Withdrawal from methamphetamine (ice)

Compared with many other drugs, withdrawal from methamphetamine can be drawn out. When someone stops using heroin or alcohol, withdrawal symptoms typically peak on the first or second day and decline steeply over the next few days and within a week, the person is typically ready to start further treatment for preventing relapse. Alcohol and other drug services are generally designed around these timeframes.

However, the typical withdrawal pattern is considerably different for people with methamphetamine dependence. The withdrawal period is generally 10–15 days and there is often a crash period prior to withdrawal beginning.

Withdrawal from methamphetamine also differs from alcohol and other drug withdrawal in relation to symptoms. Symptoms of withdrawal from most drugs, such as heroin and alcohol, tend to be the opposite of intoxication—anxiety, high blood pressure and pulse, sweats, and insomnia are common.

Some symptoms of withdrawal from methamphetamine are not unlike those of intoxication—agitation, mood swings, insomnia—but with no euphoria. Other symptoms include:

  • Exhaustion
  • Flat, depressed mood
  • Lack of motivation
  • Poor concentration and memory
  • Anxiety, agitation, impulsivity, irritability
  • Sleep disturbance
  • Cravings to use methamphetamine 

When someone who has used methamphetamine long term stops using, they are usually exhausted and may be undernourished. For the first two or three days after stopping, the person might just want to sleep, eat and drink, and sleep again. Because of depleted neurotransmitter stores, they’re often irritable if disturbed during this time and generally should be left to rest with support if needed. It is usually after this ‘crash’ period, as it is sometimes known, that withdrawal actually begins. 

Formal withdrawal settings

An outpatient setting is the preferred option for withdrawal from methamphetamine dependence, except in cases of severe dependence where there is a risk of medical complications, polydrug dependence, significant mental health problems, homelessness or unsafe accommodation, or previous failed attempts to withdraw in the community.

Many people choose to withdraw in a residential setting, however, and due to the nature of methamphetamine withdrawal, adjustments to ‘business as usual’ need to be made to give people a chance to complete a difficult process.

Due to the typical crash or come down period, there may be several days in which people in withdrawal from methamphetamine are not in a mental or physical position to engage in much activity. Insisting people get up and go to groups or other activities may increase irritability and aggression.

Due to the extended withdrawal period—usually 10–15 days—if a person is discharged from a mainstream withdrawal unit in the more usual 5–7 days, they may not have completed the acute withdrawal phase and may be more at risk of using again on discharge.

Using withdrawal scales

Monitoring withdrawal provides crucial information for management to be stepped up or down in intensity according to the signs observed and symptoms described by the person experiencing withdrawal.

Less is known about methamphetamine withdrawal than other drugs. There can be a mix of symptoms similar and opposite to intoxication. Because the withdrawal time can be long and less predictable than other drugs with acute and subacute phases, the use of withdrawal scales can be helpful in determining the severity of withdrawal symptoms and to indicate when the acute phase of withdrawal has been completed.

Withdrawal scales have been developed to provide a standardised system of monitoring the course of withdrawal. Withdrawal scales can also be used to indicate when medications are required to treat symptoms, to trigger more intensive support if symptoms increase in severity, and to show when medications can be safely reduced or ceased as the withdrawal syndrome subsides.

Two validated withdrawal scales are in common use for assessing the course of methamphetamine withdrawal:

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