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Tapering off Methadone after being on it 6 years

This1chick89

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Aug 2, 2017
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Hey everyone. I'm in the process of trying to get off methadone right now. My highest dose was 89mg. Been going down 2mg per week and right now at 14mg. I have been feeling alright but sometimes in the morning when I wake up I don't feel so great before I take my next dose. But the jump from 16mg to 14mg has been hard. Now I'm feeling cold sweats and no energy, etc. nothing too terrible but not comfortable either. Should I slow the tapering now that I'm on a low dose? Would that help? Any advice? Also once I do get off completely how long do the withdrawals last? I know everyone's bodies are different but any advice would be appreciated if any of you have been through this before. Thanks!
 
Welcome to BL!

Generally dropping no more than 1mg/week is recommended for folks under 20mg, so I'd spend at least a week stabilizing on your current dose before dropping again, and then dropping no faster than 1mg a week for the rest of the taper. There is no shame in taking a week or two off here and there if it gets to be a bit much. It isn't easy, but you'll benefit in the long run if your plan is to taper much lower. And if you need to go up a bit if it gets really tough, there is nothing wrong with that either. Basically you want to find a middle ground between keeping yourself comfortable and continuing to move in the direction of lowering your dose.

Your dose is at the point where you really want to be organizing your inevitable detox off methadone, so I'm glad you are reaching out about this. I highly recommend working with a doctor who is able to prescribe buprenorphine (or willing to prescribe something like tramadol, though these are less common). I also highly recommend organizing what you'll be taking in terms of other comfort meds.

Basically the big thing here is FINDING a doctor willing to work with you and prescribe the following medication to get you through the detox process: one-two weeks of buprenorphine (2mg twice a day), gabapentin (800mg two to four times a day), clonidine 0.1mg once to twice a day), diazepam (10mg twice a day) and a non-habit forming sleep aid (such as trazodone). There are other meds that can be helpful, but that combo (or variation on it) is the gold standard when it comes to detoxing off methadone.

When I got off methadone I had been on it for about 2.5 years. I tapered off a high dose of 90mg over about 1.5-2 years of that. The final dose I jumped off of was about 14mg. I used codeine to for three days to help more easily induct on buprenorphine, then used gabapentin+clonidine+diazepam+buprenorphine+trazodone for a week. Then I used gabapentin and trazodone (I had also been taking buproprion) for the following month or two, then just trazodone for maybe the first 6-9 months. It's been well over a year since I last took methadone now, and opioid free.

Getting off methadone is nothing like the horror stories you hear when done properly, and given the right supports (pharmacotherapies as well as more developmental and behavioral approaches, ideally all in conjunction) it isn't very painful. Of course, I'm not saying it isn't incredibly difficult. Chances are though, if you listen to your body and take care of your basic needs without getting to tough on yourself, the process will surpass all your expectations (in a good way).

Whatever you do, I would not suggest jumping off methadone until you have some comfort meds lined up (at a minimum).

Do you have anyone or are part of any communities IRL that you find supportive in this process? Do you work with a therapist you like and have found helpful? Are you going to have to find a doctor outside the clinic to write you comfort meds?
 
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Thank you so much for your reply! I have heard a lot of horror stories of people coming off... it makes me anxious but I know I'm ready to get through this. I know it will be worth it. That is really good advice to stop here at 14 for a week or so and get stable then go down by 1mg per week instead of 2mg. I will do that. My doctor at my clinic keeps offering me suboxone but I don't want to trade methadone for something else. I would use it a few weeks as you suggested but he wants me to get on that instead, I told him no. I don't know if my doctor would prescribe any of those things so I may have to do this the hard way. But hopefully not. Do you think the longer you are on methadone the harder the withdrawal is? 6 years is a long time and I'm wishing I would have done this sooner. Thanks again!
Also congratulations on being off Methadone for over a year! That's amazing... I hope to be one day too.
 
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Sooner or later you'll get there too, it's just a matter of time and trial and error (and most of all not being too hard on yourself or rushing things). There is actually a large body of evidence that suggests six months of buprenorphine following as many years on methadone is helpful (specifically in terms of preventing relapse and OD).

Of course, coming off that is its own process, and I totally understand just wanting to move on already. It's really a choice you'll have to make for yourself. If you are willing to commit to it (so basically extending the process by 6-12 months), chances are you'd benefit from it. However, it will involve a bit of additional effort on your part. If you aren't entirely behind that kind of decision and commitment, it could very well end up being counter productive. So just be honest with yourself about what you are and aren't comfortable with, and then be firm when working with doctors on your decision.

