methadone

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Methadone Opiate Detox and Taper Realities Part 2

Part 2: Methadone Facts

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     Methadone is designed to be a 36 hour drug. This is true in a sense. Take methadone long enough (2-3 months) and you’ll find a dose will often last for 24-36 hours. However, in the early stages of taking methadone it actually only lasts for 12-18 hours. The logical recourse would be to administer a split dose (half morning, half night).

    

     Methadone withdrawals can last about two weeks. Other opiates last about 3-4 days.  Methadone PAWS can last for months, sometimes up to a year or two. Other opiate PAWS last (usually) about 3-4 months. This is likely because methadone is a full antagonist drug where other opiates are generally partial antagonists.

    

     PAWS (Post Acute Withdrawal Symptoms) are a milder version of withdrawal symptoms. It’s often described as having a low level flu, while feeling weak and drained of strength and energy. Which while doesn’t sound so bad, over 3 months to a year can be incredibly debilitating, especially when no doctor will offer aid, and few will offer sympathy.

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   PAWS are one of the main factors in drug relapse. PAWS are not officially recognized by the medical community or ************** centers. Treatment is rarely offered or provided if asked. Often addicts will be met with hostility and insults by doctors who accuse them of “drug seeking” and tell them it’s all in their minds. Is it any wonder there’s such a high relapse rate?

    

     But this drug is about control. Regulation and law doesn’t allow for split dosing. Clinics find it’s too difficult and time consuming to practice this. Besides, 90% of all methadone rules are designed around controlling where the drug actually ends up. Split dosing would double the amount of methadone in the hands of the populace (via take home bottles) and the system has deemed that unacceptable.

    

     This is why so many people end up on doses of 150 milligrams or more. In the first month, the patient comes in complaining their dose isn’t lasting a full 24 hours. Since they can’t split your dose, they offer you a dose increase as a sop. (This has the added bonus for them of getting their patients up to high doses that are VERY difficult to come off). Split dosing would have patients on much lower doses. Forty, fifty milligrams would easily take care of any addiction. 
     I’m speaking about split dosing because, frankly, it’s crucial to true methadone detox taper;

Part 3: Tapering off Methadone:

 

     First and foremost, the most important thing in detoxing off of methadone is to STOP ALLOTHER DRUG ACTIVITY. If you’re using additional opiates, taking occasional other drugs, etc…you’re just spinning your wheels. If you can’t handle stopping playing about with drugs for a few months or years, then I doubt you’re able to handle getting off one of the most addictive drugs in history. Your mindset is wrong, it won’t work. This is a LONG process, and takes will, determination, and fortitude.

    

     You aren’t just fighting an addiction here, you’re fighting a society that looks down on and disdains you as a lost cause as well as a system that is only interested in the profits it can make from your illness. This is a BATTLE in the WAR of your survival and self respect and almost EVERYONE is your enemy. (Think of yourself as one of Hogan’s Heroes in that Nazi prison camp. You may as well have a sense of humour about it, it’ll make it easier!)
Important Fact:

     When you drop in dose during taper, methadone temporarily CEASES to be a 24-36 hour drug. For the two weeks after the initial dose drop, you’re back to the drug lasting in your system for only 12-18 hours. This effect is magnified according to the amount you drop, as well as how low you are. I found that in the high dose range, the effect is minimal. Under 20 milligrams, it’s greatly magnified.

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  Which is why I spoke about split dosing. To truly effectively taper with minimal negative impact (symptoms), you need to split your dose.
“But”, you say to me; “We aren’t ALLOWED to split dose! How do I manage to do this then?!”

    

     The first answer is earning the “privilege” of take home bottles. If you can get 3-4 bottles a week, you can work out a fairly effective split dosing system that will get you by. It’s not ideal but it’s passable.
Say you get a bottle on Tuesday Thursday, Saturday and Sunday (a common scheduling for four days).

