There's been a lot of talk on this forum about how bad methadone is for opiate dependence. I am going to share with you the way to be successful when on methadone, what you need to do before going on methadone and how to wean off of it.
Before you ask, I'm on methadone and have successfully come off 80mg, liquid form, without any harsh withdrawals at ALL.
BEFORE GOING ON METHADONE
Find a methadone doctor who you can sit down with and talk to. Make sure you ask the following questions.
1) Are you going to force me to lower my methadone dose? If the answer is yes, leave.
2) Are you only going to give me a certain amount according to some clinic guideline? If the answer is yes, leave.
3) Are you going to cut me off before I'm ready? If the answer is yes, leave.
4) How long have you been a methadone doctor? If the answer is less than 5 years, leave.
5) Are you willing to split dose me if I happen to need it or I am a fast metaboliser of opiates? If the answer is no, leave.
6) Will you switch me to suboxone if I request it when I get to the point where I can have it? If the answer is no, leave.
7) What is your policy on using other opiates until I am at a good dose of methadone? If there is some punitive result if you use an opiate while you're starting then leave. Any good methadone doctor has to understand that in the beginning you will have to use until you're at the therapeutic dose of methadone.
8) If further down the road I need an increase in methadone will you give it to me? If the answer is no, leave.
9) Will you give me carries if I have a job and cannot be at the pharmacy at specific times? If the answer is no, leave.
The reason why so many people in the United States have massive problems with methadone is because the doctors aren't using methadone properly. You cannot do marathon withdrawal on methadone and the patient needs to have control of their dose so that it's therapeutic. It takes time to get to the proper level of methadone and it does NOT go by weight. If a doctor says that to you then run. It means they don't know what they're doing. A good methadone doctor may be hard to find in the US but if you find one, all the power to you.
I find that the reason why methadone ISN'T successful in the US is due to the stigma and ignorance surrounding it. First, if you equate heroin to methadone then you're comparing apples and oranges. If you think methadone is a 1:1 substitute for heroin, you're wrong. It's a harm reduction method, not a substitute. It reduces harm in many ways. For example, if you've been opiate dependent for 5 years, even if it was just pills, the methadone will help you to eventually come off opiates at your own pace. If you inject opiates, methadone reduces the chances that you will use a dirty needle and therefore potentially become HIV positive, have HepC, and/or have abcesses etc. All those harms are reduced when a person is on methadone.
WHEN YOU'RE ON METHADONE
When you've reached your proper level, which can take anywhere from a week to 6 weeks appx. you will be able to function without having ANY withdrawal symptoms. However, if you are finding that you cannot function then your dose may be too high. If you find that your methadone you take in the morning isn't lasting the full 24 hours before your next dose then you may be a fast metaboliser of opiates. Tell your doctor right away about this. Another important thing is to be honest and open with your doctor. Build up a relationship of trust. This is why I put so much emphasis on finding a good doctor before you even take your first dose of methadone.
Methadone is NOT a BAD drug. Again, it's the way it's handled in the US that's incorrect. If you slowly wean down on methadone you will not have withdrawal. You may feel a bit tired or a bit down for a few days after the lowering of your dose but you should be able to go to work and function properly. You should only be coming down by appx 3mg/month. That's the stable way to do it. When I was on 195mls I came down by 5mls for the first 70mls I dropped. It was the ratio that counted. I was only dropping my dose by 2.5% and that meant I was successful. I didn't have any cravings. Again, you shouldn't feel pressured to come down on your methadone, that's why it's called Methadone Maintenance. It's not supposed to be given and then taken away by some enormous amount. If you don't have control over your taper and/or your doctor tries forcing you, then this is an unprofessional doctor.
I also can't stress enough that you should be strict in takingyour methadone at the same times every day. This keeps it at a steady state in your body.
Methadone tapered up correctly should not give you a high. There's usually no 'rush' when taking methadone properly. Usually a doctor should see you at least twice per week for the first couple weeks to keep adjusting your dose.
Never take over what the doctor has planned for you. Tell her if you are still experiencing withdrawal and she will raise you, or should raise you is she's knowledgable.
There's one key word here: slowly. Never try a taper over 5mls or you will probably experience very uncomfortable withdrawals. This is not a race. Only come down when you're ready. Methadone marathon withdrawals are used by ignorant doctors who don't understand how to use it properly. i've noticed my brothers and sisters in the USA are having such hard times with methadone but remember, it's not the drug, it's the way it's used.
Let your body guide you regarding your taper. Post acute withdrawal can last for weeks so don't be hard on yourself if you come down by 3mg every 3 months. Your body knows the right pace.
If you follow these suggestions you will not have a bad experience on methadone. You can also switch to Suboxone when you get down to appx 25-30 mg of methadone. Again, suboxone should be handled in a similar way, as far as you being the judge of when you taper and by how much.
If anyone has any questions please don't hesitate to ask me. I tried to make this as complete as possible on my first time through. I will add to this list as I find things of relevance.