Tapering off from long-term Methadone Maintenance

[hairohwin]

I have been on Methadone Maintenance for almost four years now, and would like to start tapering down. I'm worried about withdrawal, however, and how bad it may get. Personally, I can handle all of the physical stuff - the cramping, tearing/yawning, diarrhea, muscle aches & pains, spasms, sweating, chills, etc., but what gets me every single time is the anxiety I experience during withdrawal.
I have never had issues with anxiety previous to my experiences with withdrawal; the first time I (unknowingly) entered withdrawal was the first time I ever felt what anxiety and anxiety attacks were like, and to this day it remains as my biggest hurdle in ending my Methadone Maintenance Program. Its a heart-pounding, uneasy, full-fledged anxiety attack-like feeling that does not let up; it persists, at a stable level of intensity, until I find some opiate-related relief, whether I dose, get high, whatever.

That said, I am curious about the experiences others have had in tapering off of Methadone.
How bad was it?
How slowly or quickly did you taper?
What were your biggest obstacles?
How did you deal with the withdrawal symptoms (if any were experienced)?
How long did it take?
Did you receive support from your clinic and/or doctor during this period?

...and any other information, tips, ideas, advice, etc. that main pertain.
I am currently taking 90mg/twice a day, for a total of 180mg/day.

 

[brutus]

I've stopped 100mg of methadone a day cold turkey. It was hell and I wouldn't wish that upon my worst enemy.

I suggest dropping 5-10mg every week until you are at a point where methadone no longer keeps withdrawals at bay. You may be able to drop quicker than that at first. It will take a while to get clean, but you didn't exactly become an addict and develop such a tolerance overnight. At that point, I would go ahead and pay the piper.

If you can possibly get down to 20-30mg of methadone then switch to Suboxone. I was never able to quit methadone and stay clean due to the withdrawals, but withdrawals from Suboxone were much easier.

I would also recommend staying as active as you possibly can.

Why do you need two doses of methadone a day? Can you get by dosing once a day?

 

[neversickanymore]

HEY hair..since you require two doses of methadone a day I believe that your methadone half life is really quite small compared to average.. this should work in your favor as it will decrease the amount of time you will spend in acute withdrawals.. here are some interesting things about methadone that i found while looking for the liver enzime explination for the big difference in methadone half life. The withdrawals will be unpleasant.. they are temporary, you will have to go down this road sometime.. sometimes a huge drawn out tapper can just cause you to be sick forever.. it only takes a few days to wander out of hell

 

[hairohwin]

Its actually one dose, its just a split; my daily dose is 180mg, but it makes me really tired (something about a fast metabolism), so I talked to the clinic doctor, and after a "Peak and Trough" blood test, he recommended that I split my dose in half and take half twice a day, so I wouldn't get knocked out by it anymore.

How much better were the withdrawals from Suboxone? Did you ever experience anxiety related to withdrawal? Thats the ONLY thing I can't handle. I actually just got back from the clinic, I had talked to the doctor, and he developed a plan for me that would take about a year to complete by tapering slowly. He also recommended, if I needed it, some drug that starts with a C.. not Clonipin, but its something that controls your heartrate, which he said might help with the anxiety, if I need it once I start my taper. I'll have to ask him again what the name was when I see him!

 

[hairohwin]

I've heard that methadone withdrawal lasts for MONTHS!?... I have tried to go "cold turkey" from methadone before, back then I was only on 90mg, but I still using heroin heavily. I didn't even last a week. I literally cannot tolerate the anxiety, especially when I can't see the light at the end of the tunnel. If I KNEW it would only last a few days, or even a week or two.. I would grit my teeth and try it, and knowing that there is an end in sight might make it more bearable.

 

[neversickanymore]

How far can you cut the methadone rite now.. and still handle the withdrawal.. what is the lowest dose you could cut to for four days in a row?

 

[Mehm]

What are you going to do if you get totally clean? Do you want to be sober or just not using opiates?

 

[hairohwin]

How far can you cut the methadone rite now.. and still handle the withdrawal.. what is the lowest dose you could cut to for four days in a row?

I'm not sure, I haven't tried cutting it. I haven't started weaning yet. I CAN get by just ONE day if I only take half of my dose (90mg), but I definitely feel it. I usually go to bed early those nights, when that happens, so I don't have to deal with it. When I wake up, I need to dose immediately.
Even with the FULL 180mg/day, I still have a tiny bit of withdrawal that begins and stays with me before I dose at the clinic. Its not much, its manageable, but noticeable. Its there by the time I wake up, but on nights when I don't sleep, I notice that I start feeling withdrawal between 6 - 9am, depending on when I took my first and second doses (usually I take my first @ noon, and my second between 8pm - midnight). I worry that when I start weaning, it will only get worse. I've been on the same dose for a while, and assumed my body would adjust to it eventually.. it hasn't.
To answer your question a little better... recently I missed the clinic, and the day before I spilled my second dose, so I only took 90mg that day. I couldn't reach anybody for dope, but I did have some random vicodin and percosets laying around; I took all of them, but they didn't help. I couldn't sleep or eat that day, and by the time 5:30am the next day came around (that's when the clinic opens), I was going nuts, it was getting unbearable. So my guess is that I couldn't last long! d:
If I knew the withdrawals would only last a week or so, though... that's a different story! But I hear they last, literally, for months, unfortunately.

What are you going to do if you get totally clean? Do you want to be sober or just not using opiates?

I still use very occasionally, but I don't like the Methadone. It makes me so tired, I'm always constipated, takes me forever to orgasm, it made me gain a little bit of weight (not much, but enough that I notice), and if I want to go anywhere, its a pain in the ass to arrange it with the clinic first to ensure my take homes. I just want to get off of the Methadone, and see what happens. I know it might sound like a bad idea since "I still use very occasionally", but I really feel like I'm ready and in a good place to start the wean. I'm just terrified of that ONE withdrawal symptom.

 

[PortalFloyd]

Usually it's recommended to taper 10% of your dose every 2 weeks or so I believe. You can also do a "blind detox" where you're unaware of your dose while tapering which can relieve some of the anxiety for you. Below 10mgs is honestly the hardest part psychologically and physically, and I'm on 4mg right now. Switching to Bupe for a short period of time works for a lot of people too when you manage to reach a low dose (30-10mgs). Clonodine, Phenergan, and Immodium can help to relieve some of the withdrawal symptoms too. "Slow and steady wins the race" with Methadone tapering.