    

     You take your Monday dose. Wake up on Tuesday; take a half dose morning and night. Wednesday go in and take your full dose. Thursday split morning and night; and so on…

 

Methadone and Sleeping:
    
     Another way to cope with dose drops is to change your sleeping patterns. When the body is sleeping, it goes into a “waste/poison removal cycle” Methadone (any drug) is considered by your system to be a poison. During sleeping hours it processes the drugs out at a much quicker rate. On days you can’t take your dose early in the morning, cut down on your amount of sleep. Two to four hours will keep you from processing too much of your dose from your system. Frankly, it’s really a matter of which do you prefer, to be tired and feeling well or well rested and in withdrawal? Experiment and see what works best for you.
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Frequency of dose Reduction and Amount:
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     I also advise dropping once a month in this way. The symptoms you suffer, while mild, over a long period of time can be exhausting and damaging both physically and mentally. At one point I dropped every two weeks for three months straight and by the end I was told I was unbearable to be around. Always irritated, always stressed. Two weeks of “R & R’ are a good idea to give yourself a rest and feel normal. Really, you should trust your “inner voice” as to when to drop. A good gauge of how you’re doing is how people around you are reacting to you. If everyone you meet seems to be irritating the hell out of you all the time, you may want to slow up a bit (hopefully this isn’t just the status quo for you).
    
     As to how much to drop? A safe amount is no more than ¼ of your total dose. Half or more is inadvisable. Personally, I did 5 milligram drops down to 20 milligrams and was fine. But everyone is different. I still can’t decide if there’s really much difference between, say, a 2.5 drop or a 5 milligram drop. You’ll just have to experiment.
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[Note: I cannot stress the importance of a minimum two week frequency. Let’s say you’re dropping every 3 days, 5 milligrams from 80 milligrams. Since it takes two weeks for your body to adjust to the new dose, by the end of two weeks your body is reacting as if you’ve done a roughly 15-20 milligram drop. Trust me, stick to two weeks minimum.

     Remember, this is a drug that helps provide the chemicals necessary to “be happy”. If you aren’t getting enough, you’ll be physically incapable of “being happy”. Put yourself through months of very real, constant depressed misery, and you’re guaranteed to fail.
     When getting below 20 milligrams, many often complain of serious difficulties in continued success. I’ve noticed myself that at 5 milligrams, a 2.5 milligram drop seemed to stretch well into the third week in terms of mild symptoms.  As a general rule, you shouldn’t drop half your dose or more, but eventually this becomes impossible.  How you cope with this really depends on what you can stand.
    
     The only advice I can give, is if you reach a point where have to start using alternate medications to get by, you might want to consider just jumping off all the way. I’ve made it down to one half milligram taken roughly every other day, and if I have my way, I’ll go down further. I’ve been told by one other who did it this way successfully ten years ago that it works. He said towards the end he was taking about a tenth a milligram before he stopped. So far, it’s worked for me, so I’ll see how it goes.  (The idea is to let extra opiate receptors die off gradually so when you do stop, you should be back to normal).

Zero dose:

     There are some substances you can take to aid in this process. But I’ll tell you right now, I went from 80 milligrams down to taking one half milligram roughly every other day without using ANY of them. All I’ve done is be careful in my diet, while doing a minimum of exercise. Personally, I suggest avoiding taking any of them until “D Day” (Zero Dose).
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   Many of them are limited in how long they’ll be effective. The only exception I’ll mention is Amino Acid Replacement Therapy.  I’m not going to go into detail about it here, there are better write ups than I can provide (as well as Nutritional advice).
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   There are a number of medications that can help at this point if when you stop you find yourself in either withdrawals or PAWS (Post Acute Withdrawal Symptoms).  I’ll deal with Withdrawals first (which hopefully you aren’t suffering at this point, but it is possible. Hopefully they are only a misery, and not life threatening). Some of these medications are for use during withdrawals, some for PAWS. I’ll indicate their appropriateness accordingly;

Withdrawal Medications:

     Most people on methadone lack the financial resources or connections that go with said resources to gain adequate treatment. So I’m going to mostly discuss what’s realistic and accessible, while giving a few mentions of drug therapy that while excellent, is difficult to obtain.
    1: Blood Pressure Medications, (Withdrawals and PAWS) traditionally Clonidine. Can be fairly helpful. However, it needs to be taken 3 times daily, dose varying accordingly (I believe roughly .1-..4 are recommended). Clonidine can help if taken in sufficient quantity. However, there is a danger of rebound when stopping which can lead to a spike in blood pressure and heart attack. In its own way, it’s just as physically addictive. Which is why I suggest only taking it at the very end, so you don’t build up “tolerance”.
    
