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Methadone taper 120mg->25mg tough, leaked bottles tougher

RedRum OG

Bluelighter
Joined
Jul 18, 2009
Messages
3,699
Location
MN
background: I've been on methadone for about 4 years after a real fucked up time on heroin. Relapsed on Benzos a year in but haven't abused any hard drugs since Jan 9th 2014 (3.5 years). I smoke weed a few times a week though, which my clinic doesn't seem to care about. Had my dose cranked up to an excessive 120mg a day, but over the last 6 months or so I've gotten it down to 25 mg a day (technically 12.5mg 2x/day) 25mg a day has not been easy. Maybe it's in my head but I haven't felt 100% the entire month even without further reduction. So even before this I was pretty worn down. I am in good standing with my clinic, get a week of doses at a time

current problem:
So here's my problem: I took an plane to visit my dad, and it seems the pressure difference made the bottles leak. 5/7 leaked, with 2 of them losing over 50%. I'm a full 72 hours out from being able to go back and completely out. Took my last dose last night. That's almost 90 hours without.

I don't know what I'm looking for honestly. Support, advice, etc? I have gabapentin and weed which help a lot, but after 48 hours shit gets pretty unbearable. I don't want to call my counselor on Monday and tell her this sketchy sounding story, I'm worried I'll get punished, and more importantly, very unlikely they'll "reimburse " any

The fuck do I do? I'm really worried after 48 hrs the desperation of dope sickness will have me back at my old Minneapolis dope spots, taking my chance on whatever banger brothers I find. I don't want to get high, but I'm an addict to the bone and only a truly exceptional person could deal with 72+ hours of methadone sickness

I'm only 14 hours in, ~65hrs to go, like 2/10 withdrawal and the anxiety of "this is gonna be really really bad" is killing me

Ugh why did I taper
 
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I should mention that I do have a lot going for me. I'm not homeless, I have a room and a bed to kick in. I have a little weed, not enough for days of kicking, but a little. I don't have to work until after I go to the clinic on weds, thank the dear lord for that. I have no obligations other than sit in bed, watch netflix, and try to keep ideas of going to the hospital and begging out of my mind.

For all this I am thankful, but my addict side says "I'd give it all up just to get well". Even 3.5yrs later that desperate, desperate feeling comes back so easily

I might try to get to a meeting Monday night before I get "simultaneous shitting and puking" sick. Wish me luck guys.
 
So the issue seems to be that you've run out of your dose early. Did you happen to document what happened with the plane somehow (pictures or something)? This is actually a not at all uncommon issue with traveling by plane (when the pressure changes if they're taken as checked baggage).

I'd advise you to contact you home clinic, tell them what happen, and arrange a guest dosing for the time you'll be on vacation. Some clinics are better about this than others, but it all boils down the relationships you have with your clinic director and doctor. If you've been doing well enough to get a week of take homes, changes are they'll be more understanding with you than someone who was failing drug tests recently.

Now, if that doesn't turn out to work, there are three medications you can get yourself prescribed to treat the majority of the withdrawal symptoms (which really take about five days to present in their full shittiness). Those being diazepam (or clonazepam, but IME diazepam works a little better), clonidine and gabapentin. You'll probably have to dose high on the gabaneptin, but you should be able to get away with 10mg diazepam twice a day, and clonidine 0.2mg once or twice a day (just be careful about sitting down or laying down and standing back up after you've taken clonidine, and try to monitor your BP with it).

I don't mean to scare you, but withdrawal from methadone begins to fully present around day five like I said, so you're only getting a taste if you're on day three now.

I wouldn't take buprenorphine in this situation because (a) it will be difficult to get given your situation and on short notice and (b) you're best of getting back on methadone and stabilizing at your lower dose before trying to get off.

So sorry you have to go through with this. Fucking sucks.

There is one other option you have in terms of accessible meds: DXM. It will render you entirely useless in terms of an ability to engage in analytical thought or socialize, but if it's all you have it's worth doing. It can reverse the majority of the symptoms of acute withdrawal at 1-2nd plateau doses. It can be very unsettling, but the relief it can provide when in bad withdrawal is so profound I'm yet to meet someone who took it during acute withdrawal who wasn't able to tolerate its psychological side effects.

