Bomb319
Bluelighter
- Joined
- Nov 26, 2011
- Messages
- 583
This all began with an anonymous Bluelighter asking me a question via PM. It took me so long to answer thoroughly and drew upon my vast and numerous experiences with methadone so thoroughly, I thought that I may as well modify it somewhat for a general audience and then post it on the main boards in case it can help anyone else going through methadone withdrawal, which I certainly know can be an unpleasant beast to say the very least! I hope the tone and advice given in this topic are appropriate for this board, and if this is not the case or there already exists a very similar topic, mods can you please move it to the ideal location, or remove it if necessary or advise me to do so? I am aware that there are likely several similar guides that are written with respect to ALL mu receptor agonists, but I wanted to include this one because I composed it with ONLY METHADONE IN MIND. As I've been on methadone maintenance for over 7 years now, I feel as though I'm in a good position to offer such advice and tips should anyone care to read them.
I really and truly tried to emphasize safety and harm reduction here, however it still contains techniques and drugs that may be EXTREMELY UNSAFE OR EVEN DEADLY if used either with a methadone dose itself, or used after a period of withdrawal where tolerance has dropped without the user being aware of this fact; methadone withdrawal usually lasts an INSANELY long time, and it's not only possible, but actually PROBABLE that significant opioid tolerance is actually lost, even if it feels as though withdrawal is relatively early and/or has not yet peaked. As a result, I once again implore any users of this guide to do so as a tool, NOT as a way to get high(er) and NEVER to use any of the options I've listed without thorough research, and preferably a VERY good idea of your current tolerance.
That said, I hope these common and typically widely-known options can be useful as short-term solutions for anyone to help mitigate the suffering, indignity and horror of the effects of this very powerful drug.
---
MY EXPERIENCES WITH, AND TIPS FOR EASING METHADONE WITHDRAWAL - (ALL OF THE FOLLOWING TIPS ARE METHODS I HAVE USED MYSELF MANY TIMES, BUT MAY POSSIBLY BE UNSAFE IN OTHERS)
First of all, please try not to feel too badly or guilty if you have relapsed, or if you have been using some of your methadone take-homes early (something that should never be done, but can cause excessive guilt which may impair recovery); I admit that I'm guilty of the same thing, and I have in fact regularly experienced withdrawal by the end of the week because of it
Even though I KNOW that is what's going to happen when I take more than I'm supposed to, I just can't seem to moderate when I have any opioid-related product around, and I still somehow manage to lie to myself, thinking the WD won't be so bad this time (and sometimes it truly isn't - the variability in the way it affects me is still a great mystery to me even 7 years after beginning maintenance!). Even when I don't have much serious WD, I still nearly always get enormous anxiety while waiting to pick up my next week's worth of prescriptions...often partly due to the fact that I can't be sure how much worse it's going to get, and if I'm going to be throwing up before I can take my dose which often does happen, and takes a LOT out of me having to worry about going out while sick and possibly throwing up my methadone dose on top of it.... I just seemingly have zero control when opioids are around, and the methadone alone really does seem to wear off for me more rapidly than it should, which is what leads me to take more or take my next dose early.
Anyway, sorry for that bit of a tangent
I have to first point out the fact that by potentiating your methadone even mildly, your withdrawal WILL be that much worse when you run out, and it is of course much better to space out your doses, and confide in your doctor about what has been happening. I know that isn't what you want to hear right now, and it's not what I would want to hear either. I simply feel obligated to mention it because you and I both know that this would provide a much longer-term solution, and what you're going to end up doing is simply going to make you that much more miserable and that much more difficult to eventually come off of. I can tell you all of this from personal experience - very frequent, often hellish personal experience, although my problems are mostly due to the extra doses I'm taking and not so much via any potentiation which I rarely try anymore. That said, it's obviously still your choice, and I will do my best to list everything I know of that can help make your doses last a bit longer and hopefully make it easier for you in the short term to try something else or move onto Suboxone. Many of these tips are things you've already mentioned, as I pointed out earlier, and they unfortunately ARE the best and most widely known methods. I'll try to expand upon these with any details I can think of, though. Before I do, I absolutely IMPLORE YOU TO RESEARCH THESE YOURSELF BEFORE YOU TRY ANYTHING DIFFERENT!! The last thing I want you to do is accidentally end up killing yourself. Methadone is a much more powerful med than people tend to give it credit for, and carries a high risk of overdose and death unlike Subs which have a ceiling effect and are therefore harder to OD from. Really, PLEASE LOOK THIS UP AND PREFERABLY ASKY YOUR DOCTOR FIRST, especially if it involves taking other depressants alongside it such as alcohol, your Gabapentin, and especially benzos.
