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questions about methadone taper

blackmarket91

Bluelighter
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Jun 19, 2017
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i have a few questions about my taper i decided

i want this to be as unpainful as possible. iv never tried to come off it yet so not sure how ill respond in future. my whole family are drug addicts, so ill probably have it bad. but im at 25 mg a day now and was thinking of going down 2 mg a week till i hit 10. then 1 mg a week till 0. someone said if i went down 1 mg a week or every 2 weeks it would greatly reduce my withdraws when i finally hit 0 is this true? i don't wana taper that slow if it isnt gonna greatly help me

how would you suggest i take this? i absolutely have to do this.i couldnt bare the thought of withdrawing going through pain for 4 weeks then using again cause i felt to misrible and sick knowing i wasted all that time so i want to do it right the first time so there is no second.


second question is it true that having a fast metabolism helps with getting over withdraws faster?


 
First question: it depends. Generally speaking it is always a better idea to taper as slowly as possible. I'd recommend tapering no faster than 1mg a week from now until you hit 10mg, and then slowing it down to 1mg every two weeks (or just taking breaks from the taper as necessary). There is no perfect recipe for tapering here, but the ideal taper is one that doesn't end up being significantly painful. That means you give yourself plenty of time to recover from each drop whenever it's necessary.

A more important questions from us: How long have you been taper currently? What was your high dose and how long ago was that? What has your taper been like until now in terms of amounts you have reduced your dose each drop, and the frequency you've made dose reductions? Know that info will help us judge how you're doing better than just having info on where you're currently at.

Someone who has been on a high of 60mg and tapers 2mg/week from 60mg down to 0mg will probably experience more relative discomfort than someone who went from 100mg and tapered 1mg every two weeks down to 0mg over a much longer timeframe.

One of the biggest things you can do to engender success in this is getting yourself organized with comfort medications. That means finding a doctor to prescribe you buprenorphine, gabapentin, clonidine, diazepam and probably a non-narcotic sleeping med for one to two weeks. It also helps to transition from methadone to buprenorphine using a shorter acting opioid, though many doctors do not understand this and are therefore unwilling to provide it as part of the transition (going from methadone straight to buprenorphine requires you wait longer between your last dose of long acting full agonist opioid - in this case methadone - before starting buprenorphine, which is a partial agonist; this may result in more discomfort than if you transferred to a short acting full agonist between a long acting full agonist and a partial agonist like buprenorphine).

Use the time you have left tapering to get yourself organized with someone to provide you with comfort medication.

Another thing that will help you make the transition is getting yourself some kind of structure and therapeutic support. I'm thinking of a local IOP, individual therapist, perhaps meetings or some other form of wellness oriented peer support (like MBSR even) to help structure your time as you make the final push to transitioning off methadone.

Conservative taper + Comfort meds + IOP + peer support + individual professional support is pretty much going to guarantee that this process is as pain free as possible. That is essentially what I ended up doing and it was absolutely nothing like the horror stories you hear about methadone. It wasn't like a walk in the park - I was still dealing with getting off methadone - but it was far, far more manageable than I could have imagined. Keep your head up, as there is definitely a way to do this if you want off the methadone.

What does your treatment history look like? Depending on how much treatment you've had prior to this, it might make more sense to get on buprenorphine for an extended detox of six months while you stabilize in an IOP program. That is what they're recommending for people who have used methadone long term now, in terms of providing the best chances of support.

But if you've had a lot of attempts with treatment prior to this you have to be careful what treatment you put yourself through in the future. Too much behavioral treatment/psychoeducation can be counter productive IMO, so it's more about finding the right balanced between behavioral based approaches to treatment and pharmacotherapy. Six more months of traditional behavioral-psychoeducation based treatment might be overkill, is what I'm saying, but it might be just what the doctor order. Likewise, you might only need one to three months more behavioral-psychoeducation based treatment to get what you need, it all depends on your history and what you feel would be worth giving your full effort to in trying.

