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Detox Option #3: How to taper

Posted on August 18, 2012 by admin No Comments

Yes, I wanted to find an easy way out of methadone. No, I didn’t think that I would find one.

But I thought maybe there was some miracle method that I was not aware of yet. Rapid detox sites will tell you everything that you want to hear, like any good sales pitch… and if you are lucky they will reveal the realities that you do not want to read in smaller print than this. So if rapid detox is not a walk in the park (and definitely not financially feasible), how about Suboxone? Could suboxone be the miracle drug for opiate dependence that all the doctors I knew talked it up to be? If so, I could just make that switch and put this all behind me with ease. Turns out suboxone might be more manageable, but only by a small fraction… and even then it’s a coin flip. But all along this has been about anything BUT tapering… and I can’t give you a good reason why. But a few months later, I am beginning to look at tapering in a much different light. In fact, I think I have seen enough to state with confidence that I think tapering off methadone could be the best option of all.


When you read, hear, or know about someone that has been successful at something you are trying to do, and can vouch for something based on their own experience, it can be extremely valuable in itself. There are a few contributors on this blog that have made me think twice about tapering and gradually over time, I started to favor the idea of this method, not just for myself, but anyone aspiring to quit methadone.

There is one contributor in particular, going by the alias ABC, that has been clean for two years strong and counting and he tapered as well. Annie, another visitor and contributor, has been checking in on a regular basis and successfully shaving off 1mg at a time. These two individuals were very inspirational and now I am convinced and know what I have to do… and what I want to suggest to the rest of you.

Most people reading this now probably have not read my article on Rapid Detox and Suboxone, but if you have, then you are probably aware that I tend to ramble and get off subject a bit in my writing.

Not going to do that here.

We are going to cut to the chase right away because this is important and I do not want to lose you.

The Methadone Help guide to successful taper

Let me begin my stating, after this is published, it is by no means set in stone. This article can be amended and added to with the help of the rest of you, the readers. So if you have something to add or change, please click here to access my Contact Form.

Step 1: Are you ready?

You have to genuinely want this. If you are torn between wanting to be on methadone and not wanting to be on methadone, then quite frankly the odds are already stacked against you.

Frustration

If this represents you on methadone, maybe it's time to think about changing that.

Nobody can really sway you one way or the other. Just about anyone that has ever accomplished something significant in their lives might tell you that genuine motivation has to come from within yourself. Perhaps if you sit down and think about all the positives and benefits that would come with being clean and sober, at some point you will land on something in specific that becomes your drive and motivation, and you will roll with that. During the course of detox, whenever you feel discouraged, this is the source of inspiration and motivation that you will look back and it will be strong enough to help you resist any negative temptations. You cannot make yourself genuinely want anything in life, but maybe if you really take a moment to think about it, something will come from that, and you will have the much needed source(s) of inspiration to begin your taper.

There is a somewhat controversial, but growing consensus among professionals that the minimum duration of methadone maintenance treatment is two years. Some studies have even revealed that there was a greater success rate measured by duration of post-detox abstinence from opiates associated with individuals that had been taking methadone for at least three years prior to detox. In contrast, people that took methadone for less than three years and attempted to detox had a greater chance to relapse (1).

With that said, here are some questions you might ask yourself prior to committing to detox:

- Do I like methadone?
- Do I think methadone helps me in life?
- Does methadone make me feel better every day?

These are just examples, but if your answer is “Yes” to any of these questions, it can be argued that methadone detox will be more difficult because when you are at the peak of your withdrawals and feeling miserable, you might tell yourself, “You know what? Methadone was my cure to all of these things, I was actually accomplishing more in life while I was taking methadone, and despite its disadvantages, it made me a better person overall. If I keep going like this, it might do more harm than good.” That is something like what I told myself when I relapsed on opiates after three weeks of being clean a few years ago. And then, oddly enough, I started taking methadone again and got back on track with my life, accomplishing more and taking up new productive hobbies, with a refreshed motivation and positive outlook on life.

But now the way I think of methadone has changed a lot, and I do not hold it in the positive light that I did once before, and it is for that reason that I am able to work on my taper. Now, if I still actually thought methadone was doing good for me, my attempt to taper would almost certainly end with disappointment.

