Tapering off Methadone

A methadone taper is a common way to treat opioid addiction. However, methadone itself is rarely tapered, as it can lead to a return to opioid abuse.

Methadone is one of the most frequently prescribed medications for opioid use disorders. The drug itself is an opioid, but it is often used for detox purposes because it relieves withdrawal symptoms and reduces a patient’s dependence on more powerful opioids. Methadone is frequently used because it:

• Helps you avoid uncomfortable withdrawal symptoms
• Stays in the system longer than other opioids, meaning it satisfies cravings
• Is standard at rehabilitation centers as part of a tapering program, which involves a slow and steady reduction of the medication

Experts recommend that people struggling with opioid addiction should continue methadone indefinitely to avoid returning to opioid abuse. According to one study, only 13% of people who ended methadone use remained opioid-free over the long term.

Tapering Off Methadone

A methadone taper can refer to two different concepts. One involves using methadone as a tapering tool to end opioid use. The other involves tapering off methadone itself. Tapering off methadone is much rarer, and it is not recommended for people struggling with opioid use due to the risk of withdrawal symptoms like: 

• Flu-like symptoms: A patient’s nose may run, and their eyes may water profusely.
• Insomnia: Lack of proper sleep is common during withdrawal.
• Joint pain: Aching and throbbing pain can occur throughout the body. As a result, the extremities may feel weaker than usual.
• Sweating: The nervous system will attempt to regulate the body’s temperature, sometimes resulting in sweating.
• Nausea: Upset stomach and even vomiting are common during tapering and detox. This is the symptom that most people associate with withdrawal.
• Cramping: Patients may exhibit varying degrees of abdominal pain. Constipation may also be present.
• Convulsions: The body may make jerky, erratic and uncontrollable movements.
• Psychological side effects: Depression, anxiety, panic attacks, depersonalization and self-doubt may appear. These symptoms typically occur in the mid-to-late stages of withdrawal.

Types of Methadone Tapering Methods

Different tapering methods exist, including direct, substitute and titration tapers. Legal prescription drugs like methadone should be tapered by the direct tapering method.

Direct Tapering

In a direct taper, the methadone dose is slowly decreased over time until you are fully weaned off the drug. If you have taken methadone for more than a year, the methadone dose should be reduced by 10% every month or reduced by 10% each week if you have taken methadone for less than a year.

Substitute Tapering

Substitute tapering is rarely used with methadone. Instead, this strategy can be used when a person is taking an illegal drug like heroin. A doctor can’t prescribe an illegal drug, so the illicit opioid is first converted to a legal drug like methadone. The methadone dose can then be reduced over time in a direct taper.

Titration Tapering

Titration tapering is not recommended. In this strategy, you attempt to dissolve a drug in water and take progressively smaller amounts daily to taper it slowly. However, not all drugs dissolve in water, which can make titration tapering dangerous, as the quantity you consume can be unpredictable. For example, methadone is not completely soluble in water.

Why Consider Tapering vs. Stop Methadone Cold Turkey?

Quitting methadone cold turkey is not recommended. This is because suddenly stopping the drug can lead to withdrawal symptoms, which can be very uncomfortable and can increase your chance of relapse as you attempt to seek relief from the symptoms. Instead, a methadone taper slowly eases you off the drug, allowing your body to gently adapt to being without methadone and avoiding withdrawal symptoms.

Common Methadone Opioid Withdrawal Symptoms

Methadone withdrawal symptoms are similar to other opioids and include:

• Muscle aches 
• Insomnia
• Increased tear production
• Sweating
• Runny nose 
• Yawning
• Enlarged pupils 
• Abdominal cramps
• Diarrhea
• Goosebumps 
• Nausea and vomiting
• Agitation
• Anxiety 

Side Effects of Methadone Tapering

When done under medical direction, a methadone taper should be largely free of side effects and withdrawal symptoms. This is because a taper is specifically designed to gently ease you off methadone to avoid withdrawal symptoms. If you should experience symptoms, this is a sign that your taper may be proceeding too quickly and needs to be slowed.

Methadone Opioid Withdrawal Timeline

When a person suddenly stops taking methadone, withdrawal symptoms often start within 30 hours of the last dose of the drug. Symptoms intensify over the first three to eight days and then resolve around 10 days after the last dose of the drug, although resolution may take several weeks in some cases. Some symptoms like anxiety, depression or insomnia may linger for an additional few weeks to months.

Medications Used When Tapering Off Methadone

Sometimes, medications are prescribed to help the tapering process. Often, this is done as part of medication-assisted treatment (MAT), where medications can be prescribed to help wean you off a drug, preventing relapse and increasing your chances of sobriety.

Methadone

Methadone is one of the gold-standard medications prescribed to prevent and treat opioid withdrawal symptoms. Some people may stay on methadone indefinitely if medically necessary.

Buprenorphine (Sublocade, Suboxone)

Buprenorphine is an alternative to methadone and is another gold-standard medication for opioid withdrawal. The drug comes in oral dosage forms like Suboxone, a combination medication with naloxone and injectable dosage forms like Sublocade.

Naltrexone (Vivitrol)

Naltrexone is avoided during a taper because it is an opioid blocker that can trigger withdrawal symptoms. Following a taper, naltrexone may be prescribed to help you avoid relapse. Naltrexone is not a first-choice medication but is available as an alternative to methadone and buprenorphine.

Naloxone (Narcan)

An opioid blocker like naltrexone, naloxone is rarely used on its own during tapering because it can trigger withdrawal symptoms. However, naloxone is an ingredient in the combination drug Suboxone, which is prescribed to treat opioid withdrawal. Your doctor may also prescribe naloxone after your taper to help you avoid an overdose if you relapse.

Can Tapering Your Methadone Intake Reduce Withdrawal Symptoms?

Using a methadone taper can help reduce your withdrawal symptoms, if not avoid them entirely. This is because the point of a taper is to ease your body off methadone so that it is gently weaned from the drug. By slowly reducing your methadone intake over time, your body gets used to progressively smaller doses of the drug.

How The Recovery Village Uses Methadone Tapering

The Recovery Village uses methadone and buprenorphine tapering as medically indicated to help you treat or avoid withdrawal symptoms. Our doctors and nurses are with you every step of the way to avoid withdrawal symptoms and overcome methadone addiction. Contact us today to learn more about how we can help.

Editor – Abby Doty

Abby Doty graduated from Hamline University in 2021 with a Bachelor's in English and Psychology. She has written and edited creative and literary work as well as academic pieces focused primarily on psychology and mental health. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more