Why is methadone harder to “kick” than heroin?

Surveys have found that substantial numbers of MMT patients are concerned about difficulties in withdrawing from methadone, claiming it is harder to “kick” than heroin. However, this is a persistent myth that was long ago disproved.

A blind comparison study years ago at a federal facility for addiction treatment in Lexington, Kentucky, found that withdrawal symptoms actually were less severe in patients maintained on methadone than in those taking equivalent doses of short-acting opioids like heroin. Because it is long-acting, withdrawal from methadone does last much longer than withdrawal from short-acting opioids. Therefore, a person who has experienced “cold turkey” withdrawal separately from heroin and methadone might say that “kicking” methadone was worse – because it lasted longer. This is one way the myth might have started and it ignores the fact that methadone withdrawal should never be done “cold turkey” to begin with.

However, gradual withdrawal from methadone, when properly done under medical supervision, can be virtually free of discomfort. On the other hand, patients who try to withdraw from methadone by themselves, on their own time and dose schedule, almost always experience undue discomfort and fail.

Also, some patients forget that the reason they came into MMT was because they could not stay away from opioid drugs on their own. When they decide to leave MMT and find they cannot just stop taking methadone, they blame the methadone rather than the heroin or other opioids that deranged their brain chemistry in the first place. For many former illicit-opioid-addicted persons, methadone is a lifelong medication necessary for stabilizing brain function, much like a person with diabetes needs insulin every day to live a normal life.

Sources:

Rosenblum A, Magura S, Joseph H. Ambivalence toward methadone treatment among intravenous drug users. J Psychoactive Drugs. 1991;23(1):21-27.