Whether you'd benefit enough from another six months of something like buprenorphine depends on your history with using the methadone, so learning more about that would be helpful for us to give you better feedback.

p.s. If you can't find someone licenses and willing to prescribe buprenorphine on an outpatient basis to give it to you as a comfort med and don't want to go inpatient for your detox in order to get it, you should be able to get by with just clonidine, gabapentin, IBU, diazepam, a non-narcotic sleep med and perhaps another muscle relaxer. The most important meds outside buprenorphine are clonidine, gapabentin and diazepam - and even then clonidine and gabapentin are probably the most essential (diazepam makes a big difference, but it won't make as much of a difference as gabapentin and clonidine when used at therapeutic dosages).
 
well iw as at 220 i started tapering down 10 mg a week till i got to 165 is topped cause iw anted to start storing it incase stuff happened like getting kicked off or car troubles and losing takehomes and living 2 hours fromclinic

i then started the taper again down 10 mg a week till i hit 70 then i started doing 5 mg a week now at 25 i feel ok nothing bad im not high like i use to be but im content

so you think 1 mg a week till hit 10 then 1 every 2 weeks huh ill do this if it really greatly decreases my withdraws that if i went down 5 mg a week?
 
why do you think i should do suboxone subutex? wouldnt that just be switching one drug for another my brother kicked both and said they were the exact same took forever and felt like garbage im not trying to act like a know it all but im curious as to why you suggest this

i got on the methadone clinic june 2015 lil over 2 years i was buying methadone from my mother for like a month then she just cut me off to be able to get more money from someone else so then i ended up at the clinic so thats my opiate history it was all done in 2015 even though its been like 2 years and 5 months i didnt have any history of drug use before a month before i went to clinic so nto sure if that helps

the reason i sayi dont wana go sub is due to my brother and mother doing it to help methadone and they said they wish theyd stayed on methadone we have the same genes so obviously i should have the same reaction to withdraws as they do correct?
 
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I'm only suggesting you use buprenorphine for either the acute withdrawal from methadone (so for one to two weeks after you jump off methadone completely) or for an extended detox period (which would mean you stabilize on buprenorphine during the first month and then spend the next two to five months slowly weening yourself off buprenorphine).

The extended detox would be a good idea if you have good reason to believe you'll really struggle with cravings/relapsing or be in situations where relapse is likely after getting off methadone. Using it for just the acute withdrawal had no drawbacks though, because two weeks of buprenoprhine isn't long enough to become dependent on it - it will only help lesson the severity of your acute withdrawal symptom's as you finish transitioning off methadone completely).

So like I said, I strongly recommend you use buprenorphine to give you a better chance or making it through the acute withdrawal from methadone more comfortably. There is literally no downside to using it like this, especially if you use it as prescribed (so like 2mg twice a day sublingual or intranasal).

Other comfort meds will also make a huge difference though. If it's too difficult to find someone to prescribe you buprenorphine, at the very least you should do as much as you can to find someone who will help you manage the acute withdrawal by providing you with the appropriate basic medications: clonidine, gabapentin, and something like diazepam (or clonazepam, though I prefer diazepam thanks to its more pronounced muscle relaxant properties).

When I got off methadone I jumped off at 14mg (I was stable on 14mg before I jumped off). I used codeine for three or four days, then began taking buprenorphine @ 2mg twice a day intranasal. I also took 10mg diazepam twice a day, 0.2mg clonidine at night, 400mg of gabapentin four times a day, 800mg IBU once to twice a day, 150-300mg trazodone (for PTSD/insomnia), and a muscle relaxer twice a day I forget the name of (robaxin or something).

Actually I also used iboga and DXM and a number of other entheogens at various points prior to getting off methadone and post withdrawal, but in terms of the acute withdrawal the above medication was what I used to manage the process. The entheogens definitely helped in terms of dealing with cravings after getting off though.

All in all the detox was basically a walk in the park. It was absolutely nothing like the horror stories you commonly hear about. It wasn't super easy or anything - I was definitely not feeling at all myself - but it was entirely manageable. It made me realize that the stuff most doctors make you go through who don't know how to properly manage acute opioid withdrawal; there is ABSOLUTELY no reason anyone getting off opioids or methadone should have to suffer as they so commonly do.

