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Posted by: Sparrow on 2010-08-11, 11:17:21
First- are you taking methadone for pain management or for MMT for opiate addiction? My experience with it is primarily concerning MMT, but even if you’re taking it for pain management, I would assume it would be similar; the pharmacology doesn’t change. This is the answer I gave a member on my website; the same applies here; the caveat being, you’re on a fairly high dose- so those initial weekly( NOT DAILY) decreases might be okay at 10mg; but once you get down to about 150- or before that, if you’re hurting- you should cut it back to only 1-5mg a week, depending on how you feel~ Assuming it’s for MMT/ opiate addiction, my next question would be: is this a planned detox, or an administrative detox? Typically, the best chance at success when detoxing from MMT is to start out with a weekly decrease of no more than 5mg & no less than 2mg, once every week, depending at the stabilized dose you have been at. 80-100 mg is considered an average dose, and the typical start wean/ decrease for that range is a 2-3mg decrease once a week. You should try not going lower than those 2-3 m, and if you're having a hard time with that, consider taking your weaning schedule to every other week~ one thing we tend to overlook as addicts is that methadone, unlike heroin and other opiates, is a time released medication. It works for exactly that reason, but it also makes for a longer acute withdrawal period. Whereas with a heroin detox, you can expect a typical 5-7 days for to get through the worst of it worst of it, methadone takes closer to 3-4 weeks before the full brunt of the acute withdrawal abates. This is because that slow acting, time releases aspect has also allowed a residual to build up in your system~ the same applies for getting stabilized: remember when you started at 20 or 30mg, and were having a hell of a time feeling normal, but they insisted you wait 7 days minimum before getting an increase? That’s because the medication needs time to build up in your system; the same way it needs time to leave your system. If this is just your first take down in mg, this might not be as applicable, but if you’re being weaned a few mg every week for a month or longer, you might just be starting to feel the long term effects of those first initial dose decreases. It will vary for every client~ someone at a higher dose, say 150mg+ ~ may be able to handle coming down at 5mg a week, b/ c their residual will be slightly larger. It can also vary with body type- people who are heavier may retain more medication in their system. There is also supported evidence that clients can be “fast” or “slow” metabolizers- one person may be able to go up to 72 hours before feeling the onset of withdrawal (“slow” metabolizers); others feel it in 12 hours- (these are fast metabolizers, and often the solution is split dosing- taking half in the morning, the other half 12 hours later). While this is another issue altogether, it should be noted many clinics do not support this process, since the bulk of their clients require supervised dosing. I will discuss that issue in another note in the near future, but for the time being, if you’ve got take homes, you may want to try doing a split dose for a few days- even if you weren’t a fast metabolizer in the past, as you come down in dosage, you may find this pattern- smaller, more frequent dosing- helps you get through it. Once your dose gets smaller- in the under 40mg per day range- it is common to decrease the # of mg you cut each week. So, for example, if you’re at 100 mg, and you start to wean yourself down at 5mg each week, you may feel fine until you reach a daily dose of 45mg, then suddenly find yourself feeling horrible. It’s normal in that scenario to switch your weaning schedule from decreasing your dose 5mg each week, to 2mg every OTHER week~ because not only are you feeling the effects of your weekly decrease, but that of the residual build up leaving your system, on top of the discomfort from forcing your body to adjust to a lower dosage. .Those who successfully stay sober continually demonstrate following this type of pattern~ taking their time, allowing for the need to possibly decrease their original cut back. As you move into the 30mg range, you should be considering detox. Detox is tricky- no detox facility is permitted to detox a MMT patient without correlating with the MMT clinic, in most states, by law. This is meant to deter MMT clients who break the rules & are given administrative detoxes from thinking they can get away with it, since a detox will fix it. An emergency room will treat you, if they feel your life is in danger, but as we all know, detox from opiates & opioid agonists like methadone, won’t kill you (unless you have a