Methadone withdrawal: duration, symptoms, protocol

As part of heroin withdrawal, methadone is prescribed usually at 1 mg/kg. One plug globally covers 24 hours and will thus allow to have a fairly “normalized” life.

→ “The endorphinic system disrupted by the consumption of opioid drugs (heroin or derivatives such as morphine, codeine, etc.) must gradually rebalancing and produce again natural opioids, the endorphins whose goals are: euphoria, reduction of physical pain and psychological pain, failing which a feeling of malaise will persist. Some people sometimes resort to extreme behaviors to secrete endorphins, such as through, hyper sport, scarification, and thus feel temporarily soothed“, details Dr. Philippe Azevedo, addictologist.

→ During methadone withdrawal, you should be accompanied by a health professional and not try to go too fast to better understand the issues and know how to master them. “A total stop is not possible in a short time, it will take several months and can have the risk of a resumption of opioids and it is the consequences of the resumption which can be serious: consume again at similar doses before the stop and lead to an overdose, which unfortunately can be fatal; turn to another equally addictive product such as alcohol“, he adds.

→ The threshold of 30 mg of methadone is a stage at which the person in withdrawal will no longer have cravingsirrepressible craving.

→ To continue the decrease in treatment, we will adapt to the feelings of the person and consider increments of 5 mg per month or every 2 months for example. “The last 5 milligrams are sometimes very difficult to stop and it is in this case that the patient/doctor or caregiver pairing is fundamental”, insists Dr. Azevedo.

What is the dose of methadone in the event of withdrawal?

The average starting dosage of methadone is between 60-80mg. The goal is to reduce this treatment very gradually by an average of 10 mg/month to allow the internal production of endorphins to be relaunched naturally and to compensate for the effects of the shutdown which are the blandness of life with a drop in vital momentum, sadness, psycho-motor slowing, physical pain (hyperalgesia) and psychic.

When to go to the hospital?

Hospitalization as part of methadone withdrawal is not necessary : “the withdrawal being long, the person cannot stay a year in the hospital”. Sequential hospital care in day hospital or CSAPA (Centres for care, support and prevention in addictology) can be considered: “a person on 80 mg can be hospitalized for 2 to 3 weeks to consider a drop to 60 mg, go on an outpatient basis and then be rehospitalized“. Psychiatric comorbidities may appear or be unmasked during withdrawal and hospitalization for their management may be considered or necessary.

What are the symptoms of a lack of methadone?

The symptoms of a lack of methadone are quite unpleasant and resemble a “big flu syndrome” which will last several days with, in addition, a total lack of energy:

• abdominal and back pain;
• digestive disorders (diarrhea);
• rhinorrhea (runny nose), accompanied by watery eyes;
• piloerection (hairs stand on end);
• thermal dysregulation: feeling of hot-cold;
• irritability;
• sleep disorders (5-6 days later with disturbing nightmares), even insomnia.

“When these different signs appear, it clearly shows that the reduction, or even withdrawal from methadone, is too rapid. Weaning must be done according to the patient, his situation and his feelings“, he adds.

What to do during a withdrawal crisis?

The intensity of withdrawal symptoms is dependent on the current dose. A medicinal accompaniment based on melatonin, antihistamines, neuroleptics can then be put in place to help the patient contain their symptoms. “Benzodiazepines should be avoided and warn the person that on the sleep disturbances, it is necessary to avoid drinking alcohol at this time, that it will not help him to sleep. If we go at the right speed, cravings should not exist and the symptoms are very light and we will ensure that withdrawal and its effects are livable”, insists our interlocutor.

How long to completely wean off methadone?

The duration of withdrawal is quite long, depending on the person and their physiological and psychological balance. It is important that it is well integrated by the patient who may lose confidence in it during weaning. “In an 80 kg person, methadone will be reduced in steps of 10 mg per month. From 30mg, usually the decline is slower and weaning will be here arounda yearsee more“, he adds.

When do we speak of successful withdrawal from methadone?

“The end goal of methadone withdrawal is not necessarily total cessation. The person may stay on 5 mg of methadone for years and years,” he concludes.

Thanks to Dr Philippe Azevedo, addictologist, Paris.