How To Taper Off Methadone

Methadone is a long-acting synthetic opioid prescribed for chronic pain management and as a treatment for opioid addiction.

However, those who would like to discontinue using methadone should be aware of the difficulty of methadone withdrawal, as well as the benefits of a slow tapering schedule and professional detoxification treatment.

Why Taper Methadone?

Opioid and opiate narcotics like oxycodone, heroin, and fentanyl are highly addictive and their abuse often leads to physiological dependence, withdrawal symptoms, and drug cravings.

Medication-assisted treatment (MAT) using methadone has been shown to greatly improve the effectiveness of addiction treatment programs, helping reduce these symptoms so participants can focus on their recovery and day-to-day lives.

Because long-term use of methadone will also likely lead to the development of physiological dependence, those who are ready to stop using methadone will often experience withdrawal symptoms that last much longer than other forms of opioid withdrawal.

Accordingly, treatment providers likely recommend a slow tapering program to help ease this potentially difficult withdrawal process.

Methadone Tapering Schedule

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), methadone tapering should begin with a gradual reduction in a person’s methadone dose.

This should be accomplished by removing either between 5 and 10mg of methadone from a person’s daily dosage each week, with this amount adjusted depending on how well the individual is able to tolerate the change over time.

Many who use methadone maintenance treatment to manage the effects of opioid dependence will take high doses of methadone, often between 80 and 120 mg a day. Because of this, methadone tapering can take up to several months before detoxification can begin.

Methadone Detoxification

Once a person’s methadone dose has been reduced to between 30 and 40 mg, they can continue reducing their dose over time by smaller and smaller increments.

They can also stop taking methadone entirely, which will likely begin a two- or three-week period of acute and uncomfortable withdrawal symptoms.

Medication

Clonidine, a centrally acting alpha-agonist hypotensive medication, may be prescribed in order to counteract a number of methadone withdrawal symptoms, especially high blood pressure and agitation.

Benzodiazepine anxiolytics, antidepressants, and medications for insomnia, nausea, diarrhea, and other symptoms may also be provided if needed.

Medical Supervision

While opioid detox is rarely life-threatening, close monitoring can help keep individuals safe and reduce the otherwise high risk of relapse.

It is strongly recommended that those working through methadone withdrawal participate in a medical detox program where they can receive close professional support.

Methadone Withdrawal Symptoms

While the symptoms of opioid withdrawal are generally similar for all opioids, methadone withdrawal tends to last longer and some have even claimed that getting off methadone caused them an even more severe withdrawal experience than heroin.

While tapering can decrease this severity, those going through it are still likely to experience a variety of symptoms, beginning around thirty hours after the last dose.

These symptoms may include:

• anxiety
• chills
• depression
• diarrhea
• drug cravings
• fever
• hallucinations
• inability to feel pleasure (anhedonia)
• irritability
• muscle aches (myalgia)
• nausea and vomiting
• paranoia
• rapid heartbeat (tachycardia)
• runny nose (rhinitis)
• sleep problems (insomnia)
• stomach cramps
• sweating

Effectiveness Of Methadone Tapering

While methadone is considered an effective treatment for opioid use disorder, different studies and subject matter experts have come to different conclusions on the effectiveness of methadone tapering and discontinuation.

The consensus, however, is that the majority of those who attempt a taper will not complete it, either resuming regular methadone maintenance treatment due to the difficulties involved, transferring to buprenorphine/naloxone, or returning to other opioid drug abuse.

Why Is Tapering Often Unsuccessful?

An unsuccessful taper likely relates to the diversity of reasons why individuals may choose to stop taking methadone, including:

• the cost and inconvenience of treatment
• the drug’s side effects
• the need for improved pain management
• relapse
• interest in other medication-assisted treatment options
• a genuine motivation to live a substance-free life

Longer tapers are believed to greatly increase the likelihood of an individual’s success relative to shorter tapers. The same is true of participation in other opioid treatment services including behavioral therapy, counseling, career services, and more.

Methadone Vs. Buprenorphine

Buprenorphine is a newer alternative to methadone maintenance therapy. This partial opioid agonist has a lower risk of abuse, can be prescribed in any health care setting, carries a lower risk for overdose, and is easier to discontinue.

However, buprenorphine is less suitable for treating severe opioid dependency and women who are pregnant or breastfeeding and is more expensive than methadone.

It is possible to switch from methadone to buprenorphine with tapering and medical supervision.

For assistance with methadone tapering, medication-assisted treatment, or opioid addiction treatment as a whole, please contact Northeast Addictions Treatment Center today.