Tapering off methadone. Valium is becoming less effective. Open to suggestions

[Azn2101]

I've been on Valium for a very long time at 15mg from a traumatic experience with the diagnosis of mild depression and severe anxiety but when I became an intravenous user (heroine mainly) I became a dual diagnosis patient to my psychiatrist and when she connected me with a methadone clinic my Valium dose And methadone dosages were raised through a series of relapses to 107mg of methadone and 30mg of Valium and have remained at those dosages for almost 3 years. Being clean of all illicit substances for 2 years I felt comfortable enough to begin dropping my methadone dose with the assurance from the clinic Dr. And my Psychiatrist that the dosage of methadone dropped from the dosage I was at with the Valium would "make the decrease almost unnoticeable" from 107 to 100mg. 5 days have gone by and While I've gone through much much worse symptoms as far as opiate/opioid withdrawals are concerned, the anxiety and mental disturbances that the Valium was initially prescribed for have made mild appearances: Weird dreams that almost fall into the nightmare category, grinding or clenching my jaw, and a weird feeling that something isn't right (if that makes sense.) My concern is the methadone and Valium were taken together for so long that the taper off methadone is simultaneously decreasing the effects of the Valium. The withdrawal feeling is almost gone but the symptoms of my prior anxiety are still lingering and about 2 months ago I noticed the a change in the way the Valium took effect but it felt more of like a tolerance issue or maybe just more subconscious stress with work and parenting.

I'll continue to keep you posted since I'm on a 2 week methadone take home schedule. I'm an open minded person and don't think there's such thing as a wrong answer...unless it's somewhere in the stratosphere. But I guess I'm asking if changing medications or adding something I haven't thought about could help or if what I'm saying has more to do with my mental make up or is something more common

Thank you for taking the time to read and I hope I can get some advice.

 

[JessFR]

With mental conditions like this, it's extremely hard to say. Just knowing you're reducing your methadone could cause symptoms you'd likely not otherwise have experienced had you not known.

I wouldn't expect 107 to 100 to make any noticeable difference at all. I'm a little curious how you were on 107 at all given that it usually goes in 5mg per ml increments.

But anyhow. I'm not sure what to tell you honestly. At 107, I wouldn't have expected a 7mg drop to be noticable. If you were on a much lower dosage of methadone yeah, but not at 100. I doubt the Valium would make much difference one way or the other if your dosage on that has remained the same.

I don't want to tell you it's all in your head, cause I don't know that, it might well not be. But I wouldn't wanna rule it out either.

Either way though, it doesn't make a lot of difference. You can wait it out or increase the dosage. Sorry I wish I had something more useful to suggest, but I can't really think of much else.

You're bound to experience withdrawal eventually in getting off methadone, but it shouldn't get too difficult until the drop in dosage reflects a much greater percentage of the total.

Good luck man. Honestly I'm more concerned for you from the Valium side than the methadone side. Assuming you'll wanna drop the Valium dosage one day, that'll be tough. I sure don't envy it.

 

[Keif' Richards]

Hey Azn and if you haven't been already, I'd like to welcome you to Bluelight! We hope that you can become another one of the helpful, compassionate members here that help make this place such a great resource for so many people.

I'm sorry to hear that you have to deal with the Methadone withdrawal. As we all know, Opioid withdrawal is a seriously uncomfortable process, but it can and has been done by many of us, including myself. First off, I'd like to know, are you fiddling with your Benzodiazepine dosages as well or are you only tapering the Methadone currently? I ask, because I feel that it would be unwise to try to bite both off at the same time, but anyway, get back at me with that information if you wouldn't mind.

With that information in hand, we can move on to figuring out what some of the most effective treatment options for you might be. You're on a moderate dose, sure, but I met a guy in jail who was withdrawing Cold Turkey from ~240mg and he lived to tell the tale, so I think, so shall you. What medications have you used in the past for Opioid withdrawal that have been effective? Are you familiar with Gabapentinoids, including the eponymous Gabapentin (Neurontin) and/or Pregabalin (Lyrica)? Even if you don't enjoy their effects recreationally, they are highly effective in mitigating symptoms ranging from lethargy to RLS/Akathisia, depression/anxiety and so on.

