Methadone has been a primary treatment for opioid addiction for many years, and for good reason. It works. People unable to stop using heroin or prescription pain medications have progressed to stable lives under methadone maintenance therapy. They have their lives back, have reconnected with family, and have returned to work. It is literally life-saving medicine.

However, this is a topic not enough has been discussed in addiction circles: The medication that saved your life eventually becomes a problem in its own right. Not everyone who stops taking methadone does so willingly. Some individuals wish to discontinue and it often comes with an entirely different medical problem, which requires care and professionalism.

The double-edged sword of Methadone Treatment

Methadone is different from other opioid medications, both a strength and a complication. It is long-acting, meaning one dose will prevent withdrawal symptoms for 24 to 36 hours. This stability is precisely what makes it an effective treatment for opioid addiction. Individuals do not spend their days being slaves to hunting their next use and do not experience the highs and lows withdrawal symptoms bring.

Although, minimal will be said in addiction meetings that the same long-acting property that makes methadone somewhat of a challenge to stop taking the drug can also lead complications when trying to discontinue. When a person discontinues cold turkey, withdrawal symptoms can persist weeks if not months, whereas shorter-acting opioids later about a week or so. The withdrawal can be terrible, severe depression, anxiety, insomnia, muscle spasms, and a feeling worse of all that nothing will feel or be normal again. Numerous people who try to quit using methadone alone often relapse back to using those stimuluses. Usually not because they are trying to get high, but because of the actual physiological withdrawal and the duration of that withdrawal, which can be much longer than most opiates. A person could use street drug use and/or adrenaline (opiate) drug use for years and quit, with stopping the because of all the horrible feelings of withdrawal they are trying to avoid.

When Successful Stories Get Stuck

For example, someone was placed on methadone maintenance for about 3 years now. They have improved their family relationships, improved their living situation, established some routines, and even improved their jobs – by all measurable standards have been doing great – then they decide they want to try to live with no opioids. Perhaps they want to have a family, maybe they moved somewhere they wouldn’t have easy access to the clinic, or they are genuinely just tired of taking medications every single day.

There is the “cookie-cutter-responsible” way of tapering came from the standard taper of slow tapering for months, even years off of methadone. The idea was to slowly have someone get use and stable at each decrease over time until they tapered off and can reach zero for their dose and that didn’t require serving. This will work beautifully for some, as they can slowly step-down and adjust each reduction of their medication until they have a dose of zero with out big problems. Many people use a standard taper with no issues until they are at a dose of 10mg, 8mg, 6mg, and any low-dose taper that is experienced the sick, it really really hurts and is really unbearable, to adjust body.

Some individuals have found that programs specializing in methadone rehab provide the intensive medical support needed when standard tapering approaches become insufficient.

The Excessively Complicated Medical Model No One Warned You About

What is most surprising in the value of methadone withdrawal is that methadone is a specific drug all of its own. Methadone has a very long half-life, so that means that methadone will stay in the body for days after the last dose of methadone was taken, and longer after any similar medication. However, it also has active metabolites that can impact someone for weeks. The brain has adapted to the presence of methadone, and so it takes time to adjust to functioning without it.

The psychological component is usually more difficult than the physical withdrawal. People describe the feeling as if they’re living in black-and-white after years of living in color. If there is a word to describe it, “depression” is not it, although that is certainly a part of it- it is more that one cannot feel pleasure or satisfaction from anything. Food does not taste good, music sounds flat, and nothing seems worth the time to do.

This is not a character flaw, nor a lack of willpower. It is a predictable neurochemical response to removing a medication that the brain has come to depend on. The good news is that it is temporary, but temporary can mean months, and months can seem like years while one goes through it.

Why Going It Alone Often Doesn’t Work

The medical establishment often treats anyone wanting to come off methadone as if they are making some sort of mistake. Attitudes are such that if the methadone is working, why rock the boat? People have genuine reasons to come off of methadone, and should be supported in their decision rather than judged.

Family doctor typically do not have experience with methadone withdrawal. They may recommend switching to a shorter-acting opioid first, or they may suggest an extremely slow taper that takes years. While this can work for some people, it may not be reasonable or effective for everyone.

Emergency rooms are also typically not equipped to manage methadone withdrawal. If someone experiences acute withdrawal, they may just be told to go back to the methadone clinic even if that is what they’re trying to no longer do.

What Helps

Discontinuation of methadone can generally only be accomplished with medical support. And in particular not just any medical support, but ones that understand the nuances of methadone withdrawal and medical providers who are experienced in helping people.

For some people, starting with buprenorphine first will work best, as it is often easier to taper off of than methadone. Others feel best using comfort medications that will address one or more of the withdrawal symptoms. And still some people need a residential program to be immersed in a complete focus on their recovery from substance use without the distraction of the outside world.

The psychological component of withdrawal is as important as the medical management. Those withdrawing need to understand that feeling sick is temporary and normal. It is not a sign that they are failing or they will never make it through the withdrawal. They need coping mechanisms to handle the inevitable depression and anxiety during withdrawal. Most importantly, they need people who understand what they are going through, and ideally there would be other people going through the withdrawal at the same time.

Beyond the Body: Building Life Skills

Recovering from methadone is not only about dealing with withdrawal. People who have been on maintenance therapy for years often have to relearn basic life skills. How do I deal with stress without a medication? How do I deal with physical pain? How do I fall asleep without a medication? How do I find some motivation when nothing feels rewarding? There is nothing simple about any of these and you shouldn’t have to figure it out all by yourself.

Recovery from methadone dependence often requires treatment. This could be therapy and/or support groups and/or changes in lifestyle. Sometimes persons recovering from methadone may require an outside medication for depression or anxiety.

Recovery can take months and maybe even years; that’s fine. There is not a common timeline everybody must conform to in order to find recovery from methadone. Sometimes people will discover that they are not fully ready to be off all opioids; and that’s okay. The goal is not to prove something to someone else, it is how to do something that works for each individual person.

Moving Forward with Realistic Expectations

Methadone has saved countless lives and continues to do so each day. And while acknowledging that it is helpful does not mean “forgetting” the drawbacks pertaining to some people’s constant, even wonderful, desire to stop methadone. It is possible to agree with the fact that methadone is a wonderful addiction treatment, yet stopping methadone is difficult.

People who are thinking about stopping methadone need accurate particulars about methadone and the complicated process in trying to halt its continued use. They need accurate and honest medical attention who recognize and appreciate their desires or goals, that will work with them to plan a palm to do this safely and realistically. Most importantly, they need to understand that their fight against withdrawal from methadone is not failing their recovery. It is a complex medical event and they require the related knowledge to be successful.