Opioids Morphine or Methadone Taper?

I am currently on 70mg of methadone a day as maintenance treatment for heroin addiction, due to drop to 60mg next week. This treatment is essentially free to me on the UK NHS. I can taper down all the way on methadone, or choose to taper down to 30mg or lower and then switch to buprenorphine to taper the rest of the way on that. Of course these are both long acting opiates and as such the withdrawal will last a long time, for multiple months in the case of methadone.

It looks like I'm going to be offered the opportunity to taper down on morphine instead via a private doctor if I so wish. This being a much shorter acting opiate, the withdrawal will not last as long. At the moment I don't know anything else regarding the nature of the morphine maintenance; for instance I don't know what sort of formulation will be offered or how much it will cost me. I will add this info as I receive it.

Now, I need to make a decision as to whether it is worth switching over to morphine to taper down on. Is the withdrawal going to be significantly easier on morphine? Is it worth paying for? I'm hoping there are some people here who can give me some information as to what the difference between the two tapers/withdrawal will be like. I'm guessing that the morphine will be easier, but will it be significantly so?

At the moment I am sticking to my script and I intend to continue doing so, I just want to get clean and get on with my life. I'm attending NA on a daily basis and realise this is not going to be easy however I do it. Can anyone give me some useful input?

If you could widdle your way into the position, the easiest way would be all 3... from methadone, switch to morphine and then to bupe and go down on bupe then off.

Reasons for this:
*Switching from methadone to bupe is beyond hell, and you're probably better off in the ICU, depending on your daily 'done dose.
*Methadone to morphine: you would feel no pain during this switch, not even discomfort if you were given enough morphine.
*Morphine to bupe: 24hrs (max?) of discomfort, plus a little bit more in agitation, just take something to knock you out and sleep. (I went from heroin to bupe laying outside on a rock in the Grand Cayon. If I can do it there, it's safe to say you can do it at home)

Then taper down and off bupe more quickly than your own body and mind start getting used to it. This should be cake work and clock work imo, especially since the UK has better programs.

-edit: if you can get down to 30mg of methadone, I don't see the point in switching to bupe, unless you simply prefer it, as you certainly won't be walking around like a zombie. Taking this into account, "methadone to morphine" should fir your needs.

Ok, that's the sort of input I'm after, from the sort of poster I want info from (all is welcome though). The schedule you are talking about is definitely something I can get (for that read 'buy legally').

Will it really be that hard to get down to 30mg of methadone if I take it slow? The drop from 80mg to 70mg was easy, the only difference I noticed was that I definitely needed my meth after 24 hours rather than being able to go ~36hours before dosing. Obviously it's going to get harder, but will it really be that hard? I wasn't walking round like a zombie at 80mg, I was working 75 hour weeks as a cook at the highest placed new entry to the San Pellegrino '50 Best Restaurants In The World'.

The morphine definitely sounds like the best option, but it's going to cost me.

You probably won't even need the morphine (unless you get bored and childish) if you didn't have any real issues from an 80 to 70mg drop. Stress to the drug counselor and prescriber how well a slow taper is working.

Save your money and time, and skip the morphine if you can.
I would only use the morphine after dropping off 10mg of 'done, and for the first 48hrs only.

After my surgery, I was on IV Dilauded and couldn't get off so they switched me to every other dilauded dose would be a methadone dose and I slowsly went from 3 methadones to 1 dilauded dose a day and then they eventually got me on the oral pills.
but what Im saying to you is, my docs told me that trying to get off Methadone is easier than from Dilauded and it was. I don't know if your going to go to pills after, and Im no too familiar with bupe, but Im fine with the Dilauded pills now, tho my pain is getting a little worse from complications. But Dilauded -> Methadone was easy, and I did this over maybe 2 months. But the 2 months won't compare, you'd prolly need a lot longer because I was on low 2mg doses, but I was taking them every 2 hours so that could be around what your taking?
I dunno, sorry if that didn't help :/

Hydromorphone probably has a higher binding affinity to the opiod receptors than methadone, but methadone has a MUCH longer half-life. I wouldn't be suprised if hydro-m has an even shorter half-life than IV fentanyl citrate.

Tapering with methadone shouldn't be that difficult, physically. Psychologically you may feel some discomfort, and can even bring on psychosommatic symptoms simply by psyching yourself into thinking you are sick. Tapering shouldn't be torture, you should go at as slow a pace as you need in order to stay comfortable. If 80-70 was easy, that is a good thing. The drops when you're at a higher dosage can be higher without much consequence. As you start to get lower, make the mg you decrease smaller. I recommend dropping ~10% every drop, roughly every week or two, or whatever you feel comfortable doing.

It should be done at YOUR pace, not the doctor's/counselor's. Make sure you stress this at the clinic.

Don't even THINK about trying to switch to bupe unless you are below 30mg/day. Even then, the waiting time between your last methadone dose and first bupe dose will be substantial, and going from meth-bupe flat out SUCKS.

If I were you I would taper the methadone down to ideally ~10mg and then switch to a relatively short morphine taper (1-2 weeks) and then jump off completely. Once ready to stop the opiate completely there are many MANY things you can use/do to make yourself comfortable as possible. I highly recommend kratom, and also loperamide works wonders for many aspects of withdrawal.

On here we even have a mega thread specifically for dealing with opiate withdrawals. Very informative.

I was on methadone for a year and a half and jumped off at 70mg/day. Pure hell. No amount of bupe would help AT ALL and even having large amounts of klonopin and soma and neurontin, I was in HELL for over a month before I caved in and went back to dope. Don't make the same mistake I did.

Best of luck!

Hmmm, all the advice seems to be saying stick with methadone for the moment. I say the drop to 70mg was easy, it did involve vomiting up a dosage (which seemed to act as nitromethane for the onset of withdrawal) and a trip to the hospital for some anti-emetics so I could keep my methadone down. Maybe just continue with the meth and switch to morphine at the end instead of bupe?

I've been on 70 for about 2 weeks now, but the first 11 days of that was scripted at 80 and I just took 70 as I had some take home. I'm dropping to 60 in the next couple of days, ideally i'll feel ok to drop again to 50 after a week. My case worker has zero say in my taper speed really, all she can do is make a recommendation to the person that writes my script (who I've never met). It's pretty much entirely up to me. The second they start trying to make me do something I don't want to i'll be off to a private clinic.

Feel free to close thread, I've made my mind up.

If your tapering down with methadone to et off heroin, you don't want to switch back to morphine. The point of using the methadone is to GET OFF the heroin. If you go back to morphine its gonna be just like heroin and your gonna not be able to taper off. Just stick with the methadone and go off that, you shouldn't need to switch to anything else. Morphine will only make you regress.

VaderisBaddAss said:

If your tapering down with methadone to et off heroin, you don't want to switch back to morphine. The point of using the methadone is to GET OFF the heroin. If you go back to morphine its gonna be just like heroin and your gonna not be able to taper off. Just stick with the methadone and go off that, you shouldn't need to switch to anything else. Morphine will only make you regress.

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No offence or anything mate, but you sound like you don't know what you're talking about. For instance, did you know that one of heroin's original indications was as a drug to get people off morphine? Please don't post in my threads unless you actually know what you're talking about. Methadone is garbage and it's a fucking disgrace we still use it as a maintenace drug in this day and age. Not that this really means anything, but it was invented by a team of scientists working for Hitler.

The reason it's used is because of it's 'long duration of action, extremely powerful effects, and very low cost' (http://en.wikipedia.org/wiki/Methadone), rather than because it is actually the best drug to get people off heroin. The best drug for getting people off heroin is...............heroin! A carefully controlled medical taper is the blindingly obvious answer than countries don't want to accept because it's more difficult/expensive for them to make work. Be thankful I'm a nice guy who likes educating people because really I just want to tell you to fuck off.

Yesterday was my first day at 60, I'm at 20 hours since last dose and feeling it. Must be strong and wait!

edit:Oh, you're a Star Wars fan, that explains all. I believe that giving you the above information is what you guys describe as PWNED.

Just to give a different viewpoint, I think some people forget that methadone is very different for different people. Not everyone has an easy time tapering, not by a long shot, or we wouldn't have so many people who stay on methadone the rest of their lives. And just because someone has no problem dropping from 80mg-70mg doesn't mean that they will feel the same way dropping from 4-30 or 5-0 (assuming they could even make it down that low). My experience was that on higher doses I could drop 5mg without much problem, and the lower I got the harder it got and the more withdrawal symptoms I experienced. Also, you may not get withdrawals right away, as methadone stays in the body for a long time when you decrease your dose you may not feel the difference for several days. I found that the lower my dose got the shorter acting the methadone was, and I had to take it twice a day. Also there is often a "plateau effect" at around 40-60mg where many people find it extremely difficult to go any lower without getting withdrawal symptoms. Of course they are not nearly as bad as if you stopped taking the methadone completely, but they're definitely unpleasant.

I would try tapering the methadone as far as you can, then if you get stuck try switching from the methadone to morphine, and possibly then switching to buprenorphine if you have difficulty with the morphine tapering.

Also, there are real considerations regarding the differences between maintenance and/or tapering on methadone, morphine, or heroin, and they aren't as simplistic as either VaderIsBaddAss or omen_omenmk2 made them out to be. But that is a huge controversial topic and probably has it's own threads somewhere already. Morphine and heroin don't always lend themselves as well to "carefully controlled medical tapers" and I think their effectiveness really depends on the person, how much they use, their goals, their motivation level, how stable their life is, how long they have gone without addictive high-seeking behaviours and how ready they are to get off opiates completely. I wouldn't recommend morphine or heroin tapering for just anyone, but I also wouldn't recommend methadone tapering (as opposed to longer-term maintenance, then extremely gradual tapering at some future point) for people who aren't ready and haven't dealt with their addiction issues either. I certainly wasn't able to get off heroin with a heroin taper, especially injected heroin. I needed some time on opiate maintenance without getting high. It's really different for everyone and omen_omenmk2 sounds pretty ready and motivated. If you take a low dose of oral morphine and don't get any euphoria from it then it shouldn't be that much different from methadone or bupe, just shorter-acting with shorter WDs.

Given the option, I would morphine taper.

omen_owen mk2 said:

No offence or anything mate, but you sound like you don't know what you're talking about. For instance, did you know that one of heroin's original indications was as a drug to get people off morphine? Please don't post in my threads unless you actually know what you're talking about. Methadone is garbage and it's a fucking disgrace we still use it as a maintenace drug in this day and age. Not that this really means anything, but it was invented by a team of scientists working for Hitler.

The reason it's used is because of it's 'long duration of action, extremely powerful effects, and very low cost' (http://en.wikipedia.org/wiki/Methadone), rather than because it is actually the best drug to get people off heroin. The best drug for getting people off heroin is...............heroin! A carefully controlled medical taper is the blindingly obvious answer than countries don't want to accept because it's more difficult/expensive for them to make work. Be thankful I'm a nice guy who likes educating people because really I just want to tell you to fuck off.

Yesterday was my first day at 60, I'm at 20 hours since last dose and feeling it. Must be strong and wait!

edit:Oh, you're a Star Wars fan, that explains all. I believe that giving you the above information is what you guys describe as PWNED.

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Calm down there M8. If you are posting on here to ask for advice, then don't get all upset if someone gives you advice that you don't agree with. The point of a forum is to have an open discussion on a topic so you get an array of answers from people with different opinions. You started 2 threads with this name and another 1 or 2 with you other username all on the same exact topic, and then you tell people off it you don't like their answer. If you know it all, then why start multiple threads asking the same questions about it?

The person that you "PWNED" was merely mentioning that you may be more likely to abuse other drugs while on morphine than you would be while on methadone, which would be a step in the wrong direction. They were just giving you their opinion and trying to help out. If you don't agree with them, then just ignore their advice instead of telling them off. Some people have very smooth tapers off of methadone, and others don't. Some people are better off switching to a shorter acting opiate at the end of a methadone taper, and others aren't. If there is anything that we know about opiate treatments, it is that it is not "one size fits all," and in the end, the only way for people to find out what works for them is going to be through experience.

owen said:

For instance, did you know that one of heroin's original indications was as a drug to get people off morphine?

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And how did that work out for those people? I wouldn't be going by the original indications for a drug to prove a point. Thalidomide was originally developed to treat morning sickness, and look how well that turned out. 8)

BDP said:

If I were you I would taper the methadone down to ideally ~10mg and then switch to a relatively short morphine taper (1-2 weeks) and then jump off completely. Once ready to stop the opiate completely there are many MANY things you can use/do to make yourself comfortable as possible. I highly recommend kratom, and also loperamide works wonders for many aspects of withdrawal.

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I agree with this post, and I think it is very sound advice if you are looking to switch to the morphine at the end of the taper. It seems like you made up your mind though, but it would be good to hear how it ends up working out for you.