Tapering Off Methadone: How to Stop Taking Methadone

Author: Lisa Conatser

Methadone treatment is a very effective intervention when recovering from opioid use disorder (OUD). Methadone can help combat withdrawal symptoms when detoxing from opioids and can even curb cravings for the substance after detox is complete. However, understanding how to stop methadone treatment can be a difficult process, as the length of treatment varies based on several factors, and it can be hard to know when tapering off methadone is the best choice.
In this article:

• What is “Tapering?”
• When Will I Start Tapering Off Methadone?
• Is it Safe to Start Tapering Off Methadone While Pregnant?
• Is it Safe to Start Tapering Off Methadone On Your Own?
• What Happens if My Symptoms Come Back During Tapering?

What is “Tapering?”

If you decide you want to stop taking methadone, your doctor will recommend tapering off of it. Tapering is a term used to describe the slow progression of lowering the dosage of a medication. Most medical professionals will begin tapering off methadone at a slow rate instead of stopping your treatment suddenly. This gives you the chance to see how you will react to the lower dosages and minimize withdrawal symptoms.

The goal of tapering is to give your body time to adjust to each new dosage and avoid unwanted withdrawal symptoms that can occur if you stop using methadone suddenly or don’t taper gradually enough.

The World Health Organization recommends changing your dosage slowly and reducing it by 5 to 10 mg per week until you reach a dose of 40 mg and then further reducing it by 5 mg per week.¹ Your doctor may use a different tapering dosage based on your situation.

When Will I Start Tapering Off Methadone?

How long you stay in methadone treatment will vary depending on several factors. Twelve months is considered the minimum amount of time a person will be in methadone treatment, but you could continue taking methadone for years or even for your lifetime.²

Many people choose to remain on methadone without ever tapering off because of its effectiveness in preventing a possible opioid relapse. Methadone is a safe way to manage your opioid addiction long-term when overseen by a medical professional.

Studies have shown that the longer you remain in treatment, the better your recovery outcomes will be.¹ Committing to your methadone dosing and other treatment recommendations from your team is the best way to ensure a full recovery.

What Are the Reasons to End Methadone Treatment?

Your methadone treatment may come to an end for many different reasons. Some of the reasons for your methadone treatment to end include:¹

• Certain health or psychological factors make methadone not an appropriate treatment option for you.
• You reach a point in your recovery process where medical professionals decide you no longer need methadone treatment.
• Adverse effects from methadone make it difficult to continue treatment.
• There is a reason for you to be completely “drug-free” (i.e., work-related stigmas or legal reasons).
• You are experiencing social pressure or harassment to divert your methadone to other people without a prescription.
• You have been caught diverting or misusing your methadone prescription.

Some people may experience adverse effects from methadone that lead them to taper off methadone. Some of the side effects of methadone are:³

• Difficulty breathing or shallow breathing
• Lightheadedness or feeling faint
• Hives or a rashes
• Swollen face, lips, tongue, or throat
• Chest pain, increased heart rate, or a pounding heartbeat
• Hallucinations
• Confusion or disorientation

Most people do not experience these adverse effects and continue taking methadone for years without negative impacts.

Is it Safe to Start Tapering Off Methadone While Pregnant?

If you become pregnant while on methadone treatment, you should talk to your doctor about your options. You may be concerned about how methadone will impact your baby, as exposure to methadone in utero may result in a newborn developing neonatal abstinence syndrome (NAS).⁶ Some of the symptoms of NAS include:⁴

• Body shakes, seizures, twitching
• Fussiness or excessive crying
• Poor feeding or sucking
• Slow weight gain
• Breathing problems
• Fever, sweating, or blotchy skin

Despite these symptoms, most medical professionals do not recommend tapering off methadone while pregnant, mostly because they do not want you to return to using opioids. If you were to relapse while pregnant, the opioids would be more harmful to both you and your fetus than the methadone treatments.⁴

Some of the other reasons why doctors do not recommend tapering off methadone while pregnant are:⁴

• An increased risk of spontaneous abortion before week 12 of pregnancy
• Possibility of premature labor if tapered after week 32 of pregnancy
• Experiencing withdrawal from opioids which can cause stillbirth and perinatal deaths

If your doctor does determine that it is safe for you to taper off of methadone while pregnant, you should be monitored closely throughout the tapering process.

Is it Safe to Start Tapering Off Methadone on Your Own?

Even though methadone is used to treat your dependence on opioids, it is also possible to become dependent on methadone itself. Methadone acts on the same receptors in your brain as opioids, and your brain can become reliant on it to continue functioning as it is currently.

Methadone is used to alleviate the withdrawal symptoms you experience when detoxing from opioids or manage cravings when in treatment, but you can also experience similar withdrawal symptoms if you suddenly stop taking methadone rather than tapering off.

Some of the withdrawal symptoms you may experience when stopping methadone are:⁵

• Feelings of agitation
• Increased anxiety
• Achy muscles
• Watery eyes
• Trouble falling asleep and staying asleep
• Runny nose
• Sweating and/or chills
• Increased yawning
• Abdominal issues such as cramping, nausea, diarrhea, and vomiting
• Dilated pupils

Withdrawal symptoms from methadone use are usually not life-threatening but can be very unpleasant. For this reason, you should always talk to your treatment provider before stopping your methadone treatment. When considering how to stop methadone treatment, tapering off methadone should only happen under medical supervision and not on your own.

What Happens if My Symptoms Come Back During Tapering?

Methadone treatment is only one part of dealing with opioid use disorder (OUD). After you taper off your methadone dose, you will continue to be monitored for signs of withdrawal or relapse. This happens through regular therapy appointments and check-ins with your medical health care provider.

Since methadone helps to curb cravings for opioids, you may find that cravings return when you stop methadone treatment. Continued participation in other treatment modalities is thus necessary to help prevent relapse. Your treatment team may recommend ongoing therapy, peer support groups, or family therapy to help with the underlying issues involved in your use of opioids.

What Are the Risks Associated with Ending Treatment?

If you have been in methadone treatment for a long period, some risks are associated with ending your methadone treatment, including:⁵

• Returning to opioid use
• Experiencing an increase in pain symptoms
• Feeling heightened depression or anxiety

According to research, the greatest risk associated with tapering off methadone is relapse.⁵ Returning to drug use after detox and treatment is a normal part of recovery, and it is why substance use disorders are treated as chronic conditions.

Your physician may resume your methadone treatment after a period of cessation if there are signs that you need to return to a methadone maintenance plan. If you experience relapse or increased opioid cravings after tapering off methadone, talk to your doctor and follow any recommendations for a new treatment plan.

If you or someone you know has a substance use disorder, please call 800-994-1867Who Answers? to learn more about treatment options that are right for you.

Resources

1. World Health Organization. (2009). Methadone maintenance treatment – Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. National Center for Biotechnology Information.
2. National Institute on Drug Abuse. (2018). How long does drug addiction treatment usually last?. National Institutes of Health.
3. Psychiatric Research Institute. (2022). What Is Methadone?. University of Arkansas for Medical Sciences.
4. Welle-Strand G.K., Skurtveit S., Tanum L., Waal H., Bakstad B., Bjarkø L., & Ravndal E. (2015). Tapering from Methadone or Buprenorphine during Pregnancy: Maternal and Neonatal Outcomes in Norway 1996-2009. European Addiction Research, 25(5).
5. National Library of Medicine. (2020, May 10). Opiate and opioid withdrawal: MedlinePlus Medical Encyclopedia. United States Department of Health and Human Services.