So on the other hand, if you are feeling like:

- I am sick and tired of being entirely dependent on methadone.
- I am sick and tired of all the side effects that come with methadone.
- I am sick and tired of needing more methadone every few months because I build a tolerance to the previous dose.
- I am sick and tired of feeling sick and tired!

If that sounds like you, then it sounds like you are ready to work your way to a better life and get off of this medication at your own pace. You are ready for Step 2.

Characteristics of successful individuals:

Goody Two Shoes

That's right. This is what you should strive to become. Well, for a little while anyway ;-)

Before proceeding to Step 2, I wanted to mention some of the factors in common with individuals that had been successful in tapering off of methadone:

1. Discontinuation of illicit drugs for at least three months prior to taper and continued abstinence during taper.
2. Employment (particularly individuals that have demonstrated longevity at their jobs).
3. Some degree of financial stability.
4. Association with a peer group that does not use drugs.
5. Good relationship with counselor (if MMT applies).
6. Individuals that stabilize and begin taper at relatively lower doses (it is best to stabilize methadone dose at about 80mg or less prior to taper).

Step 2: Planning and scheduling your taper

So you have decided that you are ready to put methadone behind you. Well… here is where the path splits depending on how you have been taking this medication.

Some of us are taking methadone under the care of a primary care physician, without a counselor (me) and others are enrolled in Methadone Maintenance Treatment (MMT) at a clinic with a counselor.

Those individuals in MMT might believe they are ready for taper, but this decision should ideally be in agreement with their counselor and the counselor should be someone that can help the individual make the best possible decision towards the most favorable outcome. When a person tells their counselor that they want to begin tapering towards the purpose of ultimately leaving treatment, the counselor is advised to follow The Tapering Readiness worksheet as a guide. This worksheet is available for reading here.

Those of that do not take methadone at a clinic and/or do not visit a counselor on a regular basis will have to rely more on our better judgment. Ask yourself the questions in Part 1, review the characteristics of people that have successfully tapered off of methadone and ask yourself if it applies to you as well, and review the Tapering Readiness worksheet as though you were your own counselor.

As for the planning and scheduling, if you (and your counselor) believe that you are ready to proceed, your counselor will begin to schedule your taper and monitor you during the process.

If you are on your own, educate yourself and much as possible about addiction, be honest with yourself to determine if you are ready and prepared, and familiarize yourself with the guidelines for tapering that follows.

Step 3: Tapering


It is widely accepted and proven that the most effective tapering is down slowly. That is, each time there is a decrease in milligrams of methadone consumed, the individual should stay on that dose long enough (7-10 days or more) so that the transition to the next lower dose will come with minimal withdrawals and discomfort. If and when the individual experiences extraordinary discomfort after lowering their dose, it is recommended that they simply stay on that dose as long as it has to take before the next drop. This should not be thought of as a race. Ten days is by no means set in stone and it can be extended until the person is ready to start their next drop. Extending the process would not be harmful, but reversing the process instead and increasing the dose will likely create complications.

How much should the dose be lowered each time? In my (unprofessional but somewhat educated) opinion, we should not think in terms of a fixed number (i.e. dropping 5mgs at a time) but instead we should drop a fixed percentage each time. Professionals might already advocate this method, for all I know, because I would think that common sense applies here.

Think about it this way. Let’s say we approach this by cutting 5mg at a time. When you are taking 100mg of methadone, the transition to 95mg would mean you are lowering your dose by 5%. Yet if you are at 10mg of methadone, and you drop down to 5mg, you just cut the dose by 50%, and quite frankly, you would not be putting yourself in a good position.

I would advocate that we work at 15% drops until we are at 15mg, at which point, we drop 1mg every 10 days instead.

By working at a fixed percentage most of the way through, and then 1mg fixed drops once we are at a very low dose (i.e. 15mg) we are giving our body more stability and consistency which is conducive with a higher chance of success.

Here is an example of what a taper plan might look like for a person that begins their taper at 40mg and works at 15% drops until 15mg, at which point they will drop 1mg per every 10 days (or more):

40mg taper example

An example of what an effective 40mg taper might look like.

Will it take a long time? Yes. But it is a proven fact that taper regimens that are longer in duration are far more effective than accelerated tapers or rapid detox. This way, we avoid putting our bodies into shock from a sudden and sharp drop in dose and we minimize discomfort and withdrawals.