There are reliable and highly effective treatments out there for acute opioid withdrawal, it's just that most doctors aren't aware of them OR think that suffering somehow enhance the recovery/detoxification process (which is basically bullshit - more suffering doesn't make the process more effective, it more often than not does the opposite and leads to relapse and various challenges moving further into recovery). [/rant]

Your plan to taper 1mg/week until 10mg and then 1mg every other week sounds solid. If you get the appropriate comfort meds, you can comfortable jump off anywhere around where you are now though. If you don't get the right comfort meds you'll want to taper as low as possible. It is totally acceptable to take weeks off from your taper if you feel you need to stabilize - it's even okay if you feel like you need to go up a mg or two if things get dicey. The point is to keep you from relapsing, not just to get you off methadone. The goal is to avoid relapse and get you off methadone.

Comfort meds and the kind of awesome taper you're already engaged in are essential for comfortable getting off something like this.

And whether you use buprenorphine for more than to just treat the acute methadone withdrawal is totally up to you. Doing something you don't feel comfortable with like that is not something I'd ever recommend. It's important to go with you intuition, to do what feels right, because that tends to be the most sustainable option. In other words, focus on what you're genuinely motivated to do, because what feels right is an ideal area to focus your growth and recovery on enhancing.
 
thanks for the input

id drop right now if it meant i wouldnt have bad withdraws im sur ei could get some suboxone im kinda afraid tot ake it 2 weeks out of fear of becoming dependent on it but if it wont then maybe depend show bad im gonna feel by the time i get to this phase


i was told doctors dont write diazapan anymore that its basically valium and that xanax is better but not sure im afraid of xanax too i had withdraws before from only taking them for 5 days in a row but i guess being hooked on something else is better than methadone since withdraws arnt near as long
 
man i just realized how long this taper is gonna take. im at 22 mg now going at 1 mg a week till hit 10. then 1 every 2 weeks. that's basically 40 weeks almost a year then i'm gonna feel like crap for 8 additional months or so. will this method really greatly reduce my withdraws? i know i keep asking same questions, but this question effects my entire life.. Is there any doctors online who specialize in recovery treatment that i can ask specific questions to? i have no issue going slow if i will be able to work out and live a daily life. i"m starting to feel a bit of withdraws now after 7 hours of dosing i just wana make sure i dont waste my time with this taper if im still gonna feel like dog shit. id might as well taper faster t get it over with if it isnt gonna greatly reduce withdraws when i get to 0
 
Looking at it in terms of the long term isn't going to be very helpful if it freaks you out. Really, the only reasons you should take a long game approach is in terms of organizing support (pharmacotherapy+behavioral treatment+therapy+peer support) and looking forward to the day you won't have to take something every day to feel normal.

It's much, much more useful to just focus on each week, each day, one week and day at a time. That adage is super helpful, particular when it comes to a long taper like that useful with methadone or benzos.

Basically you should your plan your taper in weekly terms. Meaning, focus on how each drop affects you, nothing bigger picture. As long as you don't get to radical with how much you drop (i.e. no more than 1mg/week), you should be fairly comfortable. However, pay attention to how you feel on day 1-3 (at that is when a drop is most obvious) and then days 5-7 after each drop. If you haven't started to stabilize after a drop by day 5-7, take a week off from your taper to readjust.

How bad is your withdrawal after you drop? Like, not how bad do you think it is, but what symptoms are you experiencing? Can you describe what it feels like or what you're experiencing? Does the withdrawal abate after each drop around day 3-5? If not I'd suggest dropping once every other week instead of weekly.

Something else I found really helpful was asking for blind dosing. All that means is that the nurse won't remind you what your dose is each time you dose. You'll totally still know what it is (trust me), but it helps not being reminded what it is by staff IME.

If 1mg drops each week is too uncomfortable, try dropping every two weeks. 1mg drops per week shouldn't be too uncomfortable, and certainly not once every two weeks. If drops are two uncomfortable there are other meds and behavioral/lifestyle practices that can really help. Make sure you're getting enough sleep (if you're not, try a sleep med like melatonin, doxylamine, trazadone or Seroquel - in other words a non-habit forming one), eating three healthy meals per day (well balanced in terms of carbs, protein, leafy green stuff and fruit - ideally the more you can avoid processed and pre-made foodstuff, the better you'll feel) and getting some kind of daily exercise (even just talking an hour long walk once or twice a day goes a loooong way to helping, so going hardcore at the gym isn't necessary unless you enjoy that kind of thing).

