Opiate Withdrawal.

[Squeaky]

I'm down now to 45mg/day oxy. I'm really considering cold turkey again. Tapering is like pulling off a bandaid really slowly, and I'm a really hairy guy!

 

[loveofmynephew]

Greetings fellow humans. I have joined this forum in hopes that I may get some direction with a tapering schedule for methadone detox. It is for my nephew who is 30yrs old. He has been on Methadone for 10 (yes I mean ten) years for a pill addiction. I am just a loving Aunt who is trying to save my nephew form this monster called "opiate addiction". Yes it is true that ANY addiction is awful, but if you have any experience with this particular demon you know where I am going.....or where he is going rather. So please if anyone out there feels like helping me, I would be forever grateful and promise to pay it forward.

 

[loveofmynephew]

So with Kraytom, don't you have to be completely opiate free for it to work?

 

[Squeaky]

loveofmynephew- He got on methadone at age 20, because of pills, and he's been on it for 10 years? There's more going on than what he's letting you see. Tapering schedules are available all over the internet.
My experience is that you may love him more than he loves himself and the only solution for him may be an inpatient rehab. But even then it won't stick unless he wants to get clean. Forcing a tapering schedule on an addict who doesn't want to get clean is likely to fail. Myself as an example: I want desperately to get off the opiates, but I have been failing for months now. Imagine if I didn't really want it.

 

[YMI_BISHoP]

I just went cold Turkey from 1g of H a day and 3+ 100mg morphine. Finally feeling "normal".took 1.5months

 

[loveofmynephew]

No HE WANTS IT. He is completely on board with what ever schedule, I am well aware that you cannot force someone. I was just hoping to get feed back on the taper. I don't want to push him off a proverbial cliff. I want him to succeed of course, so going too fast is what I want to avoid. He started at 68mg. I took him down to 45mg for 4 days. Fifth day (today) down to 25mg. Rough day but the sooner we can get to zero, the sooner we can start Kraytom. He has not even begun to w/d. Still does not even have runs or nausea but has had significant comfortableness. It about to get extremely REAL. Wish us luck.

 

[Squeaky]

loveofmynephew- That's awesome. I have been tapering down from 150 mg oxycodone and 8 mg Lorazepam per day. I have felt every damn step. Each time I reduced dose of either, I got some new and very unpleasant wd (insomnia, nausea, etc) on the first day and they last for 2 to 7 days. The normal taper schedules have not worked for me. I have done plenty of research and all I can tell you is that everyone is different. You are pushing hard at his taper, bordering on cold turkey. And failure is depressing enough to make anyone go out and get high.
If you have the means, keep him at 25 mg for 7-10 days. He'll be back to normal by then and you can go back to reducing dosage every 4-5 days.
Keep him away from processed sugars and any foods containing MSG(they amplify wd symptoms). No exceptions. All the Fresh fruits, vegetables, and meat he wants. Avoid cheese and milk. Read the labels on everything and cook every meal at home until he is through. A full stomach is the second biggest natural way to 'get high' (sex is the first). Junk food gets you higher, but comes with wd's of its own.
Stay away from alcohol. I've gotten drunk while in wd and the hangover was just insult to injury.
Lastly, try and plan for something to help him sleep if he has problems. Insomnia + withdrawls = where the F is my methadone! Benzos are great if you can get them, just don't use more than 2 or three days in a row. Benzo wd is way worse.

 

[Squeaky]

Also, anything you can do to keep him distracted will help immensley. Movies, video games, etc. Sitting around staring at the clock is murder.

 

[loveofmynephew]

OMG Squeaky that is great advise. I do have enough to keep him at 25mg. for 5-6 days. He is not aware of how much I have, I thought that best. It makes sense to keep it a steady 25mg to stabilize him. Then would you say a 10mg reduction from there? I have also encouraged him to lay off the processed food, but he has terrible eating habits! I do need to buy some fresh fruits and I noticed another post about coconut water for when he starts diarrhea & nausea. thanks again.

 

[Squeaky]

You can't stop him from craving McD's and soda, but you can entice him with steak , fried potatoes, and homemade lemonade. And cook extra so he can take meals and not be hitting the drive-thru. PM me if you need directions how to cook a great steak on the stove.
As for coconut water, that stuff makes me nauseous. You should try it but it may not help. Saltine crackers work best for me.
Figure out how much methadone you have, then design your taper plan on paper. Usually 10% per week reduction is painless, but if you need to go faster.... Try not to do more than 50% reduction per 5 days.

 

[loveofmynephew]

Well yesterday was rough. Today he seems to have stabilized on the 25mg dose. We smoked some weed last night which he said helped him a ton. We also watched some comedy movies bc laughing is natural endorphins, right? His color is back but I am going to keep him at 25mg for a couple more days. I figured 4 more days, then down to 15mg. for 4-5 days. then 5mg.
I actually got lucky, and a friend of mine GAVE me the Methadone. Her husband passed away from lung cancer & she had a whole bunch left over. She said that she would rather give it to us to save his life, which is amazing of her. We had been relying on the clinic to taper which was a nightmare. So I believe things just fell into place for him and I could not be more grateful. Also Thank you Squeaky for responding to me, and sharing your advise. I feel so much more confident that he will be okay.

 

[Squeaky]

My prayers are with you and your nephew. Anybody can live through cold turkey. Tapering is all about making life suck less while you're getting your body used to not having the drugs. He is lucky to have your help. I'm doing it on my own and failing miserably.
Keep going to the clinic if you can and keep the extra meds locked up. Don't tell them about your friends gift. If you have any problems in the next few weeks, you will be better off having the reserve methadone. You can destroy it when he us done (or pay it forward and help someone else with tapering?) Imagine your house gets burglarized or there is a fire- the clinic is not going to help out and replaced the lost medications. This would be bad advice for an addict on his own since he would just use it and get high, but since you're there to play traffic cop it would be smart to stash some for an emergency.

 

[Sunriseoversea]

Listen...I can tell you, without a doubt, that Kratom can help diminish suffering during opiate Wds TREMENDOUSLY. I was a non-believer until I tried and let me tell you...it saved me. There are MANY others who have used Kratom and I would never suggest anything that didn't work. I WD off of Fentanyl once without it and it was literally the worst experience of my life. Then, foolishly I got involved with fent again and this time, when I WD, I used Kratom and it made WDs so much more manageable that I couldn't believe it. It was literally a miracle for me. Once you get your dose right, you can use anywhere between 3-5 grams every 5 or 6 hours, sometimes more or less, and after a week or 10 days, you can begin backing off on the Kratom. After a while, you'll experience PAWS, which sucks very hard, and Kratom can even help alleviate the anxiety and depression that you have to deal with. So yes...no kidding...more people should be aware of Kratom and it's effectiveness for Opiate WDs.

Im reading this thread cause im quiting oxy now. Big tolerance, like 840mg/4 days. It all started after hip and back surgery. I detox from fentanyl patches but oxy its so hard. Been on them again for 3 weeks and NEED TO STOP. I have Kratom and not much else. Gonna buy Loperadime and what else? Thanks for the advice on Kratom. I now it works for PAWs but never tried it for actual w/ds in CT.
Squeaky: Reading your story has help tremdously. Thanks for sharing it. Im so afraid of the pain..That Im thinking about Tapering. Fuck fuck.

 

[loveofmynephew]

hey Mariconix, did you take the Kraytom after you were at 0 opiates? Bc from what I understand you have to be off all narcotics for it to be able to bind to the receptors. I am just making sure I understand correctly. Good luck to you.

 

[Sunriseoversea]

Hey Loveofmynephew, yes I was off all opiates when I started taking Kratom. I was to help with the PAWs, like I still had big chills and felt cold all the time with not much energy and lack of sleep. I did wonders.And it doesn't bind to the same receptors as the opiates. Receptors mu for kratom and receptors ? for opiates ( dont remember now). But never had it on full w/ds...not yet. Thanks a lot. How is your nephew doing? Ive read a bit about it.

 

[loveofmynephew]

he is not doing well. Another rough day, and he asked me for more than his 25mg dose of Methadone this afternoon. Of course I told him no, that we gotta stick to the plan. Doing any more is going backwards. He is mad at me but I know it is best. I suggested a hot shower, maybe a couple hits of weed. He settled for a Valium. I know we just gotta get through it. It breaks my heart to watch him suffer this way, I know all to well what he is going through, been there more than once I am ashamed to admit. But it is the way of opiate addiction.

 

[VastEmpty]

he is not doing well. Another rough day, and he asked me for more than his 25mg dose of Methadone this afternoon. Of course I told him no, that we gotta stick to the plan. Doing any more is going backwards. He is mad at me but I know it is best. I suggested a hot shower, maybe a couple hits of weed. He settled for a Valium. I know we just gotta get through it. It breaks my heart to watch him suffer this way, I know all to well what he is going through, been there more than once I am ashamed to admit. But it is the way of opiate addiction.

whoa...this taper feels wayyyyyy too fast, what is the rush?

- VE

 

[Jabberwocky]

whoa...this taper feels wayyyyyy too fast, what is the rush?

- VE

Precisely. Why are you two taking this so darn quickly? The dude's got the rest of his life to recovery. It is hardly reasonable to expect him to do it in a few months. I'll elaborate bellow... Please don't take what I'm going to say personally. Yes, it is directed at you. Yes it is fairly confrontational, but frankly you two need to be confronted about what is going on. At thing stand now, nephew is on a quick road to relapse.

Well yesterday was rough. Today he seems to have stabilized on the 25mg dose. We smoked some weed last night which he said helped him a ton. We also watched some comedy movies bc laughing is natural endorphins, right? His color is back but I am going to keep him at 25mg for a couple more days. I figured 4 more days, then down to 15mg. for 4-5 days. then 5mg.
I actually got lucky, and a friend of mine GAVE me the Methadone. Her husband passed away from lung cancer & she had a whole bunch left over. She said that she would rather give it to us to save his life, which is amazing of her. We had been relying on the clinic to taper which was a nightmare. So I believe things just fell into place for him and I could not be more grateful. Also Thank you Squeaky for responding to me, and sharing your advise. I feel so much more confident that he will be okay.

What is his actual plan with this taper?

What is your actual plan with this taper?

I don't mean to be unduly harsh, I understand you just want to see him happy and healthy, but it really doesn't sound like you have actually any kind of planned taper, that you two are at best simply winging it with little understanding of how tapers really work, and that the goal is simply to see him off methadone, as opposed to the much more significant goal of increasing his quality of life. This is (his taper), after all, about his quality of life - not yours.

What I must emphasize is that what he has been doing with his taper is RADICAL in the extreme. There is absolutely no reason anyone should ever have to taper this fast without some kind of administrative reason from legal authorities, his clinic or prescribing doctor. No good doctor would suggest any kind of voluntary taper deceases by more than 5mg a week PERIOD. No good doctor would encourage him to taper more than 2-3mg a week once he as the 30-40mg mark. And no doctor that has any clue about what he is doing would ever suggest tapering faster than 1mg a week once he is at the 20mg mark. Any good doctor would let him set the pace for the taper and NO ONE else, regardless of their relationship to the person tapering, no matter how well intentioned OR well informed they were - or even if the patient requested such.

So lets see... A reasonable taper with the best chances of him transitioning off safely, one that isn't likely to lead to an inevitable relapse and return to more harmful patterns of substance use than taking methadone (and quickly at that!) would take about...

Starting at 68mg...
Month 1: 68mg-->63mg
Week 2: 63mg-->58mg
Week 3: 58mg-->53mg
Week 4: 53mg-->48mg
Month 2: 48mg-->43mg
Week 6: 43mg-->38mg
Week 7: 38mg-->35mg
Week 8: 35mg-->32mg
Month 3: 32mg-->29mg
Week 10: 29mg-->27mg
Week 11: 27mg-->25mg
Week 12: 25mg-->23mg
Month 4: 23mg-->21mg
Week 14: 21mg-->19mg
Week 15: 19mg-->18mg
Week 16: 18mg-->17mg
Month 5: 17mg-->16mg
Week 18: 16mg-->15mg
Week 19: 15mg-->14mg
Week 20: 14mg-->13mg
Month 6: 13mg-->12mg
Week 22: 12mg-->11mg
Week 23: 11mg-->10mg
Week 24: 10mg-->9mg
Month 7: 9mg-->8mg
Week 26: 8mg-->7mg
Week 27: 7mg-->6mg
Week 28: 6mg-->5mg
Month 8: 5mg-->4mg
Week 30: 4mg-->3mg
Week 31: 3mg-->2mg
Week 32: 2mg-->1mg
Month 9: 1mg-->0mg

That is the kind of taper any good clinic or prescribing doctor who has any clue about how methadone works would be recommending. And here I need to emphasize that...

The thing about a taper is that, just as how the patient ultimately decided upon their maintenance dose was when they stabilized on methadone at the beginning of treatment, the taper needs to be set by a schedule determined by the person actually doing the taper - and not any other authority figure, friend or loved one. The schedule I have suggest, as long as it might seem to you, is even then a fairly speedy taper. The majority of successful tapers tend to require for taking a week off here, particularly around the 30mg, 20mg and 10mg marks, whenever the patient feels the drop too much.

When done properly (pun intended %)), the patient shouldn't feel much significant issue with his or her weekly dose drop until around the 20mg mark. Again let me highlight that your nephew's dose should NOT be dropped more frequently than one a week to once every five days. That is how long it takes his body, at least, to adjust to each new dose. Not doing that will simply cause completely unnecessary pain and suffering for the person tapering. And I know you don't want to contribute to that with all he is going through right now.

How has your nephew been tolerating this "taper"? Does he have any comfort meds to help secure his transition off methadone (particularly concerning the radical nature of the rate he is tapering at)?

I'd also be very curious to hear your nephew thoughts on the the tapering process as he's experiencing. Truly, it sounds like something you are controlling according to what you have experienced for yourself and your own personal (negative, stereotyped beliefs about MMT) and not the person going through the actual tapering process. And that is very dangerous when it comes to his role he's going to play in his ongoing treatment and recovery post methadone.

Let me try and put this tapering business in a little perspective:

I spent 2.5 years on methadone. Before I started MMT I was using approximately 3-6grams of high quality street heroin every day by IM injection.

The first six months I went up to 90mg. The second six months I went down to 65mg.

It took me a whole one and a half years to comfortably and successfully come off that 65mg (I had only been on methadone up until then for a year, not 10! Only imagine how much more challenging it would be for someone with 10 times as much of a dependency to methadone as me).

When I finally was able to come off methadone I was able to do so successfully because I had secured the necessary medications for the withdrawal that is nearly inevitable with methadone tapers.

That included using codeine for three days after dropping to 0mg methadone to allow me to smoothly transfer to 2mg buprenorphine (Suboxone) twice a day, 10mg of diazepam (Valium) twice a day, 800mg of gabapentin (Neurontin) three times a day, 0.2mg clonidine twice a day and 150mg trazadone at night, all used for another week. The acute detox (which only took about ten to fourteen days) was followed by a hard core intensive outpatient program lasting 90 days and living in a sober housing unit.

All that taken together ended up leading to a highly successful taper off of methadone with very, very little pain or suffering. The detox was next to entirely painless outside of some malaise (minor depression), sloth (tiredness of body) and torpor (tiredness of mind). I just realized the other day that is has been well over six months since I got off methadone. I honestly never think about it. Since beginning the actual detox off methadone (day 0mg), I hardly have had craving for opioids, only knowing too well all the hardships I had to endure to achieve such a successful taper and detox. I'd think about using and my mind would go directly to all the damn energy, time and resources I applied to my taper and detox. When I think about opioid now, I simply get a little nauseous and remind myself how they fucked my life up.

I never cease to be amazed that, despite all the horror story misinformation and stigmatized bullshit that is out there about getting off methadone, that is was really that easy. There is really no reason it has to be unnecessarily hard for ANYONE, whether you've been on it two years or ten. I would imagine, given the choice and ability (you seem to at least have the choice), you'd want something as productive and successful for your nephew.

Successful tapers, and coming off successful tapers, IS HARD WORK with a HUGE commitment, one required by all involved. You're in this for the long haul after all, both for the patient but also for supportive family and loved ones that are involved in the process. This kind of thing is best not rushed, at least assuming the goals include long term sobriety, abstinence and recovery form long standing harmful patterns substance use.

A hell of a lot normally goes into a successful taper. You can do them faster than I have described. You can even do them with any detox meds. However, such individuals are very, very, VERY rare. Like fucking unicorns man. Only one's I've every really heard of or met were folks who did extended detoxes using methadone (from start to finish they were only using the medication for six months). Frankly your nephew doesn't sound like one of these classes of people.

And, I apologize if any of this came off as harsh. Methadone is just so far from the "demon drug" people make it out to be. It might not be the panacea that the uninformed might refer to it as (though I've NEVER heard it referred to as a panacea in any circles), but that sure as hell doesn't mean that there is anything demonic about the stuff. It's substance. All depends on how it is used - and with methadone there are some highly beneficial things its control used can accomplish.

I mean, MMT/BMT is the current pinnacle of treatment when it comes to heavy long term opioid users trying to get into recovery. There is just so much misinformation and stigma surrounding methadone, MMT and MAT - all despite the fact that MMT is more than ten times more effective at getting patients clean and sober and off opioids longer term compared to any primarily abstinence (or abstinence-only) based therapy. It has been around for over 40 years by this point, and such information is well document and researched by folks in the field. Compared to the quality of the research conducted on MMT patients, there is nothing that can compare used to attempt to treat folks with moderate to severe opioid use disorder. Furthermore, MMT is generally between 100-155% less expensive than the vast majority of inpatient abstinence based treatments (in the states at least - compared $60,000-20,000/months for inpatient 30 day stays in rehabs based on the abstinence-only model to a mere $400-200/month for 30 days of MMT).

When it comes to long term users with severe opioid use disorder (sounds like your nephew might quality), MMT/BMT is beyond the best choice for treatment, particuarly when combined with therapy, a private psychiatrist and community support (self help groups most commonly, but also Mindfulness Based Stress Reduction communities - which are actually probably much more effective than mere 12 step participation).

I know you want long lasting recovery for your nephew. But it is very likely this isn't what you'll get if you continue doing what you're doing for/to him.

Tapering can be a complex matter, particularly when one is as unfamiliar with it as both you and he seem to be. At the very least, when it comes time to come off methadone, ESPECIALLY if you keep doing is as you guys have been doing it, your nephew needs to get his butt into a buprenorphine program ASAP. That will give him the best possible chance of maintaining abstinence in early recovery.

And please remember, taking methadone or buprenorphine DOES NOT mean one isn't sober or isn't abstinent. Such an individual is utilizing a substance prescribed to them for legitimate reasons and, particularly if they are using it strictly as prescribed (as most do), saying someone like that on MMT or taking Suboxone isn't clean or isn't sober or isn't abstinent is no different than telling someone taking propranolol for anxiety (a rather benign beta blocker) or telling someone trying to quit smoking using Chantix or treat depression using Wellbutrin that they aren't clean/sober/abstinent just because they are utilizing what modern medicine has to offer.

In other words it is pretty damn ridiculous.

 

[VastEmpty]

^ Im afraid TPD is right. If you want your nephew to have to best possible opportunity at success, please get him back to the methadone clinic. If that one didn't work, find another.

Has he considered maybe switching to another maintenance drug and reducing off of that?

Please stabilize him at a safe dose and proceed from there. Best of luck to you both!

- VE

 

[Sunriseoversea]

Toothpastedog, can I ask you some advice on tapering oxy? I really don't know how I should do it or if I should do it or just CT...And if I don't start now, It will become harder and harder.
Thanks.