That said, DXM is serious shit. You WILL NOT be able to act normal on it, and trying too hard will just make you feel even worse. But if you're able to seclude yourself for four to eight hours after dosing DXM it should be manageable. I wouldn't recommend taking this if you have to do a lot of stuff with family though. In that case it would be better to just go the prescription med route and let them know you're sick (whether you frame it as the flu or what you're actually going through, you know what will work best with them).

Hopefully your family is understanding given the shit nature of this whole thing. If you have no obligations than to just isolate with movies and music in bed, DXM is a viable option if you have the money for it (low cost/day for two good doses you'll probably need to keep most of the withdrawal at bay).

Well, there is also loperamide, which I've heard good things from people using when they need to make up for missed doses on methadone. It's certainly not safer than DXM, but I prefer DXM to high dose loperamide (high dose meaning 80-150mg - and don't kid yourself, regular doses like that will be uncomfortable in side effects, at least if not more dangerous than DXM, certainly more dangerous than 1st plateau DXM doses, and you could inadvertently increase your tolerance to opioids which would suck when you try to get back on your normal dose of opioids).

I wouldn't advice combining methadone and DXM, but you could take your methadone in the morning and take the DXM as soon as it wears off. Definitely do not combine methadone and loperamide. You can safely combine methadone with the comfort meds I mentioned, though the gabapentin will probably overpower it and you'll need to be extra careful about blood pressure when combining it with diazepam and clonidine.

Next to iboga/ibogaine though, I've never come across anything that helps opioid withdrawal (including methadone withdrawal) as profoundly as DXM can. You'll need to play around with the dose a bit, especially if you're not already familiar with the substance. I wouldn't start out taking more than 150mg or so until you know how the substance will affect you. You'll likely need about twice that though, and probably twice a day (so say around 9am and again around 6pm).

Keep your head up. Like you said, you've got options and at least you've got somewhere safe to stay. You don't need this shit though, it's not doing your recovery any favors. The only silver lining perhaps is that (a) it gives you a taste of what withdrawal from methadone can be like under less than ideal conditions and (b) when you are able to get back on your normal dose at least that should be more effective than it was before this sort of enforced sort of detox.

Try to keep yourself hydrated and well nourished. That helps more than you might imagine. Or at least, you'll feel a lot worse if you aren't getting hydration or eating enough. If you can manage to get yourself out of bed to take a hot bath or shower, that really helps, especially at night. I'd suggest watching more upbeat or funny movies, or whatever warms your heart, and listening to a lot of good music. Especially music, it can really help the mood. And if you are able to find comfort meds or do the DXM thing, I'd definitely encourage you to spend some time outside, go for a walk, sit in the sun, that stuff can help a lot too.

Can you get more gabapentin (I'd probably need to take about 4000mg twice a day in your situation, but we're all different), diazepam/clonazepam and clonidine?

How long have you been on the split 25mg dose now, before this shit fest happened? When you get home, it would probably be a good idea to try the 25mg dose again and see how you feel. If it isn't enough, go up a little on your dose and stabilize on that before continuing to try tapering. And don't taper more than 1mg/week if you've been having a hard time with that. How much were you tapering before, more than 1mg/week?

And whether you do it now in order to try and get guest dosing on an emergency basis or just wait until you get home, definitely let your counselor know about this unfortunate course of events. I don't know what methadone prescribing policies in Minnesota are like, but they're pretty good from what I hear. So at least you will stand a change of getting guest dosing approved if your home clinic is onboard with it and supportive. You'll probably need to wait another 24hrs to get guest dosing arranged though.
 
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Thanks for the long and detailed post. Very much appreciate it. I am very well versed in this stuff but doesn't make it any easier. Trying to chug white grapefuit juice and cimetidine to delay the inveitable. DXM makes me nervous, mostly because it's a fine line between helping dope sickness and a horrible disorienting semi-tripping state. Will consider it as things get worse. Loperamide has been on my mind, will probably invest in a couple grams to stop the horrible GI explosivness. Unfortunately benzos are not an option because 1) I've had addiction problems with them in the past and would rather die then ever even dip my toe into benzo world. 2) that would be a "dirty " UA. Luckily I have a limitless supply of gabapentin, thankful.