The bottom line is that these methods effectively break down into two categories. One, potentiating the methadone itself, and Two, using other substances (CAREFULLY AND ONLY IF YOU KNOW YOUR TOLERANCE IS VERY HIGH) to mitigate withdrawal until your next dose. Under no circumstances should you EVER increase your dose or take something new if you've missed a dose or more, or otherwise haven't taken any opioids very recently. Tolerance can be lost very quickly without realizing it, and this in turn can make even methadone by itself lethal. That right there is the cause of the large majority of accidental deaths from overdose. Unfortunately, there is no easy way to have your cake and eat it too by having both a strong buzz from the methadone as well as having it last much longer than usual. You will eventually build tolerance to these methods which will take you back to square one, but with a stronger tolerance and worse withdrawal. I obviously can't guarantee the safety of any of these methods since I don't know your tolerance, body mass, etc. Please be super, super careful if you have to do this.
POTENTIATION AND DECREASING HALF-LIFE
1. Reduce the acidity in your stomach. The stronger the antacid, the better. Tums or baking soda will never do all that much, so you would be better off trying Zantac (Ranitidine) or other H2 antagonists like Famotidine. The most effective drug class however are the Proton Pump Inhibitors such as Nexium, which is now available over the counter, at least in Canada.
2. Try taking your dose after eating some food. This is a tradeoff between having it take effect sooner and be somewhat stronger, and having it last longer so you can avoid the worst of the sickness until you can get your next dose. You can try having SOME food in your stomach first and then work your way up to more and more food if the results work for you.
3. Grapefruit juice - you've already used this method, but you should specifically try taking about a cup of WHITE GFJ (if you can find it; order online if no local store carries it) an hour or so before dosing to maximize the effect. Pink GFJ will not work nearly as well. Even though you haven't had much success with this, it is as far as I know both the STRONGEST EFFECT and is the easiest thing to do. It uses up the enzyme responsible for metabolizing the methadone, therefore it stays in your system longer. It should definitely have an effect for you if you're using WHITE juice and having enough of it and the right time.
4. Eat more food during the day long after dosing. I sometimes find that always having food to digest seems to keep my digestive system and associated metabolic processes slower, which could in turn affect the length of the methadone left in your system as well.
5. Eat fatty food just before or after taking your dose. Methadone is an EXTREMELY lipophilic (fat soluble) molecule, and it should help absorption if you consume such fats along with it. We aren't talking hundreds of calories here, don't worry. A tablespoon of butter or mayo may do the trick. You can experiment here more safely, and see what foods and how much seem to be beneficial for you.
6. I've never been able to confirm this one, but I've actually noticed that methadone can last longer if I miss a bit of sleep. It does seem somewhat logical, as sleep is when your body and brain are highly active building up your body and clearing wastes, so it stands to reason that sleep itself may cause a faster clearance of certain drugs.
7. Small doses of benzos MAY be appropriate for you if your doctor says it's OK, but it's essential that you do NOT start taking them on their own with methadone or shortly after coming off of it. Benzodiazepines are depressants that can and do increase the respiratory depression caused by opioids. On the other hand, if it has been a long time since your last methadone dose or other opioids, their sedative/hypnotic effect can be helpful for easing some of the most intense symptoms such as anxiety and insomnia. I put this in the "potentiation" category because of this cross-reaction with methadone.