Anyway, please just let me know a little bit more about your situation and we will see what we can do. Your decreases are not astronomical, but if you feel they are moving too quickly, we can always try slowing it down. As you've indicated, it is on your own accord that you've initiated this taper. Your Benzodiazepine habit is nothing insane either. You're bound to experience some degree of discomfort upon withdrawing, dependent obviously upon the speed and severity of the taper, but you shouldn't have to worry to seriously about advanced complications like seizure and death.

Jess: Methadone is typically dispensed in 10mg/ml increments in the United States, but the dosage is arbitrary as the volume is simply adjusted, regardless of the potency of the elixir itself i.e. to administer 7mg of Methadone elixir, a nurse is going to dispense .7ml or 7/10th ml.

 

[JessFR]

Hey Azn and if you haven't been already, I'd like to welcome you to Bluelight! We hope that you can become another one of the helpful, compassionate members here that help make this place such a great resource for so many people.

I'm sorry to hear that you have to deal with the Methadone withdrawal. As we all know, Opioid withdrawal is a seriously uncomfortable process, but it can and has been done by many of us, including myself. First off, I'd like to know, are you fiddling with your Benzodiazepine dosages as well or are you only tapering the Methadone currently? I ask, because I feel that it would be unwise to try to bite both off at the same time, but anyway, get back at me with that information if you wouldn't mind.

With that information in hand, we can move on to figuring out what some of the most effective treatment options for you might be. You're on a moderate dose, sure, but I met a guy in jail who was withdrawing Cold Turkey from ~240mg and he lived to tell the tale, so I think, so shall you. What medications have you used in the past for Opioid withdrawal that have been effective? Are you familiar with Gabapentinoids, including the eponymous Gabapentin (Neurontin) and/or Pregabalin (Lyrica)? Even if you don't enjoy their effects recreationally, they are highly effective in mitigating symptoms ranging from lethargy to RLS/Akathisia, depression/anxiety and so on.

Anyway, please just let me know a little bit more about your situation and we will see what we can do. Your decreases are not astronomical, but if you feel they are moving too quickly, we can always try slowing it down. As you've indicated, it is on your own accord that you've initiated this taper. Your Benzodiazepine habit is nothing insane either. You're bound to experience some degree of discomfort upon withdrawing, dependent obviously upon the speed and severity of the taper, but you shouldn't have to worry to seriously about advanced complications like seizure and death.

Jess: Methadone is typically dispensed in 10mg/ml increments in the United States, but the dosage is arbitrary as the volume is simply adjusted, regardless of the potency of the elixir itself i.e. to administer 7mg of Methadone elixir, a nurse is going to dispense .7ml or 7/10th ml.

I've never found them to be quite so precise here in Australia. I've never tapered off methadone. Just switched back to heroin. So I'm not sure what they'd do if I one day tried but I get this feeling they'd exhibit the usual degree of care and competence I've come to expect. Which is they'd say they can't go any slower down than 1ml at a time and it won't make any difference if you did. Which is code for "we're lazy fucks and can't be bothered to measure it that precisely so we're going to call this standard practice so we can excuse not having too". But like I said, I wouldn't know.

 

[Azn2101]

@Jess & @Keif. I really appreciate your support and willingness to help. But to answer your questions sequentially:

@JessFR: I'm in Southern California at an independent clinic and I thought it was strange too that I could go gown 1mg-10mg at a time and even in doses (if you have over a week take-home schedule) 1 mg every 2 days, 3 days, whatever you want but in return it's a very strict clinic that does let you know that if you're a methadone user just to get through those days where you run out until your paycheck/social security checks come in you will be weeded out because there's a pretty well known clinic named Aegis right down the road and they tolerate that sort of stuff. I was dropped from 110 to 107 out of a clerical error from a biannual file being transferred from my councilor to the dosing windows filing system and decided it wasn't enough to make a deal over. I don't take any offense to you saying it could be all in my head, the mental aspect with substances if half if not more of the battle (feeling good until you drop a spoon full of your last bit or thinking you have another dose and then realizing you don't sent me into minor withdrawals) so it's a perfectly good theory but my mind is usually so preoccupied with my daughter and work and meeting financial deadlines that if it is it's not coming in the direct form of "oh snap I just dropped 7mg and the itching and restlessness (very minor) is too much." I'm on the start of day 8 and the methadone withdrawals are almost non existent but the Valium just seems to have lost its full effect. The systems are less severe than the original post when I would have put them at a 6 to now a 4 and last night I didn't have a dream that evoked a weird uncomfortable feeling when I woke up but my girlfriend said the jaw clenching was so bad it sounded like cracking down on hard candy and checked my teeth for signs of fractures or chips.