Furthermore, the ten days between drops is not set in stone (yeah yeah, I know I am repeating myself), but instead I use this as a minimum decrement. If at any point during this taper, you experience extraordinary comfort in contrast with previous stages in the taper, maintain your dose until you feel a little better and then continue.

This took me a little while to create and get the formula down, but I have come up with a Taper Schedule spreadsheet for anyone that is doing this on their own and all you have to do is enter your current methadone dose, and the spreadsheet will calculate a taper plan for you that goes all the way down to the last dose!

Click here to download my Custom Taper Schedule spreadsheet (Right click this link to ‘Save As’ to your computer).

If you have questions about how to fill out the Custom Taper Schedule, contact me here and I will do my best to assist.

Nutrition

Fruits and vegetablesUpdated 2/5/2013

There is something very important that I left out here, hence the update. You have probably heard this from someone or somewhere and like me, maybe you forgot about it or heck, maybe you even neglected it altogether. But it cannot be overlooked. Proper nutrition during methadone detox is absolutely critical. That’s why I have this in italics and bold. You might be wondering “why” and instead of attempting to explain this to you, I will use an example that I found which illustrates it brilliantly:

The body on methadone, or any other mind altering drug or alcohol, is like the house that has been damaged in a storm. If you were repairing the house what building materials would you need? You would need lumber, sheet rock, shingles, and etc for the major supplies…these are the equivalent of the bodies need for protein, carbohydrates, and fats. How would you hold everything together?…nuts and bolts, nails, and screws—these are the equivalent of the bodies need for vitamins and minerals. To make the repairs we need the proper tools to cut the lumber and fit it into place…one would need the saws, the equivalent of the bodies production of enzymes…these are made from the proteins we eat…one can draw analogy after analogy to explain the necessity for nutritional treatment to facilitate one back to health…only one thing needs to be clearly understood…you put back into the body the things it needs to come back to health. Oggy on Drugs-Forum

Now that this is hopefully understood, here is a list of important items that should be included in your nutrition:

1. You will need to take a multivitamin.
2. Take fish oil or flax seed oil.
3. Drink a lot of water and green tea is also good.
4. High protein diet that can include protein powders.
5. Raw fruits and vegetables
6. Avoid candy and high sugar foods
7. Use common sense and better judgment; you probably have a good idea about what is or isn’t healthy.

* Please contact me if you have anything to add to this list.

Conclusion

Studies have shown that structured tapering from methadone yields the most successful long term results. One of the main reasons that most people are unsuccessful in their attempts to quit methadone is because the entire approach is flawed and often times, people put together a recipe for disaster for themselves. I know that I have done it myself in the past, but this time will be much different and I will provide updates on my own experience along the way.

Here are some of the key points that were made in this article:

Tunnel

Some tunnels are longer than others, but I promise will find the light if you keep moving forward.

1. Slow and structured tapering gives you the best chance of success.
2. According to various studies, methadone tapering has been shown to be most successful after a person has undergone Methadone Maintenance Treatment (MMT) for a minimum of 2 years.
3. Genuine motivation is paramount, so determine your drive and why you want this (Part 1). Your reason(s) for quitting should be strong enough to conquer any obstacles that you will face along the way. This is a breaking point for many individuals.
4. Familiarize yourself with the Characteristics of Successful Individuals listed in Part 1, and ask yourself if these things apply to yourself. If it does not, you might want to make some changes in your life where possible and if this is important enough to you, then you will.
5. Educate yourself about addiction and accept the fact that you have this disease as well. There are resources and forums in the Links section of this site.
6. Try to develop a close relationship with your counselor if you have one.
7. If you do not have a counselor, follow the taper plan in Step 3 and Download the Custom Taper Schedule. Even if you have a counselor, you can see what they think about this plan and if you really want to try it, any good counselor should be in agreement. After all, slow tapering has been shown to yield the best results.

If you have any questions, comments, and suggestions, please contact me here. Again, I would like to make this resource as helpful as I possibly can and you – the visitors – are a major factor in my ability to do just that.

Thank you for reading and I will leave you with this. A very encouraging message board post that I found online from a person that obviously went with the slow taper method that we advocate here:

Message board post

We can do this. Really, we can…

Sources:
(1) Tapering off of methadone maintenance: Evidence-based Guidelines – Aegis Medical Systems, Inc.

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