawal. MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000949.htm
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances — Opioids. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
- Legal Information Institute. 42 CFR § 8.12 — Federal Opioid Use Disorder Treatment Standards. Cornell Law School. https://www.law.cornell.edu/cfr/text/42/8.12
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
- National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction — Treatment and Recovery. National Institute on Drug Abuse. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
This page is for general information and is not medical advice. Only a licensed clinician who
knows your history can tell you what is right for you. If you or someone you know is in
immediate danger, call 911. For free, confidential support 24/7, call or text 988.
Author
Chief Medical Officer,
The Recovery Village
