SoCal424 is the man
Thank you for being so open to share what's going on for you hikfromstik. To be frank, your health does worry me a bit.
As a general rule, it's really worth waiting to make the final jump off methadone until one's stable on their current dose. The difference in intensity of acute withdrawal (and PAWS) between someone who's recently tapered down to 20mg and hasn't stabilized versus someone who has fully stabilized on 20mg is pretty dramatic.
I just wanted to echo SoCal424's suggestion about trying to stabilize a bit more before making that final jump off to 0mg methadone. How long have you been on 20mg?
Especially because under a year is not at all a long time to go from 100mg+ to 20mg of methadone, it's really going to be helpful if you can get as stable as possible with your current dose. Worst case scenario this means sticking with 20mg/day for a week or two longer. It might not be the most fun, as when someone wants to get off staying on methadone can be pretty painful (tapering withdrawal aside), but you'll thank yourself down the road.
And with benzos, using 10mg diazepam twice a day for 14 days (or the equivalent) is highly unlikely to cause major issues. I'd recommend trying to stay on gabapentin for a month though, and having clonidine and a non-habit forming sleep aid available during this time. Actually I tend to recommend people have a non-habit forming sleep aid available for the first year post methadone.
Tramadol is, in my humble opinion, an ideal med for treating methadone withdrawal. With a habit like what you're coming from, I will be surprised if anything under 200-300mg/day makes a huge difference though. No reason not to start low with it, but if it isn't helping at 50mg 3x/day, it isn't really a huge surprise.
Hopefully the gabapentin/clonidine/etc helps enough to make going to crazy on the tramadol something you'd serious consider doing, but when someone knows how fucking annoying a serious methadone habit can be they tend to understand the significance of using opioids as sparingly as possible.
You'll get there my friend, just please don't get too far ahead of yourself. Yes, it sucks. I can't frankly imagine how much more it would suck if I was in middle age when I got off than when I did, as a young adult. And you are clearly ready to get off the stuff. Yet, when you feel the urge welling up inside to move on with all the bullshit already, keep in mind the following:
The slow and steady are the winner of this race.
I think that becomes even more significant the older one gets or the longer one uses.
I'm actually going to move these posts into your own thread mate. Feel free to start a new one once you've jumped off or just start where we leave off.