Should I expect withdrawals from 5 milligrams of methadone? Yes, you should. Even though this is a low dose, just about any amount of this powerful drug will produce some degree of withdrawal symptoms if suddenly stopped or even if gradually reduced. Tapering is always better than sudden cessation, but it’s not a guarantee that you will escape withdrawal altogether. The degree of withdrawal would also depend on the past use history of methadone. For example, someone taking 5 milligrams after a long taper starting with 60 milligrams will likely have more problems with withdrawal than someone who has never taken more than 5 milligrams a day. Of course, someone taking 5 milligrams of methadone daily for a short time, perhaps less than two to three weeks, may not experience any withdrawal symptoms. This period of time may not be long enough for withdrawal-causing brain changes to occur. This will vary from person to person.
Methadone is a synthetic opioid developed in Germany around the time of the second world war. The Germans, master chemists, were concerned about supplies of opium being cut off by the Allies. They needed opium to extract morphine for their injured troops. The new compound, named Dolophine after Adolph Hitler, proved to be a superior pain killer, even better than morphine, and it could be given by mouth or injection. Methadone is at least three times stronger than morphine and is far more active orally. In fact, methadone has an astonishing 80 percent bioavailability or BA. This means that 80 percent of the ingested dose, even by mouth, actually reaches the brain, where it works on special receptors there to relieve pain. Morphine’s oral BA is less than 50 percent. Methadone also has a long half-life, meaning that a single dose may last up to 24 hours, depending on patient needs and other factors. In any event, it’s far more long-acting than morphine is.
For all of its analgesic and sedative power, methadone produces little euphoria, especially when compared to oxycodone and hydrocodone. Although both of these are weaker than methadone, they can produce a soaring euphoria leading to addiction in some individuals, although certainly not in everyone. Because methadone produces less euphoria and is long-lasting, it’s often used for the treatment of opioid withdrawal and addiction. The same is true for buprenorphine, popularly known as Suboxone. It produces even less euphoria and may remain active for several days on the brain’s opioid receptors.
Methadone Withdrawal
Methadone produces a withdrawal syndrome similar to that of all other opiates and opioids, although these tend to be delayed by as much as a few days. Typically, methadone withdrawal will begin with feelings of anxiety and restlessness some 24 to 48 hours after the last dose. Drug cravings set in. Other symptoms include:
- Nausea and vomiting
- Insomnia
- Diarrhea
- Bone and muscle pain
- Restless leg syndrome
- Stomach pain
Withdrawal from methadone tends to last longer than that of most other opioids. The severity tends to be dose-dependent and 5 milligrams may not result in very severe symptoms. They may even be manageable at home, assuming the person just wants to quit the methadone and isn’t addicted to it. Physical dependence isn’t the same as addiction. Someone who is only physically dependent doesn’t feel any compulsion to take the drug for reasons other than pain relief. On the other hand, an addicted person will continue to crave methadone and possibly other opioids as well, even though there may no longer be a medical reason for taking an opioid. This person, while they may be able to make it through withdrawal at home because the symptoms will likely be mild, will still need drug rehab treatment because the risk of relapse is extremely high.
Anyone addicted to a substance should seek further drug rehab treatment without exception. This may not necessarily mean residential treatment. There are many excellent options available on an outpatient basis, especially for those highly motivated to remain sober. Withdrawal or detox is only the first step. It’s an important one because no further substance abuse treatment can occur until someone has completed the withdrawal process and no longer has their drug of choice in their system. Rehabs generally require total drug abstinence for at least ten days before recovery treatment can begin. It really doesn’t matter if the detox was completed at home or under medical supervision, but certain drugs should never be suddenly stopped without medical advice and supervision. Withdrawal from methadone and other opioids is typically not physically dangerous, but alcohol, barbiturates, benzodiazepines and any kind of hypnotic drug can produce life-threatening symptoms if suddenly stopped. Always consult with a drug treatment medical professional if any of these drug classes are involved.
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