Also, having a therapist, especially someone who is familiar with how to properly get off meds like buprenorphine and methadone, can be really helpful. It can be difficult to find such a therapist, or even one you seem to benefit from/get alone with, so you'll probably have to experiment here.

Other than healthy lifestyle choices and focusing on the hear and now to avoid getting to anxious or stressed out about the future (as, in reality, you have no idea what the future will bring until it does, or doesn't), the big take aware here is that the long amount of time it takes to get off methadone using a proper (i.e. comfortable) taper is that it's actually a big blessing in disguise.

What I mean is that the time it takes to transition off methadone via taper gives you time to get your affairs in order in terms of A) establishing healthy lifestyle habits (especially re healthy patterns of sleep, diet, exercise and leisure activities), get yourself organizes with an MD in terms of comfort meds for the detox, organize some form of treatment like inpatient detox or 90 day IOP, get established with some sort of peer support community (I found MBSR and the secular mindfulness community to be much to my liking, but anything works as long as you benefit from it and feel good about it, so it could be NA, could be AA, could be something totally non recovery related too like a sewing group - literally whatever involves people supportive of your process and focused on something you feel good about and safe engaging with), and get things organized with work/family/school for when it comes to when you'll need to take a week or two to deal with the acute withdrawal down the road.

So, this time is really a blessing like I said. It gives you time to get your shit together, basically, and get yourself in a position setting yourself up for success in early recovery. The more you can focus on improving your health, coping skills and getting healthy habits and support already in place for when they'll be most necessary, the better your chances are and the easier it will be.

In my case, I spent about two years tapering and getting myself ready in terms of a good psychiatrist, peer support (namely SL on BL, MARC, ATS and Refuge Recovery) and lifestyle habits. The single biggest thing was probably learning a lot about mindfulness and how to effectively use meditation to self regulate. It was amazing how much of a difference that made is allowing me to more skillfully manage the discomfort (particularly the stress) of withdrawal. But it takes quite a while to establish a daily practice for most people, and I spend a lot of time getting myself to a point where that stuff was basically second nature before I tried to really deal with coming off methadone.

Methadone really isn't advised until you've got your life in order (all of it). Now, if tapering becomes more painful than not, you're already fairly low and could just switch straight to buprenorphine (either for a six month extended taper off that or just using it for a few weeks to deal with acute withdrawal). But even then, don't rush to just get off methadone. If you don't have the habit and skillset in place and already established prior to attempting to get off the ORT, it isn't really reason to expect yourself to be able to do that very effectively. What I mean is that, unless you haven't already changed your habits, thinking and behavior for the more skillful self reliance and healthy, and you're still doing the same stuff you were when you got on methadone originally, it isn't realistic to expect yourself to be able to deal with life without some form of ORT.

If you just need off methadone now (for whatever reason) but haven't established the healthy habits and whatnot that will enable you to really move ahead with your early recovery, that would probably be the best case for an extended taper using buprenorphine. You could switch right to that (basically), and then use the time you spend tapering off that get these healthy habits established before you get off ORT entirely. Buprenorphine is far inferior to methadone when it comes to support with cravings, but it will still help enough so that you can realistically learn new healthy habits (and it doesn't have many of the restrictions or stigma associated with methadone).

Unless it is absolutely necessary (please explain why if so), I really suggest you just stay on methadone until you're ready to get off it. Yes, it takes time, but you'll be setting yourself up for success if you can put in the effort to invest in yourself now in terms of your physiological, mental, emotion and interpersonal health and wellbeing. And if you spend as much time as you need (i.e. don't rush - this isn't a sprint, it's a long, long, long marathon, a lifelong walk with the occasional sprint more like), when the time comes you feel ready, coming off ORT will be more manageable than you could ever imagine.

Sadly very few doctors know much about ORT or how to effectively come off it (most of them at best simply don't emphasize the important of establishing lifestyle choices prior to attempting detoxification). There is a really good doctor out of I think Maryland or Ohio or somewhere that is one of the US's foremost MD experts on stuff like ORT, but I forget his name off the top of my head. If you want his info let me know, I can look it up (pm me or quote this post so I know you need a reply). His big thing is encouraging people to use buprenorphine for an extended detox if not acute withdrawal after getting off methadone though, so be prepared for that. But he's pretty much the best I've encountered, and his office is quite good about talking to folks about this stuff.
 
well iw as at 220 i started tapering down 10 mg a week till i got to 165 is topped cause iw anted to start storing it incase stuff happened like getting kicked off or car troubles and losing takehomes and living 2 hours fromclinic

i then started the taper again down 10 mg a week till i hit 70 then i started doing 5 mg a week now at 25 i feel ok nothing bad im not high like i use to be but im content

so you think 1 mg a week till hit 10 then 1 every 2 weeks huh ill do this if it really greatly decreases my withdraws that if i went down 5 mg a week?