pre-existing condition that is exacerbated by the withdrawal). It might feel like it- and yes, MMT withdrawal is overall a longer, harder detox-but it won’t kill you. So an ER doctor is at liberty to pick and choose if they will treat withdrawal symptoms before sending you on your way, and the stigma of the disease of addiction makes our plight somewhat unsympathetic, so odds are slim. They cannot, however, send you to a detox in the event they take up your cause, that is out of their hands (unless, again, your life is in danger, or the patient is pregnant, since the withdrawal can bring about miscarriage). The exception to the case being, a proper weaning through your clinic. A client who decides to take the big step and begin their extradition from MMT has options: and at about 0-30mg, detox is indeed one of them, and a wise one Your clinic should have some familial relationship with a couple detox facilities who are equipped and educated to handle such a withdrawal~ and it will often be the difference between success and failure. I know many clients who went through 2-3 years of being weaned 5mg a week, who never felt uncomfortable~ but who, at 10mg, were switched from being weaned 5mg to only 2mg a week- who came back the next day begging for their 2mg back. It all relates to the individual, and to the long term decrease of residual and dose. You should have a plan arranged at the onset of your weaning: your counselor and your MMT clinic physician should explain the process to you in detail, and all of you should agree on what steps you will take~ including hypothetical ones. You may not need the detox, you may find 5mg a week never really bothers you; you may find 1mg does- so be prepared for those obstacles, BEFORE you reach them~ because if there’s one thing we can all agree on, it’s that we don’t make well-planed decisions when we’re dope sick. There are also medications your MMT clinic physician can prescribe to help with some of the discomfort through out your withdrawal; though you shouldn’t rely on them until you’ve reached a considerably low dose. Starting to rely on them too soon will leave you ill-prepared for the long haul. Common meds used in detox apply here- vistaril, trazadone, ultram~ but will vary by clinic & physician. Also be sure to account for any changes in your own life: weight loss/ gain; a new medication (OTC or Rx- even the simple ones can make a change in the way you metabolize your dose). Stress, grief, job loss, and other emotional issues can also be factors. It should also be mentioned that while there is no specific, tried and true formula, the vast majority of MMT clients who succeed in weaning themselves completely off have been on MMT for a minimum of 2 years. And I mean 2 years of MMT without any other chemical abuse; 2 years attending every group, counseling session and other appt- even when you don’t want to; 2 years of having a stable home life, a job you enjoy (or at minimum, one that doesn’t make you suicidal, lol), 2 years free of unresolved court cases, warrants, probation, parole, etc. Two years of having the life you had- or wanted- BEFORE you got hooked on the junk. We’ve already got the odds stacked against us: opiate addiction is hands down, statistically, the hardest addiction to beat, and has the lowest success rate. It doesn’t need any help to make us fail; you need a life you consider worth fighting for. Remember to take it slow, and not rush yourself- MMT has the highest success rate of any opiate addiction treatment, but it doesn’t happen overnight- allow your body the time it needs to adjust to each take down. Your clinic should be very much in agreement with this. Unless you’re going through an administrative detox (typically administrative detox means going down 10mg a day until you’re at zero mg; and administrative detox IS NOT intended to keep you sober- it’s a punitive action taken when a client is not paying their bill, coming up dirty repeatedly on tox screens, gets arrested, or is missing groups)- if you’re going through a planned withdrawal, your clinic should be very supportive in spacing out your weaning- if you’re feeling pressured about going faster, and you’re NOT being admin. detoxed, then you have rights, and you can invoke them. If you’re having issues with this, email me; I will help you find the right channels to deal with it. If you’re having trouble with your clinic, or a physician, then email me; I an get you in touch with some regional contacts that can help get you into a physician with a better understanding of the pharmacology of methadone. If this is a MMT clinic, PLEASE get in touch; this is absolutely inappropriate, and dangerous- we’ll get you in touch with NAMA (National Alliance for Medication Assisted Recovery), and get you where you need to be. Best of luck. |
