There are several methods for getting off methadone, none of which are pain-free. Going "cold turkey" — or suddenly stopping the use of methadone without using any medications — is the most painful of all the possible ways to remove the drug and its lingering effects from one's system. Less difficult ways include tapering off the drug, using partial agonists to help control withdrawal symptoms and rapid detox.
The effects of the cold turkey method for getting off methadone are known to be twice as intense as well as twice as long as when getting off morphine or heroin. Sleeplessness, anxiety, nausea and many other very serious symptoms are all associated with getting off methadone. These effects of withdrawal often last about a month, getting less and less severe as time goes on, but it is not unheard of for them to last longer. This is because of the long half-life of the drug — 15-60 hours — which is the amount of time after getting off methadone that it takes for one's body to essentially digest and clear the chemical from the body.
Even after the body is methadone-free, withdrawal symptoms can persist because of the brain's inability to produce the neurotransmitters that the drug mimics. Getting off methadone via cold turkey can result in death because of breathing problems that can occur just a few hours after the effects of the last dose have worn off. Therefore, one should always consult a doctor and a psychologist when attempting to quit cold turkey and should have friends and/or family members around to keep an eye out for dangerous symptoms.
The next simplest way is by tapering off the drug one week at a time. The recommended amount of tapering per week is 1 milligram. This should decrease withdrawal symptoms to a tolerable level so that the person can continue to go about his or her regular, day-to-day activities. This is good because the tapering process can take up to a few years to complete if one starts at a dose of 100 milligrams or more. Still, some not uncommon side effects of this method include a less-intense version of sleeplessness, anxiety, body pain and more.
To make the tapering process easier, another method includes buprenorphine-containing drugs as a step between regular tapering and complete cessation. Heroin and methadone are agonists, meaning that they bind to receptor sites in the brain to produce a flood of pleasure, but buprenorphine is only a partial agonist. Partial agonists also bind to receptor sites and cause a release of the same neurotransmitters, but at a much lower, less pleasurable level. Drugs with buprenorphine are therefore ideal for slowing down the tapering process while switching to a drug that has less serious symptoms of withdrawal when the process reaches an end.
Another drug used for methadone addiction is a combination of buprenorphine and naloxone, which is a fully competitive antagonist. This means that it binds to the same receptors as the opiate agonists but does not start the pleasure-inducing chain reaction of neurotransmitters. The fact that it is fully competitive means that it will compete with agonists for receptors, and it will often win. Antagonists such as naloxone keep the addict from taking opiates after he or she has gotten off methadone because the opiates will not be able to bind to receptors that are taken up by the antagonists and will not produce euphoria because of this.
Perhaps the easiest, yet most expensive, way to get off methadone is through rapid opiate detox methods. This is a physician-run procedure in which the patient is taken to an intensive care unit and, under the supervision of an anesthesiologist, is put under anesthesia for a few hours. During this time, full opiate antagonists are injected into the body, compete for opiate receptors and eventually win out completely. By the end of the treatment, the body is cleared of opiates all together, because they will have no place to bind and will therefore be discarded. This results in extreme withdrawal because of the rapid time frame in which the brain is emptied of all pleasure-inducing chemicals.
The brain also needs quite a while to replenish itself with a few of its own, natural pleasure chemicals. As soon as the patient wakes up from anesthesia, he or she is given sleeping pills or sedatives to allow him or her to sleep through the rest of this period. Afterward, another antagonist, this one only partially competitive, is prescribed to keep the former addict from relapsing.