I highly recommend finding a doctor outside the clinic to work with. That is great the clinic doctor is willing to put you on buprenorphine for any length of time, so frankly I'd take him up on that. Worst case scenario you end up with more than you need, something that some find helpful (having some buprenorphine around for when relapse is likely I mean). Personally I found it easier to just have what I needed around, because self control and opioids don't go together so well for me anymore.

There is literally no reason a doctor wouldn't prescribe gabapentin and clonidine to transition off methadone, even if it's onto buprenorphine. The methadone to buprenorphine transition can be rough when not managed properly, and even having these two most basic comfort meds on hand will make a big difference.

The difficulty with only working with the methadone clinic doctor on this is that you're already dependent on them to prescribe you methadone, which at this point you really still need. So you still want to be on good terms with them, however they might not see eye to eye with what you want to do either. So it is really helpful to have another doctor outside the clinic you can more easily take or leave if they're unwilling to work with you.

Finding a good doctor who is willing to work with methadone patients and support their individual goals isn't the easiest thing in the world, but it's easier than finding someone who can prescribe buprenorphine IME. So that's great you already have access to that through the clinic doctor when the time comes.

The more time on methadone, the more time it will take to transition off it and stabilize without opioids. But when managed properly it isn't necessarily more painful or any more difficult than a shorter habit with it. Like I said, it just requires you take a bit more time and are all the more gentle with yourself.
 
Thank you... you have been very helpful. I'll make an appointment with my primary doctor and see if he can prescribe me anything to help once I'm off the methadone. I'm 28 years old with two sons 5 and 1... I want to put this past me and the reason I got off heroin and into the clinic was finding out I was pregnant with my first and I have been clean for 6 years off completely everything other than the methadone. I didn't want to relapse so I stayed in the clinic a long time and I have been feeling ready. I started tapering about 2 years ago. The clinic wouldn't allow me to continue tapering once I told them I was pregnant with my second child. Which I agree isn't good, I also had to go up even since my baby was taking some of my dose. so that is part of why I have been in the clinic so long. As soon as I had my second child I waited a month then started right back to tapering. But I feel like it's time to move on and I don't see myself being a person who stays on it forever so I want to stop being afraid of the withdrawal symptoms and just get through it. I had no idea about those medications that can help me through the withdrawal though. That was very helpful information. I was thinking I would just have to deal with being sick for awhile. I know my friend who was in the clinic jumped off at 7mg and 90 days later still claims he's not back to normal. He didn't have any help with meds though just got off and dealt with his symptoms. I was prepared to deal with it too, but knowing it could be easier for me if I find a doctor that can provide me with these medications is great to know.
 
It's true, the bottom line is that it will be unpleasant. The thing to know is that there are lots of tools out there to help aid your process. That includes the appropriate medications (such as those I have described) as well as supportive communities. If you live in a city with any Against the Stream meetings I high recommend those, but this sort of thing is whatever you feel helps you continue to cultivate your sobriety.
 
Thank you so much. How were you feeling through your detox having those medications to help? Was it rough still? How long until you started feeling well again?
I'm not sure if my city has those im from Detroit
 
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I spent the first two weeks after jumping off methadone basically just hanging around the house. With the right combo of meds I found for myself it was probably the second easiest kick I've experienced (the easiest being a free pass). After that I start up with my normal class schedule, going to meetings, basically regular life.

I still had a bit of insomnia and RLS for the first couple months, but eating right, exercise and meditation helped a lot with that (plus medication). Same goes for having a routine - very important. But the point is that, while I wouldn't say in retrospect I felt normal exactly, life was far more managible than I'd imagined (again, based on the horror stories). Basically I was just stoked to feel more or less normal without needing to take opioid every day. That feeling has only increased since.

I did also use various entheogens to basically help me stay away from other drug use during the first six months post methadone. In retrospect I'm not entirely sure how necessary this was, but at the time I believe I benefited from it for the most part. It definitely did a lot to help me solidify my commitment to live and cultivate a different, healthier lifestyle than I had been able to dependent on opioids.
 
I hate RLS it's a bitch! But mostly I hate that no energy feeling. When I kicked heroin before years ago (only lasted a few weeks) it literally felt like it took all my energy just to stand and take a shower... I know sounds fucking ridiculous but it's true. I can't just lay around this time. I have a job and kids so that part will be hard too. But I'll definitely check into those meetings. And getting prescribed those meds that you mentioned. I have asked others for advice and you have helped me the most so thank you for that!
 
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