OTHER LEGAL SUBSTANCES TO HELP GET OVER THE WORST OF IT
1. Simple Advil or Aspirin can actually work wonders because they help take away some aches and pains. This alone will cause a noticeable relief which in turn can seem to help with other symptoms via reduced anxiety and therefore lower norepinephrine secretion.
2. Clonidine - a must if you have regular WD for any reason. It directly inhibits norepinephrine release in the brain which reduces anxiety as well as blood pressure and many other symptoms such as chills and sweating. It does this by decreasing nervous system activity, but in a very different way than opioids do. This makes it safer than taking more depressants, and also lowers blood pressure and causes drowsiness. These effects are extremely useful when trying to get through tough times. It even has some activity as an anxiolytic in a way separate from placebo or reduced norepinephrine secretion! I take 0.6 mg a day. Another huge advantage of this drug is that it has little no no dependence liability. This plus its non-narcotic nature means that most doctors are quite happy and even eager to prescribe it, so you should have no trouble if you tell him or her that you need to try it for persisting withdrawal symptoms.
3. Kratom - you've likely heard of kratom if you've spent much time online researching opioids and so-called legal ways to get high. It's typically fairly mild and has a low risk of dangerous side effects like respiratory depression, however it absolutely IS a mu opioid antagonist, and as such will cause withdrawal upon cessation of its use as well, though symptoms are typically less than with other such drugs. It may also be cross-tolerant with the methadone, so you need to be careful how much you take and when.
4. Poppy seed tea - this is the worst option because it contains high amounts of the strong opiate morphine, and therefore comes with great dependence liability if you are able to get potent seeds especially unwashed, or pods (far more potent still). The greatest risk here is the unknown quantity of drug it contains. A certain batch of seeds may not do much at all for you, or they could be powerful enough to send you into OD especially when combined with methadone or other drugs. The darker yellow/brown the resulting "seed water" is, the more potent it is in general. Pods contain far more morphine and are therefore far more powerful still; if you take even a fairly small amount of pod tea with methadone, it's a likely death sentence. Just don't do it. It MAY be somewhat safer if you very slowly sip the solution over long periods of time, but even this can backfire because it can take a fairly long time to notice its effects, and in the meantime you will likely have the urge to drink more. I would never suggest its use in any circumstance due to its potency and high variation in alkaloid content. If you absolutely MUST use it, NEVER do so with other depressants, and ensure that you've been off methadone for weeks or more before taking even tiny sips because your tolerance will drop down to the floor without you even realizing it.
5. 7. Imodium (Loperamide). This is an opioid that does not cross the blood-brain-barrier (sort of, more on this in a bit), but can be extremely useful for managing the severe diarrhea that typically accompanies opioid withdrawal. Some people even say that it can help reduce a few other symptoms as well at lower doses. As many people already know, the drug has been used in excessive quantities in order to get past the BBB by overwhelming the transporter protein (P-Glycoprotein) responsible for shuttling the drug back out of the brain (as it does technically move through the BBB first) through sheer quantity. Needless to say, this is potentially very dangerous since it can cause a number of terrible consequences such as a prolonged QT interval in the heart which can lead to the potentially lethal arrhythmia Torsades de Pointes, severely upset stomach and fecal impaction. So if you don't like the idea of rushing to the ER in agony so the doctor can help you give birth to a giant, impacted ball of shit, just don't do this.
The best practice is to do any of these things with a friend and never alone, or at least tell someone you trust what you're doing or are about to do. You should use a "lifeline" app on your phone which allows you to notify it when you use, then it expects a call from you after you dose (this is usually for IV use, so that time may only be a few minutes after dosing in this case). If you fail to confirm, it will automatically dial 911 or other local medical authorities who can hopefully reach you in time to save you in the event of an overdose.
EDIT: A big thank-you to user negrogesic for recommending that I mention physical exercise here as well. I personally have found that it's difficult to impossible for me to summon the will to do so much as move, but this absolutely should be included here if some people are able to get past this and find that it does confer benefits. It's essential that everything and anything (that's safe) should be tried to mitigate a withdrawal that is seemingly without end.