I am going home tonight (sunday) so thank god will not need to try to "guest dose". Sometimes they have a good Samaritan posted on the clinic phone line 24/7, will try and call him tonight see what he thinks about the chances of being "reimbursed"... But from what I hear from other clients there are only 2 ways for that to happen: 1) it is stolen and there is evidence enough for a good police report and 2) you throw up your dose in front of a clinic nurse, after taking it in front of a clinic nurse but as I have a decent reputation maybe they'll make an exception, well see.

Personally, every day is worse when it comes to methadone. Never made it to day 5 but I've done 72 hours once before and I barely even made it to the clinic I was so sick. Day 1 is unpleasant, day 2 really hard, day 3 I'm ready to beg a hospital to just knock me out till I can get more. Im on hour ~18 since last dose and about 65 to go. I think suicide is an insult to life and I don't believe in it for 99% of people, but I think day 4-5 would have me seriously considering that to escape the skin prison.

I hate putting people in the position of "this sounds like a junkie scam, but he will be fucked if I don't believe him" I have a lot of that infamous addict shame and guilt, and telling a story that could easily be fiction makes me relive a lot of that, I hate feeling like people think I'm scamming them, snd i really like my counselor. She's so young and cute and innocent. Idk tough position

Thanks again man. Will give loperamide a try. Will see if I can cop some weed edibles and just go into extended weed coma.
 
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Seriously reconsidering my taper. I never felt worse than 3/10 withdrawal doing 10mg decreases from 120mg->40mg, then 5mg decreases from 40mg->25mg. Even though I've been at 25 mg for 5 weeks I've felt 3/10 withdrawals every day, which is bearable, but long term fucks up my life. Sleep average 4 hours a night even with gabapentin and weed. I went from 215lb aspiring bodybuilder eating 4500 calorie a day to 200lb eating 1500 calories/day, lifting 3x/week instead of 6x. Exercise is my new vice, it saved my ass, gave me a reason to live. Now I can't eat or sleep well enough to even try. This is starting to sound like a TDS post and I wanted to avoid that.


At least I'm not homeless, a least I don't have to kick Benzos after a 6 month blackout, at least my most loved ones are alive and well, I have all my limbs and no serious health problems, I have a shitty job, but a job. Will try to keep this in mind as the confusing, disorienting claustropobia of sickness comes.
 
Ugh that's like my worst nightmare. I got a week's take out right now too and I was so nervous about something happening to them earlier in the week. I don't know your clinic but mine acts like you shot somebody when your a patient there. No way they would of done anything to help other then calling me a junky.

Did you call them? In a perfect world I would. In this one I wouldn't.
 
Yes, that is a very good point I failed to mention. That there is also a case to be made for keeping this info from your clinic doctor/manager if they're more likely to use it instead to revoke your privileges like take homes (that said, most clinics give you one freebee before revoking privileges if you've been in good standing a long time and didn't have serious issues with abstinence and only using methadone drug wise after you first started).

Seriously reconsidering my taper. I never felt worse than 3/10 withdrawal doing 10mg decreases from 120mg->40mg, then 5mg decreases from 40mg->25mg. Even though I've been at 25 mg for 5 weeks I've felt 3/10 withdrawals every day, which is bearable, but long term fucks up my life. Sleep average 4 hours a night even with gabapentin and weed. I went from 215lb aspiring bodybuilder eating 4500 calorie a day to 200lb eating 1500 calories/day, lifting 3x/week instead of 6x. Exercise is my new vice, it saved my ass, gave me a reason to live. Now I can't eat or sleep well enough to even try. This is starting to sound like a TDS post and I wanted to avoid that.


At least I'm not homeless, a least I don't have to kick Benzos after a 6 month blackout, at least my most loved ones are alive and well, I have all my limbs and no serious health problems, I have a shitty job, but a job. Will try to keep this in mind as the confusing, disorienting claustropobia of sickness comes.

Please don't take more than 80-120mg loperamide if you're not already familiar with high dose use. There is a good chance most of your symptoms will be addressed by "just" 60-80mg of loperamide, but you may need a little more. It also takes a long time to kick in, long than methadone even IIRC, so don't redose right away.