You started on methadone at 220 mg? That's a pretty high dose--is it typical of your clinic? I was asking what your drug history was prior to methadone, but I just found the answer in another post. The fact that you didn't use very long before the clinic is helpful. If you've tapered from 220 all the way to 25 mg at the rate of 5mg weekly, you deserve congrats and kudos! If you didn't experience much in the way of withdrawal during those drops, maybe you were at a higher dose than you needed. I've been on three methadone clinics over my life, all years ago, and each had its own ideas of what a "proper" dose was. It seemed that all of them cared more about giving everyone their favorite dose than titrating to the actual patients.

You can trust your own instincts, but remember that methadone stays in your body for a long time. When I got off the last time, my withdrawals didn't start for almost a week, but they lasted for months. I also had been addicted to IV heroin for about 15 years before I got on the clinic. Then when I got on (late 70's) they liked you to stay on for as long as you wanted--in my case that was about 5 years. Then, all of a sudden they changed their policy to kicking everyone off within 2 years, whether they were ready to get off or showed any actual recovery. It was just--well, you've hit your quota, so bam, 30 day detox. I was detoxed off (against my wishes) from 90 mg to 0 in 30 days. That may be why my withdrawals were pretty horrific. I'm glad that most clinics have changed back to not forcing people off if they aren't ready. I, of course, mostly because I was so sick for so long, immediately began doing anything that would make me feel better, which kept the withdrawals going on and on.

Toothpastedog has the information for how to taper the rest of the way; sounds like he's actually done it successfully--I don't think my experience can be called a "success." One thing to keep in mind: What you've already done is a very fast taper. If you haven't stabilized for a month of so, you might want to do that before you start dropping again. Like I said, because it's a long-acting drug, the drops you've already taken may catch up with you. Or not... It's up to you whether you want to stick to 1mg weekly or try a little faster. You may be able to get down to 10 without too much trouble. What will be the toughest will be after 10mg; that's been my experience anyway.

If you have the rest of your ducks in a row; outpatient counseling or peer support, clean and healthy living, not craving, and if you aren't being triggered by your family--that's a tough one, especially if you have to live with them--you probably can finish your taper without using Suboxone. There's a definite place for it, but unless you use it for an extremely short time, you risk getting physically dependent on it. Maybe in your case you'd be better off taking as long with your methadone taper--you've already had great success, seriously--and avoiding it altogether. If you start feeling like using again, though, the thing about Sub is that it will fill all your brain's receptor sites so that methadone or heroin will have little effect. Methadone does that as well, but only at fairly high doses. Another thing you can do if you feel tempted to use and want to give yourself a little insurance, you can always get Vivitrol, also called naloxone. It does the same thing; prevents you from getting high if you do use. However, don't even that until you have completely tapered and all the methadone is out of your system. If you have any habit left, it will send you into terrible precipitated withdrawals. My doctor doesn't recommend that his Suboxone patients use it until they've been completely clean a month or so. Best of luck with your taper!
 
I really need to stress the value of buprenorphine in managing the transition off something like methadone.

The reason I suggest buprenorphine is for the acute detox only (or especially). It makes the detox much, much more manageable. It isn't about it's blockage effect in this sense, but how it treat opioid withdrawal, allowing a more comfortable (and more comfortable means less stress; less stress means the body has more time to adjust to life without buprenorphine/opioids).

Naloxone is useful for some people, but compared to buprenorphine or methadone it is highly ineffective. It does nothing (read: nothing) for craving or withdrawal symptoms.

The big dangerous of using buprenorphine for the acute detox ins't actually dependence (this is simply due to the reality that it is really, REALLY hard to become dependent on something like buprenorphine if you're only using it for about a week), but precipitated withdrawal, similar to using Vivitrol.