@Keif: that's awesome that the moderators take the time to read through their sections posts as often as you seem to, I've never had a forum moderator be on a thread I posted so quickly so thank you (and Jess) for responding so quickly. Back to your post, up until the day before I began the taper I had moved myself from 30 to 25mg a day for a separate reason (I was having seriously hard bowl obstructions and painful trips to the bathroom) and that was only for about 10 days prior to the methadone taper but I'm back to my recommend dosage of 30mg. I do know it's possible to go cold turkey I did it from 140 to nothing in jail but to avoid law suits the County tapered me 5 mg a week off the Valium so that make the first month a lesser ring of hell and avoided the possibility of seizing out or death but my fear is that in jail, all your responsibilitys are on yourself and no one is relying on you to follow through on commitments made and depending on you to function to maintain what I've build up from the hole of addiction you know? And I've got the mother of my child looking for any reason to slip up to revoke joint custody of my daughter so stress is indeed a strong factor and this new "complication" is just a real pain in the ass. I've never used or even heard of any of those medications other then Gabapentin and that's from when my grandma was going through dialysis a few years back before she passed but I'll list all the medications I take
Morning: 100mg Methadone,10mg Diazepam, 100mg 5HTP, 100mg Docusate sodium
Afternoon: 10mg Diazepam, 100mg Docusate sodium
Bedtime:10mg Diazepam, 100mg Docusate sodium, 2200mg Passion flower, 3mg Melatonin Blend: melatonin 3mg/vitamin B6 5mg/Calcium 5mg/L-Theanine 25mg/Gamma-aminobutyric Acid 25mg/Proprietary Herbal Blend- Chamomile Extract & Valerian root Extract.

I reached out to someone who is on a very low dose of suboxone now but went down a very similar path regarding recovery efforts but he went to a well known candy doctor who started him on 2x 8mg strips a day, Tramadol, Somas, 1mg alprazalam 2x a day, and 25mg of Valium a day and I didn't want to shell out the money or be associated with him or that many controlled substances during my custody battle, but, He recommended trying to switch from Valium to Clonozopam or maybe even alprolazam until I get off the methadone taper because from his experience of self tapering off the suboxone sublingual she said the Valium/tram ado combo got him through the day and soma/Valium/Xanax got him through the nights but I'm not so sure how much to trust him since he still uses every other month or so he'll do a weekend bender on speedballs.

The taper plan the clinic doctor signed off on is 7mg to 100mg (the stage I'm currently at) then from 100 to 90 hold at 90 for one week drop 5 for 2nd week and from there 5 mg a week until I hit 50 then we have our next meeting. Since I only go in two times a month and am con tiered a low risk patient, I have to give a one week notice to see him to stop the process but honestly I'm really tired of methadone guys and want to get off quick as possible without going so far out of my comfort zone as to want to go back up or something worse...I just didn't expect it would change the way my Valium effected me if you guys need any more info I'm happy to give it and Keif I will talk to my physician about those medications but the area I'm in does tend to be a bit tight when it comes to anyone who's had any sort of addiction.

 

[Keif' Richards]

Okay then, thanks for getting back to us with that. I know what it feels like to be in precarious situations with family and loved ones in relation to drug use. It can be really hard to keep it together, but I believe you're going about all of this in a fairly reasonable way. It's simply my opinion, but I feel like the decreases that you're describing might be a little bit brisk, but it's really up to you how fast you want to go and what you can handle.

There are a lot of variables at play here, but one of my golden rules regarding the speed and intensity of a Methadone taper is that you cannot cross the line of severity in which you are unable to sleep for more than 6 hours every night. Methadone withdrawal, due to its relatively long duration, has to be played carefully. Things accumulate. If you don't sleep at night, you'll begin to feel much worse, which will lead into complete loss of functionality after only a few days. There are surely other variables to consider, but just make sure that you are able to get a decent amount of sleep each night.

So, you're unfamiliar with Gabapentin (Neurontin) essentially? Well, it and Pregabalin (Lyrica) and Cannabis (for appetite and sleep) are my immediate go-to's. I am essentially a life-long Opioid addict and have withdrawn and redrawn more times than I can fully remember, so you can take my advice seriously. Gabapentin is amazing for Restless Legs/Akathisia as well as depression and anxiety associated with the withdrawal. Cannabis is useful for inducing sleep, but mostly for stimulating appetite and preventing nausea and vomiting.