And yes, by day five it's significantly worse than it was at day three IME. That seems very common. By day five your body has begun to really get all the methadone that has build up that is active in your system is now gone, leading one to enter a very full period of acute withdrawal that can - if left untreated - peek a week later (or more even in worse scenario).

Gabapentin will go a super long way. As will loperamide. If you can get clonidine or even propranolol, it will also help (clonidine far more so). Gabapentin for the win though. You'll be alright, at least you know redosing is just a day away.

And definitely consider taking some time off your taper while your body stabilizes again at your current (or even a slightly increased dose of like 5mg). And also, I strongly suggest slowing the taper down to 1mg/week. If you've been taking as efficiently as you have, no wonder your body's set level is struggling to catch up with each dosage adjustment. 10-5mg reductions are pretty significant, and as you continue to decrease the total dose you're on, each decrease become quantitatively more and more significant.
 
Thanks for taking the time to reply guys.

I ended up calling the clinic and as I suspected they will not replace any methadone. They offered me a doc appointment to get clonidine tomorrow 11.15am. Right now 2pm Monday, on about hour 40 without, 40 to go, halfway there (whoaaa.. livin on a prayer). Today will be doable but the 48-90 hour mark will be the worst.

It's kind of a bummer because I've been on opiates from age 18 till 25 now, and I don't want to be in for more years decades, I don't know how I feel about "low dose methadone for life" but in kind of worried that's my future. Oh well, at least I wouldn't be one of those guys on 100-200mg for life.

I get the worst claustrophobia nightmares and wake up almost literally flying out of bed after 15min of disorienting half sleep. If I can't find my phone to check the time I panic as I feel very disoriented or lost in time or something ("please god, please let an hour have passed since I last checked ")

If I can get through this, boys, I can get through anything. Only had to do withdrawals this bad once before in my days of shooting a half gram of dope and 250mg oxy/day. Will be a journey.
 
Try not to think about this in terms of whether you'll be on it forever or not. It's not that simple. And what's more, you just can't know whether you'd benefit from being on it 10 years or simply another 10 months. Try and take it week by week and day by day as opposed to getting caught up in the trap that is worrying about the future.

If you want to get off it, there is no reason you cannot do that. I'd just encourage you to go about getting off it skillfully if that's what you want. That means restablizing when you get back to your clinic, possibly increasing your dose a few mg, and then once stable slowing down your taper to a max of 1mg/week reductions if nothing else.

The conservative taper is also useful because it won't just allow you to better acclimate and tolerate your dose reductions and manage the eventual acute detox, but it will also give you the time to get your support organized for whenever you will be getting off.

Generally speaking I'd suggest planning out 6-12 months at least. If you want to detox in a year from now, set that as your goal and follow through on it once you have an effective, reliable and safe support system (therapist, GP, psychiatrist, whatever other specialists your condition(s) requires, peer support (recovery or wellness or otherwise).

It's also really worthwhile getting into some volunteering or education to help you pass the time, although you'll probably want to take a week or two off for the inevitable detox - but that's so far away not worth worrying about ATM. In many ways, boredom and idleness is the near enemy of recovery given the drawn out nature of your taper.

On another note, clonidine can be really useful for treating nightmares/night terrors.
 
Hey red rum, that's so shity what happened to ur done I hope u are managing ok. I once accidentally put my methadone in freezer (stupid I know) and the water that is mixed with the done froze and the actual done just all leaked out so I was left with pretty much straight water. Anyways I took it to my pharmacy and showed/explained to my dispensing pharmacist and he said was best to see my doctor which I did. I felt like he wouldn't believe me but I sure as hell didn't wanna go without but he actually let me get some more and called up my pharmacist. Just thought I would let u know about this as I know u are seeing doctor so worth a shot explaining ur story. Good luck ?
 
Well guys I made it through without doing anything stupid other than smoke more weed than i could afford. Dosed ~5.45am, 8.15am now and finally starting to feel normal.

The last 9-12 hours were really tough. Did it with just weed, gabapentin, and mind numbing tv.

Thanks again for replies. It helps even knowing people care and want to help. Best of luck to you in your own struggles.
 
Good shit man! I dosed this morning too. I had forgotten how euphoric it is to go from feeling like death to normal in the course of 20 minutes.
 
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