Best of luck, and let me know by PM if you have any questions! Remember that you are NEVER truly alone in what you're going through, you WILL think of yourself as a better person afterwards with more confidence, and of course never forget the golden rule - ALWAYS SAFETY FIRST. None of these chemicals are EVER worth our lives!
I really and truly tried to emphasize safety and harm reduction here, however it still contains techniques and drugs that may be EXTREMELY UNSAFE OR EVEN DEADLY if used either with a methadone dose itself, or used after a period of withdrawal where tolerance has dropped without the user being aware of this fact; methadone withdrawal usually lasts an INSANELY long time, and it's not only possible, but actually PROBABLE that significant opioid tolerance is actually lost, even if it feels as though withdrawal is relatively early and/or has not yet peaked. As a result, I once again implore any users of this guide to do so as a tool, NOT as a way to get high(er) and NEVER to use any of the options I've listed without thorough research, and preferably a VERY good idea of your current tolerance.
That said, I hope these common and typically widely-known options can be useful as short-term solutions for anyone to help mitigate the suffering, indignity and horror of the effects of this very powerful drug.
---
MY EXPERIENCES WITH, AND TIPS FOR EASING METHADONE WITHDRAWAL - (ALL OF THE FOLLOWING TIPS ARE METHODS I HAVE USED MYSELF MANY TIMES, BUT MAY POSSIBLY BE UNSAFE IN OTHERS)
First of all, please try not to feel too badly or guilty if you have relapsed, or if you have been using some of your methadone take-homes early (something that should never be done, but can cause excessive guilt which may impair recovery); I admit that I'm guilty of the same thing, and I have in fact regularly experienced withdrawal by the end of the week because of it
Even though I KNOW that is what's going to happen when I take more than I'm supposed to, I just can't seem to moderate when I have any opioid-related product around, and I still somehow manage to lie to myself, thinking the WD won't be so bad this time (and sometimes it truly isn't - the variability in the way it affects me is still a great mystery to me even 7 years after beginning maintenance!). Even when I don't have much serious WD, I still nearly always get enormous anxiety while waiting to pick up my next week's worth of prescriptions...often partly due to the fact that I can't be sure how much worse it's going to get, and if I'm going to be throwing up before I can take my dose which often does happen, and takes a LOT out of me having to worry about going out while sick and possibly throwing up my methadone dose on top of it.... I just seemingly have zero control when opioids are around, and the methadone alone really does seem to wear off for me more rapidly than it should, which is what leads me to take more or take my next dose early.Anyway, sorry for that bit of a tangent
I have to first point out the fact that by potentiating your methadone even mildly, your withdrawal WILL be that much worse when you run out, and it is of course much better to space out your doses, and confide in your doctor about what has been happening. I know that isn't what you want to hear right now, and it's not what I would want to hear either. I simply feel obligated to mention it because you and I both know that this would provide a much longer-term solution, and what you're going to end up doing is simply going to make you that much more miserable and that much more difficult to eventually come off of. I can tell you all of this from personal experience - very frequent, often hellish personal experience, although my problems are mostly due to the extra doses I'm taking and not so much via any potentiation which I rarely try anymore. That said, it's obviously still your choice, and I will do my best to list everything I know of that can help make your doses last a bit longer and hopefully make it easier for you in the short term to try something else or move onto Suboxone. Many of these tips are things you've already mentioned, as I pointed out earlier, and they unfortunately ARE the best and most widely known methods. I'll try to expand upon these with any details I can think of, though. Before I do, I absolutely IMPLORE YOU TO RESEARCH THESE YOURSELF BEFORE YOU TRY ANYTHING DIFFERENT!! The last thing I want you to do is accidentally end up killing yourself. Methadone is a much more powerful med than people tend to give it credit for, and carries a high risk of overdose and death unlike Subs which have a ceiling effect and are therefore harder to OD from. Really, PLEASE LOOK THIS UP AND PREFERABLY ASKY YOUR DOCTOR FIRST, especially if it involves taking other depressants alongside it such as alcohol, your Gabapentin, and especially benzos.
