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Avatar universal

Looking for emwave - q about methadone detox

Hi- posting for the first time (I'm new to this) and have a q - need input - from emwave. Last October you posted to Lisa that you had info on methadone blood levels during tapers/ detox. You said you have a bunch of spreadsheets and I'd love to see that info. Here's some info: Ive been on methadone for just 2 months - currently at 50 mg. After the first six weeks I decided it wasn't for me and asked clinic doc to taper, which he refused to do. So, only having takehomes for Sundays, last Sunday I skipped my dose. When I went to dose Monday morning I mixed my liquid with that tang they provide and only drank half (tossed the rest). I figured if they won't do it then I will take matters into my own hands and do it myself.
Well, had a follow up doc appt at clinic and he agreed to do a 5 mg/week taper as long as I promise to switch to bupe when I get to 25 mg. I am not sure yet if I want to do that or just taper down on my own and jump. That's for later. But for now, I can't say I'm on a stable dose but I am curious about the blood levels and drops, if I keep this up.

I know I should just be patient and go slow because the end result will be the same, regardless of how long it takes. I just needed to exert some control over a bleak unethical situation.

Any info on blood levels and tapering is greatly appreciated. Oh and dropping my dose in half resulted in NO WITHDRAWAL symptoms at all. Weird. It's been 4 days so maybe I'm doing my happy dance prematurely but I don't really notice and difference, except for improvements.

Thanks-
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Avatar universal
Thanks Jeremy for your input. I had some major ankle swelling, bloating, and could barely stay awake on 70 mg. Nevermind my memory loss! When I first met with the clinic doc about a decrease he said he suspected I was on too high a dose (then why did he approve it in the first place?) to begin with. I'm hoping the new doc will help out. This doc, and his colleague, are super busy and I just found out My boss planned a trip for me the day of my appt. (yes my work calendar was blocked out - no respect for personal time where I work)!

I will certainly keep you all posted wherever I go from here. If the new doc doesn't work out for some reason I figure I will keep on doing what I'm doing until it's time to switch to bupe and then transition, then wean off that asap. Will have to do some research on how though.

My only fear is that I will get impatient and just quit CT, but deep down I'm too fearful. A friend of mine said to do it and then when withdrawals set in, hold off as long as possible and when I can't stand it anymore just take a sip of my stash and see if that helps. Then gradually decrease the sips as the withdrawals subside.

I know I'm trying to cheat the system, or put one past the devil - and it will/may catch up to me. Then again maybe not since I was on it for such a short time. Only time will tell. And please if you are reading this know that everyone is different and please don't try this or if you do have a backup plan. I certainly don't want others to think this is the norm. I have read enough withdrawal stories to know that what I'm doing and how I feel is atypical.

Thanks again for everyone's help!!!
AR
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185545 tn?1331074866
Do you have access to accurate measurements of your current serum methadone levels. I think it would be interesting to see what your levels were at when you were on 50mgs. If they were sufficiently high, that would go some way towards explaining why halving your dose had little or no effects. Here is a plasma level chart which interprets blood levels and the appropriate response.

  

-------------------------------------------------------------------------------
Interpreting Methadone Serum Methadone Levels


Trough level  200-400ng/ml Sometimes little or no withdrawal,but opioid
blockade probably incomplete.
> 400-500ng/ml Optimal, usually no withdrawal and opioid
blockade achieved.
>500-700ng/ml Withdrawal unlikely, but possible monitor
clinically for overmedication.
>700ng/ml Withdrawal unlikely, examine other reasons for
any discomfort (and monitor for overmedication)

I know this isnt what you were asking for but i think it is useful and provides some insight into the possible effects your decrease has caused.

I guess the point i am trying to make is that it may be possible that your 50mg levels were high( in the 500ng/ml range) and the rapid decrease may have only bought your levels down to a therapeutic dose hence the lack of significant withdrawal symptoms. You may find that decreasing from here on may incur more severe symptoms.

I cant believe doctors force their patients to remain on methadone when they are no longer wanting to be on a maintenance program. This is a real problem with the way methadone is administered in some countries. Here in NZ methadone detoxes are client led. That is the patient dictates the the terms of their detox plans. Doctors are obliged to comment if they believe the plan is irresponsible but ultimately they must support your decisions no matter how outlandishly slow or fast.

