Assistance with Pain management & detox

[Readiculous]

I am asking this question for my significant other.  He has been on methadone for 15 years for severe chronic back pain.  Before the methadone he could barely get out of bed.  Now, 15 years later, he would like to get off the methadone and explore other options.  He has come up against a wall because the doctor that has been treating is now refusing to treat him anymore because of a drinking problem.  He has tried to quit drinking several times but drinks about three beers a day, just to keep from shaking.  Also, he has a pacemaker.  He needs a few answers.  He needs to detox from alcohol and methadone safely and he needs to find an alternate to methadone.  He is concerned about detoxing from both due to his heart.  His cardiologist sold his practice and he can't see his new one until December.
What are the risks and the best approach to detox from these substances?

[philnoir]

Weaning from methadone can be difficult, and he'll need at some point to rotate to another opioid.

I'm not a doctor but a patient -- I spent 12 years on 160mg / day methadone, and weaned in 2010-2011.

Here's how I did it.

I reduced my dose about 10% per month until I hit a wall about 40mg/day. I sought medical help, and a pain doctor helped me wean from methadone to another opioid over the next 3 months.

All in all, I spent perhaps 1 year weaning down from 160mg/day.

You've got to go slow, because methadone works in at least 3 ways -- as an opioid, as an NMDA-antagonist, and as a serotonin uptake inhibitor-- ie, it acts on 3 different neurotransmitters.

Also, the half life of methadone is very long -- over 50 hours, perhaps more. So, it will be at least 2 days before his body realizes the dose is lower.

However, I had little trouble during the first 75% reduction. It was the last 25% that required help, along with rotation to a different opioid.

I was glad to come off the methadone -- the drowsiness from that medication was always with me. I never felt like I had enough rest.

However, it was also the best pain medicine I've ever used, and I've used them all.

[corey4433]

Do you guys have a family doctor it would not be safe to detox without a doctor supervision there is a substance abuse site here post on that they can help you better on that site i wish you and your husband the best