In my opinion, these are the best places to start. Their are other drugs that can be helpful in a more minor way, like Clonidine (Catapres) for instance, but it's my opinion that Gabapentinoids should be your main quest.

 

[Azn2101]

Okay then, thanks for getting back to us with that. I know what it feels like to be in precarious situations with family and loved ones in relation to drug use. It can be really hard to keep it together, but I believe you're going about all of this in a fairly reasonable way. It's simply my opinion, but I feel like the decreases that you're describing might be a little bit brisk, but it's really up to you how fast you want to go and what you can handle.

There are a lot of variables at play here, but one of my golden rules regarding the speed and intensity of a Methadone taper is that you cannot cross the line of severity in which you are unable to sleep for more than 6 hours every night. Methadone withdrawal, due to its relatively long duration, has to be played carefully. Things accumulate. If you don't sleep at night, you'll begin to feel much worse, which will lead into complete loss of functionality after only a few days. There are surely other variables to consider, but just make sure that you are able to get a decent amount of sleep each night.

So, you're unfamiliar with Gabapentin (Neurontin) essentially? Well, it and Pregabalin (Lyrica) and Cannabis (for appetite and sleep) are my immediate go-to's. I am essentially a life-long Opioid addict and have withdrawn and redrawn more times than I can fully remember, so you can take my advice seriously. Gabapentin is amazing for Restless Legs/Akathisia as well as depression and anxiety associated with the withdrawal. Cannabis is useful for inducing sleep, but mostly for stimulating appetite and preventing nausea and vomiting.

In my opinion, these are the best places to start. Their are other drugs that can be helpful in a more minor way, like Clonidine (Catapres) for instance, but it's my opinion that Gabapentinoids should be your main quest.

Ok so I've run into a bit of a wall here that involves release of confidentiality and unwillingness to interfere with other Dr's orders and packed schedules . I went to my primary care physician this morning who prescribed my Valium at 15mg before becoming a dual diagnosis case thinking that because we have quite a bit of history we could work something out short term until I go back to the methadone clinic in a week. I went in before taking my methadone or any of my routine morning pills and he didn't want to prescribe Gabapentinoids because he can't confirm the taper from my clinic because I don't have a release of confidentiality to his office (and I don't know how much of a difference it makes that he's actually only a practitioner in an office run by offsite Dr's.) When we did the normal BP/HR & Temperature check he did notice it was a bit off but nothing that he considered too out of line to step into what he said was (an area that was being monitored and treated by another professional.) After a call into my psychiatrist office a few hours later got a call saying lyrics was not going to be an option because of its habit forming risk + my addictive personality and in her mind would be going backwards in terms of sobriety but said to schedule something with the front desk and told me to start getting ready for random UA tests. The next appointment is 12 days past my next appointment with her anyway so I'm just gonna have to bite that bullet.

I'm scared of having my psychiatrist think I'm trying to get her to fill the "high" that methadone gives when I'm finally off or some other reason, I've never been asked to give a UA at her office before and I feel like I'm walking on eggshells right now.

As far as the methadone clinic Dr. goes he only comes once a month and has no other offices or numbers to reach him on so he's basically just there for the purpose of covering the clinics ass and for admissions when the clinic has openings. The withdrawal has been the same and the valiums effectiveness has gotten a tiny bit better but it's still not the normal feeling and anxiety is still noticeable to others around me.

Thanks Keif.

 

[Opioidergic]

I know 100 percent for me that the psychological and the physiological aspects of withdrawal are so intertwined that your mental state can absolutely exacerbate physical symptoms or even create them to an extent especially when it comes to the anxiety related aspects of withdrawal. You may be creating physical anxiety symptoms from the mental fear of coming down on your dose which can be interpreted as withdrawal symptoms. I think if you start teaching yourself some brain tricks to relax yourself or even start exercising regularly may alleviate these issues for now and it's good practice of finding healthy coping mechanisms that will aid you when you finally medication free, if that is your goal. Just be prepared for the tail end of your taper absolutely nothing will make your feel better except father time, mother patience, and uncle hope ?. Hope the best for you brother!