I used suboxone to get off the final 22.5 mgs of methadone and found it helped immensely. I say this with a caveat though. I did this in a residential detox facility and was only on the suboxone for a very short period( less than 3 weeks).

Skipping days is probably not the best way to detox off of methadone. I have seen a chart( Will try and find it for you) which shows how disruptive missed doses can be on serum levels resulting in irregular highs and lows. Ideally a small decrease every 4-7 days will have a more predictable and linear effect on serum levels .

I also toyed with the idea of using a short acting opioid( I was going to use IR morphine tablets). I decided against it because i didnt trust myself to responsibly dispense the correct amount. I did think that this would have been a great option had i been able to acces a program which would help to facillitate this plan.

I wish you all the best with your plan. Keep us informed.
kind regards Jeremy.
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Avatar universal
Hi .....your really lucky you haven't been in withdrawals tapering off so fast but its good 25 or so is holding you overI was at 150 but I detoxed myself from 60ml on down but had 2 week take homes so I only had to ditch once every 2 weeks thay had me at 40  when I was actually doing 20
methadone can go both ways some people find it ez to get off in the higher doses others struggle with every drop in dose...most people wind up some where in between once your in the lower doses its going to get a lot harder to do what your doing its usually around 20ml that most people start to really feel the drops in dose thats why so many switch to bup or as wee call it here in the states sub....I recognize emwaves nic....I helped her with her methadone addiction she eventually went into a detox center to get off it she hasn't been on the forum in quit some time as far as I know she is doing well...getting off the methadone is not ez but it is so so worth it to be free from it keep posting for support get rid of the percs you'll be to tempted to take them when you dope sick coming off the methadone will be out her to help you remember this is not a race you dident become addicted overnight its going to take a wile to come off this stuff good luck and God bless.....Gnarly    
Helpful - 0
1472850 tn?1290125172
Dude, you are so lucky that you didn't go directy to Jail when you crashed........kicking in jail really *****.  There is no sympathy or meds there.  Clonidine if you're lucky.  You had/have a pretty good habit going for some time.  Don't lose your job by not traveling.  You have to get past this or you will.

Going to a clinic is a ball and chain in that you have to go everyday until you can get take homes.  Even then, if you're lucky you get what, weekends?  I agree with your internist.  The sooner that you can get to a Pain Management/Addictionologist (never heard of that one) the better.  They should be able to lay out a plan to fit your work/lifestyle and get you clean.  Can an Addictionologist write scrips?  If so, all good.  If not, find a Pain Management Doc. That can.  Be straight up with them, tell them about where you were and  where you want to be.

In answer to your questions:

If you can continue taking 1/2 dose without getting caught, more power to ya.  It's 25mg +/- (?mg.) but it's that much less to deal with at the end of day.

Stopping CT and trying to do this yourself  with Percs is a bad idea.  You would likely fail.  Our brains and bodies like the stuff too much.  Get rid of them.

Docs are all different, there is no telling what he'll prescribe.  My Doc, the good one that is interested in Patient welfare and not his bank account ramped me down on Bupe, slowly starting at 4mg. daily (I was on 16mg. daily and ramped myself to 4) then took me off at 3mg.  I was prescribed Clonodine, Flexoril and Trazadone to take for w/d symptoms.  The stuff helps but it's still like trying to kill a Lion with a BB Gun.....there is no magic cure that will stop your addiction without w/d.  Bupe 3mg.?!  Phhtt that's nothing!  BS!  It's sounds like such a small amount but it ain't.

I don't think your logic on MD blood level is correct because of the long 1/2 life of the drug.  I hope this helpful.  Give me a shout as needed.  WM



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Avatar universal
I have no idea how bupe plays into this. I don't want to be on it but I have read that it can be used to get off MD and then docs taper you off the bupe rather quickly.

Thanks again and sorry for the typos. I'm on my phone.
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Avatar universal
Thanks wolf fir the feedback. I don't really want to switch to bupe but told my doc I would bc it was the only way he would agrr to taper me. My internist said that was completely unethical and referred me to an addictionologist - that appt is November 30 and I'm curious to see what he has to say. I'm currently at a clinic.