     I had one idiot doctor tell me that using this drug this way is too dangerous due to the risk of hypertensive rebound. My answer to this is;
“Which is more dangerous, an opiate addiction or a temporary danger of hypertensive rebound?” I think we know the answer. If you do use a blood pressure medication, be sure to arrange a taper schedule for coming off it to avoid hypertensive incidents.
    2: Antidepressants: (Withdrawals and PAWS) I am militantly against antidepressants. Considering the recent uncovering of the lies told about the effectiveness as well as addictive qualities of SSRI’s, I’m of the opinion they’re more dangerous than opiates. But if you do choose to use one, my advice is the following;
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a: Pick one that has an immediate effect. Don’t use the ones that take weeks to take effect.
b: Only use it short term, for a month or two at most.
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     3: Imodium and Antacids. Imodium should only be used in emergency. It actually has a non active opiate base which can set back your recovery, and like opiates is addictive.
Anitacids (Withdrawals and PAWS) should be used as needed. 
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     4: Buphenorphine/ Suboxone: (Withdrawals) these are opiates. Don’t use them.  IF you do, keep it to an under a month.
    5: Herbals. (Withdrawals and PAWS) I’ve actually had great success with herbals. The problem is there’s no industry regulation so usually you get herbals with little to no potency, which is why everyone thinks they don’t work. The trick is to finding a reliable company. I won’t go into detail about them here; I’ve got another write up else where you can e-mail me for access or find in the health pages.
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     6: Amino Acid Therapy. (Withdrawal and PAWS) Refer to the health pages for a full description. Link provided: http://www.medhelp.org/health_pages/Addiction/Amino-Acid-Protocol/show/15?cid=66
    7: Multiple Drug Therapy:  (Withdrawals) the following is a recopied used in the 1970’s for withdrawal treatments that is VERY effective. Please note I haven’t taken into consideration changes in medication names or FDA availability:
Chloral Hydrate – Darvon – Librium – Antiemetic – Dalmain (sp?)
(I’m sorry I don’t have the exact dosages. It’s been impossible to locate them so far. But it’s very effective (according to my research). 
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     8: Benzodiazepine and Barbiturates: These medication groups can be helpful in the short term but they’re VERY addictive. Honestly, they aren’t very helpful with withdrawals. They can provide temporary relief with PAWS, but avoid taking them more than once or twice in a 7 day period. Personally, I’m of the opinion they’re best avoided.
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     9: Antihistamines: (Withdrawals and PAWS) these are surprisingly helpful if taken in a large dose (use caution!).
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There are other detox methods, but I’m not going to go into them as they’re quite expensive, and I can’t speak for their success. One thing I will comment on; if you’ve been off opiates for more than two months, and are still suffering PAWS, you may want to consider LDN therapy.
    10: (PAWS) LDN (Low Dose Naltrexone) therapy is a treatment that’s been around for quite a while. It’s traditionally used for cancer patients who have undergone radiation therapy (and the pain medication use that goes with it).  The theory behind it is that a small dose of naltrexone mixed with a specific inactive ingredient will have the effect of “jumpstarting” natural opiate production in the brain. I’ve chatted with numerous people who swear by it, claiming it saved their lives.
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     You do have to be sure to use a responsible pharmacy who will mix the medication properly (using the appropriate inactive ingredient). Since there’s no law or rule requiring them to use a specific inactive ingredient, it’s really up to their sense of honesty. Those interested can go to naabt.org to get further information on LDN. Take advantage of this before our government finds yet another way to block what is an effective treatment for addicts.
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Those with questions on this write up, can contact me at medhelp.org; user name Savas

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