The bottom line is that these methods effectively break down into two categories. One, potentiating the methadone itself, and Two, using other substances (CAREFULLY AND ONLY IF YOU KNOW YOUR TOLERANCE IS VERY HIGH) to mitigate withdrawal until your next dose. Under no circumstances should you EVER increase your dose or take something new if you've missed a dose or more, or otherwise haven't taken any opioids very recently. Tolerance can be lost very quickly without realizing it, and this in turn can make even methadone by itself lethal. That right there is the cause of the large majority of accidental deaths from overdose. Unfortunately, there is no easy way to have your cake and eat it too by having both a strong buzz from the methadone as well as having it last much longer than usual. You will eventually build tolerance to these methods which will take you back to square one, but with a stronger tolerance and worse withdrawal. I obviously can't guarantee the safety of any of these methods since I don't know your tolerance, body mass, etc. Please be super, super careful if you have to do this.
POTENTIATION AND DECREASING HALF-LIFE
1. Reduce the acidity in your stomach. The stronger the antacid, the better. Tums or baking soda will never do all that much, so you would be better off trying Zantac (Ranitidine) or other H2 antagonists like Famotidine. The most effective drug class however are the Proton Pump Inhibitors such as Nexium, which is now available over the counter, at least in Canada.
2. Try taking your dose after eating some food. This is a tradeoff between having it take effect sooner and be somewhat stronger, and having it last longer so you can avoid the worst of the sickness until you can get your next dose. You can try having SOME food in your stomach first and then work your way up to more and more food if the results work for you.
3. Grapefruit juice - you've already used this method, but you should specifically try taking about a cup of WHITE GFJ (if you can find it; order online if no local store carries it) an hour or so before dosing to maximize the effect. Pink GFJ will not work nearly as well. Even though you haven't had much success with this, it is as far as I know both the STRONGEST EFFECT and is the easiest thing to do. It uses up the enzyme responsible for metabolizing the methadone, therefore it stays in your system longer. It should definitely have an effect for you if you're using WHITE juice and having enough of it and the right time.
4. Eat more food during the day long after dosing. I sometimes find that always having food to digest seems to keep my digestive system and associated metabolic processes slower, which could in turn affect the length of the methadone left in your system as well.
5. Eat fatty food just before or after taking your dose. Methadone is an EXTREMELY lipophilic (fat soluble) molecule, and it should help absorption if you consume such fats along with it. We aren't talking hundreds of calories here, don't worry. A tablespoon of butter or mayo may do the trick. You can experiment here more safely, and see what foods and how much seem to be beneficial for you.
6. I've never been able to confirm this one, but I've actually noticed that methadone can last longer if I miss a bit of sleep. It does seem somewhat logical, as sleep is when your body and brain are highly active building up your body and clearing wastes, so it stands to reason that sleep itself may cause a faster clearance of certain drugs.
7. Small doses of benzos MAY be appropriate for you if your doctor says it's OK, but it's essential that you do NOT start taking them on their own with methadone or shortly after coming off of it. Benzodiazepines are depressants that can and do increase the respiratory depression caused by opioids. On the other hand, if it has been a long time since your last methadone dose or other opioids, their sedative/hypnotic effect can be helpful for easing some of the most intense symptoms such as anxiety and insomnia. I put this in the "potentiation" category because of this cross-reaction with methadone.
OTHER LEGAL SUBSTANCES TO HELP GET OVER THE WORST OF IT
1. Simple Advil or Aspirin can actually work wonders because they help take away some aches and pains. This alone will cause a noticeable relief which in turn can seem to help with other symptoms via reduced anxiety and therefore lower norepinephrine secretion.