Using buprenorphine for detoxing methadone is a very specific use that most doctors are unfamiliar with and don't have the experience to really address well. Not all, but most. Which just means one has to really take the front seat in making sure they use it appropriately. That means waiting for 3-5 days (depending on the dose you're stable on you jump off) before inducting on buprenorphine. That means ensuring you don't become dependent on it if using it for just the detox.

No, dependency isn't always a horrible thing. It also can mean stability. That is the thinking of an extended detox using methadone or buprenorphine. The dependency from an extended taper is very different than something like maintaining on methadone at high doses though. It means one stabalizes on about 8mg/day and then begins to immediately begin another slow, drawn out taper. That didn't sound ideal to me (I didn't feel like I really needed that kind of support making the transition, so I opted to use it just to treat acute withdrawal).

What I also really want to emphasize, something LopLover pointed out I really want to emphasize is that how you handle this is all about you OP. If you are feeling at all unstable or like you might relapse on opioids (take a sober minded look at what you feel like your chances are with this, consider all the other support you might have, or not have, in making the transition, etc), an extended taper is worth considering. Or just taking more time to stabilize on a low dose of methadone before transitioning off.

If you feel like you're ready to detox, do it. Ultimately this is about what will work well for you, and we're all different. There are things you can do to maximize your chances for success (stabilizes on a low dose of methadone before jumping off, doing an extended taper using buprenorphine and/or using appropriate comfort meds like gabapentin/clonidine/diazepam/buprenorphine/etc, find social, peer and professional support you feel good about, etc). But ultimately this is about how you feel about how you're doing.

Given the nature of methadone, there is a lot to be said for ensuring stabilization on a low dose of methadone before jumping off. 200+mg at a 5mg/week dose reduction until nothing, while certainly better than nothing and do-able, simply won't be as comfortable as a transition getting off it than it would if you slowed the taper down and made sure to stabilize at the bottom end before jumping off. If you have a really fast metabolism, the faster taper might be more manageable, but it's really important to stabilize before getting off methadone.

And again, using appropriate comfort meds (which doesn't include naloxone/Viv - it's arguably more of a behavioral treatment, and most definitely not a comfort med) will make things much more manageable. More manageable means less stressful (after all, I doubt anyone started using opioids because they were trying to deal with low-stress lifestyles). Less stressful means less cravings. Less stress or cravings means less chances for relapse. It means more opportunity in terms of how you want to treat behavioral, psychological, social and emotional aspects to recovery from substance use disorder. So, more chances for success.

The you set yourself up for success, the less chance there is for making mistakes down the road. Recovery is very and much a trial error, and relying on your own intuition is far more important IMHO than toeing the line according to what ANYONE (me, people in meeting, doctors, family, etc) tells you. One of the biggest challenges I've found in recovery is picking apart the gems from the bullshit, and figuring out what might apply to my situation I might actually benefit from implementing.

Personal bias in people giving out advice is ever present after all: in my case, I was able to successfully get off methadone after taking it for over two years following a decade long heroin/opioid habit, in particularly through utilizing all the appropriate pharmacotherapies that are out there, while being careful to avoid further dependency; others have had issues becoming dependent on the comfort meds they've been giving (for whatever reason), and that likewise affects the advice they give.

I've seen and worked with by now thousands of people trying to get off opioids, methadone in particular. There are definitely some commonalities I've noticed, and I try to emphasize them in my advice about treating opioid use disorder and withdrawal from various opioids, from codeine to heroin to tramadol to buprenorphine to methadone.

After you detox from methadone and have about a month abstinent, that is when you would want to consider Vivitrol/naloxone treatment. That is more about if you're likely to lapse, as it will tend to prevent you from feeling opioids. Again, it won't do anything for cravings, so peer and professional support is still very important. It's only about preventing you from feeling high from opioids. If you feel like that would be helpful (although it isn't without potential side effects), go for it. But it isn't recommend someone pursue until they've been off opioids for 1-3 months first.

Definitely under no circumstances take it within a week or taking any other opioid. And that is a minimum. I'd say two weeks is more like the necessary safe time when dealing with super long acting opioids taken for long periods of time like how you've used methadone for ORT.

Let us know how you're doing OP, and what you're plans are looking like. Hope you're well.
 
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