I jumped into using H full force about 5 years ago. After dealing with withdrawals over and over aging and really wanting just to commit suicide I went to this clinic and got on bupe. I was on it fir about 7 months and just stopped taking it one day. I didn't do ANY reading/research and could not understand why I felt soooo lousy. Thus I picked up again with the intent of being a weekend warrior. When I found my using was getting out of control again I weaned back some - maybe only using 2-3 times a week but added crack to the mix. Fast forward to last December- got into a car accident (I was t boned). Even though it wasn't my fault I was hitting the pipe just before the chick hit me and had a decent stash on me. Thank God no one found it and I did not get in any trouble with the law.

So- having damaged my neck pretty badly I ended up in pain mangement with a script for 120 percs and 300 norcos a month. I was going through them within a two week period, if lucky, and ended up in withdrawal every two weeks or buying stuff off the street. I got sick of the merry go round and went back to the clinic this sept 10 and got on methadone.

I really don't mind the way it makes me feel at lower doses. I can't stand going to the clinic everyorning and was recently sick with bronchitis and panicked because I was afraid I couldn't make if in. Plus I travel a lot for work and have had to back out of two trips already bc I am nit eligible for take homes or any concessions because I don't have enough time in yet. Thus, I feel the need to detox and just get clean. I'm also working with an addictions counselor but have nit yet been to AA or NA.

It's been 4 days since u started taking only halfy dose and I really am only feeling better. They had me on 70 and I asked for a few reductions. They obliged, which has gotten me to 50, but the doc really didn't want to take it any lower. He feels it's too soon and I haven't do e any real work and that I still need MAT. So I agreed to bupe and he agreed to lower me to 25, 5 mg a week. I still plan on drinking only half my dose though.....

I guess my questions are this: if I'm only drinking appx half I should be at about 25 plus or minus. I'm  wondering what the new doc will suggest: starting a bupe taper immediately, stabilizing me on 25 mg and then starting bupe? Assisting me with meds to go CT?

If I continue with half doses I can stop on my own when I get to the "prescribed" 25 at the clinic bc I should only be at 13 or so. Of course I've stockpiled some MD just in case u need a
sip or two.

I also still have 120 percs. I could just stop CT and supplement with the percs just to get me through. I know this is a bad option that is just opening the door again, but has anyone tapered off MD with short acting opiates?

Also last q I promise- if I skip a day will my blood levels of done be half of the dose? This is what led me down the path I'm on. I figured - let's say I'm at 60. If I skip a day then the following morning (48 hours since dosing) I should be at 30. So then by taking only half my dose I can stabilize at 30 and then do it again the next week, thus rapidly tapering. Thoughts? Or is that not how it works.

Thanks and sorry so long winded-
AR  
Helpful - 0
1472850 tn?1290125172
An afterthought...let's say that OK you do the 5mg. per week until you get to 25mg. (5 more weeks) and start Bupe.  What's the plan after that for the Bupe?  Dose amount, duration and then what?  Thanks.
Helpful - 0
1472850 tn?1290125172
Hey Rule,

I can't help you with blood levels etc. however, I have a LOT of experience with Methadone and Bupe.  Are you going to a private Doc or Methadone clinic?  The 5mg. per week is a good plan if you can hang with it.  Depending on what, how much of and how long you used your drug of choice prior to getting on MD, you may have moderate WD or minimal when you stop using MD.  My concern is that this guy wants to put you on Bupe.  I would highly recommend against it and get him to prescribe non narcotic/non addictive meds (muscle relaxer, Clonodine, something for sleep if needed) instead.  Bupe works great for some people and entirely different on others.You've only been on MD 2 months.  Get off it and all addictive narcotics before this gets strung way out (pun intended).  I'm afraid that you getting on Bupe would be trading one addiction for another.

I am day 27 now with no bupe, no narcotics after being on the evil sh** for 1.5 years.  See my thread Sub Experience.  I have been dragged through Hell getting off it and I'm only now begining to feel Human.

I have kicked a long term MD/Heroin combined habit long ago and it ain't no fun......As far as Bupe goes, for me the physical W/D was not as bad as from Opiate/Opioids, but it's a real mindfck.  I'm a pretty strong guy but have cried like a little school girl, had audio hallucinations and waves of depression, anxiety etc. over the past three weeks.

Don't be so quick to do your happy dance....MD has a long 1/2 life and many people feel no symptoms until up to three days after dosage stop.

Good Luck.  Give me a shout if I can help. WM
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495284 tn?1333894042
COMMUNITY LEADER
emwave hasnt been around for awhile but we do have others here who can help.  Keep checking back......Glad you found us!!            sara
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