2. Clonidine - a must if you have regular WD for any reason. It directly inhibits norepinephrine release in the brain which reduces anxiety as well as blood pressure and many other symptoms such as chills and sweating. It does this by decreasing nervous system activity, but in a very different way than opioids do. This makes it safer than taking more depressants, and also lowers blood pressure and causes drowsiness. These effects are extremely useful when trying to get through tough times. It even has some activity as an anxiolytic in a way separate from placebo or reduced norepinephrine secretion! I take 0.6 mg a day. Another huge advantage of this drug is that it has little no no dependence liability. This plus its non-narcotic nature means that most doctors are quite happy and even eager to prescribe it, so you should have no trouble if you tell him or her that you need to try it for persisting withdrawal symptoms.
3. Kratom - you've likely heard of kratom if you've spent much time online researching opioids and so-called legal ways to get high. It's typically fairly mild and has a low risk of dangerous side effects like respiratory depression, however it absolutely IS a mu opioid antagonist, and as such will cause withdrawal upon cessation of its use as well, though symptoms are typically less than with other such drugs. It may also be cross-tolerant with the methadone, so you need to be careful how much you take and when.
4. Poppy seed tea - this is the worst option because it contains high amounts of the strong opiate morphine, and therefore comes with great dependence liability if you are able to get potent seeds especially unwashed, or pods (far more potent still). The greatest risk here is the unknown quantity of drug it contains. A certain batch of seeds may not do much at all for you, or they could be powerful enough to send you into OD especially when combined with methadone or other drugs. The darker yellow/brown the resulting "seed water" is, the more potent it is in general. Pods contain far more morphine and are therefore far more powerful still; if you take even a fairly small amount of pod tea with methadone, it's a likely death sentence. Just don't do it. It MAY be somewhat safer if you very slowly sip the solution over long periods of time, but even this can backfire because it can take a fairly long time to notice its effects, and in the meantime you will likely have the urge to drink more. I would never suggest its use in any circumstance due to its potency and high variation in alkaloid content. If you absolutely MUST use it, NEVER do so with other depressants, and ensure that you've been off methadone for weeks or more before taking even tiny sips because your tolerance will drop down to the floor without you even realizing it.
5. 7. Imodium (Loperamide). This is an opioid that does not cross the blood-brain-barrier (sort of, more on this in a bit), but can be extremely useful for managing the severe diarrhea that typically accompanies opioid withdrawal. Some people even say that it can help reduce a few other symptoms as well at lower doses. As many people already know, the drug has been used in excessive quantities in order to get past the BBB by overwhelming the transporter protein (P-Glycoprotein) responsible for shuttling the drug back out of the brain (as it does technically move through the BBB first) through sheer quantity. Needless to say, this is potentially very dangerous since it can cause a number of terrible consequences such as a prolonged QT interval in the heart which can lead to the potentially lethal arrhythmia Torsades de Pointes, severely upset stomach and fecal impaction. So if you don't like the idea of rushing to the ER in agony so the doctor can help you give birth to a giant, impacted ball of shit, just don't do this.
The best practice is to do any of these things with a friend and never alone, or at least tell someone you trust what you're doing or are about to do. You should use a "lifeline" app on your phone which allows you to notify it when you use, then it expects a call from you after you dose (this is usually for IV use, so that time may only be a few minutes after dosing in this case). If you fail to confirm, it will automatically dial 911 or other local medical authorities who can hopefully reach you in time to save you in the event of an overdose.
EDIT: A big thank-you to user negrogesic for recommending that I mention physical exercise here as well. I personally have found that it's difficult to impossible for me to summon the will to do so much as move, but this absolutely should be included here if some people are able to get past this and find that it does confer benefits. It's essential that everything and anything (that's safe) should be tried to mitigate a withdrawal that is seemingly without end.
Best of luck, and let me know by PM if you have any questions! Remember that you are NEVER truly alone in what you're going through, you WILL think of yourself as a better person afterwards with more confidence, and of course never forget the golden rule - ALWAYS SAFETY FIRST. None of these chemicals are EVER worth our lives!
Last edited:
