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Treatment Methadone withdrawal methods?

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whenwhy

Greenlighter
Joined
Oct 2, 2012
Messages
37
So i'll make this post quick, im 32 been on methadone/biodone for about 2 years and subby bout 1yr prior. (My drugs of choice was Heroin, originallly from injured back at the gym, oxycontin etc)

I have worked my way down from 120mg to 32.5mg a day ( I just dropped again today) im keeping my magnesium up and taking the odd clonazapam but keep it to an absolute minimum as I already suffer from anxiety.

So to the question.

I hear people switching to subby and coming off easier. Which Im not sure about.
I hear of people trying a shorter acting opiate for a week then going into detox, which methadone taking so long to get out of your system scares the shit out of me and ive experienced 6 days without methadone before.
Then I read of a methode inwhich they put you under and inject you with naltrexone, thus getting the drug off your receptors and out of your system while in hospital.

I am currently reading about detox treatment centers on the east coast as we will be moving there, also I have private or will be getting it very soon for this purpose as the waiting period is only 2 months for drugs treatment.

So anyone if they can recommend a center, or share their experience it would be much appreciated.

Thank you again I just feel confused on the next step

thank you
 
Suboxone is actually two drugs, naloxone and buprenorphine. From what I understand, naloxone binds to the opioid receptors and regulates how much stimulation can occur, only allowing mild stimulation so shooting dope won't produce a high. Taking naloxone, or narcan, alone will send you straight into withdrawal by stopping or blocking the action of opioids. Buprenorphine is a partial agonist of opioid receptors where as methadone is a full agonist, meaning bupe will produce more mild effects/stimulation.

Comparatively, methadone has a long half life which is why you can dose once a day, but also why the withdrawals come on slowly and last longer. Taking an opioid with a shorter half life would send you into more severe withdrawals quicker, but they wouldn't last as long. It's sort of like rolling down a hill or falling off a cliff. Hopefully someone with more experience in this can chime in.

I would recommend going to a detox or rehab center. I'm on the opposite coast so I don't know of any specific places, but having people who can help you take care of yourself could help tremendously. From simple things like food and water when you are bed ridden to more complex things like emotional support will all help you. A lot of people talk about feeling depressed, lonely and anxious and having someone to talk to could be very beneficial. Much better than pacing in circles and climbing up walls alone in your house.

I detoxed in jail which was horrible, but I must be honest that having food and water brought to me was helpful. After that I went to an inpatient rehab which really helped me learn to manage my emotions and urges to use. I'm not sure I would have made it to 6 months if I didn't get help. I still see my substance use disorder counselor from time to time.
 
You could taper to the lowest dose possible ,then switch to something like oxy, or even Heroine. Just because the WD lasts 2 weeks instead of 30 days ,
So if u manage to stabilize on another opiate for 30 days ,while the methadone leaves your system, you could then detox from that.
Suboxone , tapered for 5-7 days will get you through the first part of it. The key is to NOT get dependant on it. That's why it's important to taper.
Then you could use tramadal for a few days while the sub leaves your system. It has a 72 hour half life .Tramadol can be taken with Suboxone . So if the taper is hard on you , tramadol will help ease it out some. But be careful not to get dependant on that as well. Don't use the tramadol for more then 5 days in a row.
Try and wait 72 hours , or as long as you can , after you stop the sub , then use methadone , for no longer then 5 days , smallest dose possible . You will probably only need 10 mg then try 5 mg.
That will get you through approximately 13 - 15 days of withdrawals , relatively comfortable.
You can use other drugs to help . It's ok So long as you aren't substituting . I've done this a few times.... Never coming off methadone.. but off other opiates...
It's one method.
Another is switching to Suboxone. It's easier to taper with because of the half life. You can actually get down to like a half mg . Ive done this as well , the first time I kicked. That was for a 5 year Heroine/oxy habit.
I used 10 mg percocets after that for a little over a week because when I stopped taking the subs I got a sick. Even though I tapered down to only a speck of a strip. But the percocet helped ALOT.
So that is an option as well.
Clonidine is a big help. As well as any benzos . Just be careful with the benzos.
Also if you switch to Suboxone ,because it's easier to taper, you can use tramadol to help during the transition.
If you can get into a program that's great too. I would rather detox myself though, because they don't offer Percocet after a sub taper , or tramadol or any nice things like that...
 
whenwhy said:
So i'll make this post quick, im 32 been on methadone/biodone for about 2 years and subby bout 1yr prior. (My drugs of choice was Heroin, originallly from injured back at the gym, oxycontin etc)

I have worked my way down from 120mg to 32.5mg a day ( I just dropped again today) im keeping my magnesium up and taking the odd clonazapam but keep it to an absolute minimum as I already suffer from anxiety.

So to the question.

I hear people switching to subby and coming off easier. Which Im not sure about.
I hear of people trying a shorter acting opiate for a week then going into detox, which methadone taking so long to get out of your system scares the shit out of me and ive experienced 6 days without methadone before.
Then I read of a methode inwhich they put you under and inject you with naltrexone, thus getting the drug off your receptors and out of your system while in hospital.

I am currently reading about detox treatment centers on the east coast as we will be moving there, also I have private or will be getting it very soon for this purpose as the waiting period is only 2 months for drugs treatment.

So anyone if they can recommend a center, or share their experience it would be much appreciated.

Thank you again I just feel confused on the next step

thank you
Click to expand...

The detox method you alluded to is known as a rapid taper. They are generally incredibly ineffective and highly dangerous. They're all incredibly costly. Best avoided.

Buprenorphine will absolutely be helpful in your transitioning off methadone. If you're afraid of using it for an extended detox of six months following cessation of methadone, which is actually what most knowledgeable doctors are recommending following long term methadone use (I'm not sure two years on methadone is quite long term though, as it's that is pretty standard), using it for a week or two to aid in the acute detox is absolutely recommended. You won't have to taper or detox from the buprenophine, as two weeks on it isn't nearly long enough to become dependent. All it would do is allow you to detox from the methadone more comfortable.

The most comfortable and efficacious method of detoxing from methadone I'm aware of involves:
  1. Taper, taper, taper! Taper as long and as low as you can. Some people say that jumping off 20mg isn't any different than jumping off 10mg or less of methadone, but there is very good reason to taper as low as you comfortably can. Don't taper by more than 1mg/week dose reductions once you get to 40-30mg, and take breaks from your taper whenever you want. I was able to jump off around 15mg of methadone by using the following medication...

  2. While you're tapering get yourself organized with a medical professional who is willing to provide you with the following medications to manage your acute withdrawal (you may have to source your own short acting opioids though, as most doctors are unwilling to provide something like that to transition to buprenorphine even though it makes a big difference and have very little potential to cause more problems than its worth).

  3. After you jump off methadone, take an opioid like codeine, tramadol or even hydrocodone for about three days. This will allow your body to get rid of any methadone hanging around in your system so you can safely transition to buprenorphine to avoid precipitated withdrawal upon induction on that.

  4. On day four of no methadone start taking buprenorphine. You shouldn't need more than 2mg twice a day, but you should take whatever you need to feel comfortable. Less tends to truly be more with buprenorphine, particularly in this context, and I'd recommend not taking more than 4mg twice a day. Use buprenorphine for one to two weeks. If you use it for two weeks it's a good idea to halve your dose for the second week.

  5. Use the following medication for one to two weeks along with buprenorphine: diazepam (or another moderate to long acting benzo like clonazepam - what you want to avoid are the short acting benzos; diazepam is ideal because it has the best muscle relaxant properties of other benzos, so it will help as an anxiolytic and muscle relaxer, whereas clonazepam will be more the former than the later) 10mg twice a day; gabapentin 400-800mg three to four times a day as needed; IBU 600-800mg two to three times a day as needed; clonidine 0.2mg once to twice a day as needed (definitely at night, although not taking it during the day is okay is the RLS/hot and cold flashes aren't too bad); and a sleep aid like trazodone or Seroquel (I prefer trazodone for a variety of reasons).

  6. Discontinue the buprenorphine after one or two weeks. Continue taking the gabapentin and clonidine for up to a month if needed. Continue taking your non-habit forming sleep aid for up to a year or more following your detox (three to six months is enough for most people to avoid issue with detox related insomnia, although it's good to have around for the first year). Consider getting on an antidepressant like bupropion (whatever works well for you) prior to detoxing, and continue this for a year or more following your detox. It probably won't make a huge help, but anything that helps helps.

  7. Get exercise! Hiking during methadone withdrawal totally saved my life. Also, learn to meditate, do yoga, or whatever kind of structured contemplative practices you're drawn to. Certain types of meditation (vipassana, self compassion, tonglen, etc) go a hell of a long way to helping you learn to self regulate in healthier ways without having to just rely on drug use. Also, work on ensuring a healthy diet, as nutrician and hydration are really helpful.

  8. Also find yourself a therapist you give with and work with them. You'll have more than enough of stuff that you're best off having one-on-one support with.

Two things to consider is finding an inpatient detox place (one that uses ALL the above mentioned meds, namely buprenorphine, diazepam, clonidine and gabapentin) in order to help you kick in. Also consider some kind of 90 day IOP program to help get yourself the support you'll need following cessation. Inpatient rehab can cause more problems than it solves, and generally speaking a good IOP program (assuming your living environment isn't too unhealthy) goes farther to helping you transition to a healthier lifestyle. Keep in mind that with any kind of treatment it will be up to YOU and you alone to advocate for yourself. Most "profressionals" in the recovery industry have no business working in a health care field (horribly undertrained, not knowledgable about opioid use disorder, generally fucked up individuals, etc).

Mafioso's post is a little misleading though. For all practical purposes the naloxone doesn't actually do anything. Buprenorphine has both a higher binding affinity to opioid receptors than naloxone and doesn't even get into your system in significant amounts unless you were to inject the Suboxone (possible if you plug or snort it might). But even if it got in your system it wouldn't do much compared to buprenoprhine.

The blocking properties of buprenorphine are entirely the result of buprenorphine. Naloxone was added more as a marketing ploy than anything else. It allows the company to claim that is prevents misused via injection or something, but this doesn't really happen as advertised given buprenorphine's higher affinity to opioid receptors.

More at anyone's request. Someday I'm going to make a sticky about this stuff so I can just link people to it instead of having to write this out each time :\ No worries OP, happy to do it. It would just save me some time.
 
Last edited by a moderator:
" Buprenorphine has both a higher binding affinity to opioid receptors and doesn't even get into your system in significant amounts unless you were to inject the buprenorphine (possible if you plug or snort it might). But even if it got in your system it wouldn't do much compared to buprenoprhine."

I'm guessing you meant naloxone doesn't get into your system if ingested?

"The blocking properties of buprenorphine are entirely the result of buprenorphine." and the blocking properties of suboxone are the result of bupe?
 
LOL you caught me! Yes, buprenorphine has a higher affinity, especially at the relative doses used, than naloxone in Suboxone :) thanks for catching that hehe
 
^ two weeks is definitely long enough to get dependant on Suboxone .
For me , 8 days was enough. At 8 mg a day . I was screwed for the full 30 days of sub withdrawal. If u can believe that. Everyone is different. 7 days isn't long enough for everyone. But two weeks is definitely long enough to get dependant on ANYTHING. Even with that low of an amount . You said two mg for one week then half the next .. and you won't get dependant?? Idk. I definitely would not risk it.. especially if they take 4mg twice a day.
But if op takes subs for two weeks , and then stops, won't they be in the middle of methadone withdrawal?? Like doesn't it take 30 days to kick? Or is that why you said continue to take gabapentin??
 
The most honest is it's going to suck bad and it's unavoidable. If you take that mind state then everything else is cake
 
yompf said:
^ two weeks is definitely long enough to get dependant on Suboxone .
For me , 8 days was enough. At 8 mg a day . I was screwed for the full 30 days of sub withdrawal. If u can believe that. Everyone is different. 7 days isn't long enough for everyone. But two weeks is definitely long enough to get dependant on ANYTHING. Even with that low of an amount . You said two mg for one week then half the next .. and you won't get dependant?? Idk. I definitely would not risk it.. especially if they take 4mg twice a day.
But if op takes subs for two weeks , and then stops, won't they be in the middle of methadone withdrawal?? Like doesn't it take 30 days to kick? Or is that why you said continue to take gabapentin??
Click to expand...

Acute withdrawal from methadone when one properly tapers doesn't generally last more than two weeks. And perhaps I should have been more specific, but two weeks on something like buprenorphine isn't long enough for *most* people to become dependent on it. The big exception to this is people who have recently been dependent on it, but this doesn't include the OP.

I didn't find I needed to take buprenorphine for more than a week (so from day 4-11 after cessation from methadone), and didn't experience anything difficult whatsoever after getting off buprenorphine after a week (I have also been dependent on buprenorphine for long periods of time; I feel pretty confident saying that if the OP only takes it for a week there is next to no chance they'd become dependent on buprenorphine).

There are a lot of myths and misconceptions about methadone out there, similar but more extreme than buprenorphine. It's very frustrating. Like I said, acute withdrawal is very similar to buprenorphine in terms of duration. In both cases acute withdrawal doesn't actually need to last more than about two weeks, but because many people do not properly taper or don't have access to the appropriate comfort meds, the withdrawal often drags on far long than the minimum amount of time.

It's just a very frustrating situation. For sure, the OP will have to do a lot to ensure success getting off methadone, but it's entirely possible. And there is no reason for them to suffer if they adequately prepare for when it comes time to jump off. I was amazed how much more manageable my experience was compared to the horror stories out there. Those horror stories generally come from worse case scenarios though, like having to kick in jail or jumping off methadone without adequately preparing for the transition.

It's good to continue to have some meds around just in case some of the withdrawal symptoms linger, which is possible. Wasn't my experience with methadone, but definitely was with buprenorphine. Then again, I didn't engage in a proper taper when I came off buprenorphine back when I used it for ORT. So the moral of the story is really taper taper taper some more. Comfort meds will also make a huge difference, but the most important aspect of this is tapering.

For what it's worth, I know of many people who were able to come off methadone just by tapering. But also having access to appropriate comfort meds maximize one's chances for success.
 
^ ah! , ok , I didn't know that. If you taper properly , the WD can last half as long then if you just stopped cold turkey.. I guess that's why when I tapered subs for the first time , 9 or ten days of Percocet after, got me through , and I was ok... Real weak but ok... I got down to a speck of a strip. .5 - .25 mg maybe a couple times a day maybe 3 sometimes . I don't have any experience kicking methadone. I just know subs are easier to taper down with.
Anyway , ya it's weird I got dependant after only one week . Though that doesn't happen if I TAPER over a 7 day period.. but yes, weird .. so anyway ,most people won't have to worry about that . There is a big difference between one and two weeks though. Idk , I would not risk taking subs for TWO weeks without tapering..
 
It's weird. It takes A LOT of naloxone to break through when someone's OD'd from buprenorphine (which is only really possible when one is opioid naive). It's similar to how it takes A LOT of heroin to break through buprenorphine's blockade effects. Very dangerous.
 
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