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[Research Study] Tapering vs. Cold Turkey

Posted on February 15, 2013 by admin No Comments

Most posts and articles online related to methadone detox experiences are generally negative and discouraging. As expected, positive experiences are a lot less common and that is one of the reasons I launched the Success Stories section here. These stories are valuable, but harder to find. Every week I am on the web trying to dig up more of these “diamonds in the rough” so you and I can learn from them. I am sure some readers out there think I’m naive and/or nuts for trying to paint a pretty picture about methadone tapering. First of all, my attitude is merely a reflection of the people that inspired me in the Success Stories section because I relate to their experiences on certain levels and after learning from them and all the research I have done, I truly believe that I am in full control of my own experience with methadone detox. In other words, if my approach is disciplined and structured as planned, I fully expect to have minimal discomfort. Second, this is how I see it: Let’s say you wanted to learn Algebra. Would you rather learn from someone that absolutely dreads math and just barely passed the course? Or would you want to learn from someone with a structured approach to learning algebra and has a fool proof strategy that anyone could adopt to help them solve algebra problems? If you would rather learn from the dude that dreads math, then I am convinced of one thing: You just want to disagree with me… Because that’s damn crazy.

Personally, I am an advocate of methadone detox via slow and structured tapering. My guide – always under construction – is located here. I never wrote about cold turkey because I don’t believe in it even though, ironically, two years ago I attempted just that: methadone cold turkey. After 21 days of being clean, I relapsed on hydrocodone with arguably the most difficult stages of withdrawal already behind me. Back then I didn’t even know 5% of what I know now about methadone, and I still got very close to turning the page and moving on.

During the last couple of Success Story fishing expeditions, I started to pick up on a trend in the search results. It appears that most of the results for search queries related to quitting methadone reveal lots of (gobble gobble) cold turkeys. This sparked my curiosity. Even though I am personally convinced that slow tapering is the best detox method for anyone that wants to quit methadone, cold turkey should still be recognized as a legitimate method that might actually be better for some people. And it’s still the leading option in terms of popularity (although I have a theory that it’s the most popular option in large part because of the convenience factor and because most addicts are not disciplined enough to taper their doses consistently).

So I decided to do a quick study on people that quit methadone by Tapering vs. those that quit Cold Turkey.

For now, I will be looking at 6 taper posts and 6 cold turkey posts completely at random and then compare and contrast the results. I will not be selective at all; if I land on the post, I’m counting it. It has been a long time since I attended college, so my research methods skills are a bit rusty, and admittedly I was never really polished in that area to begin with, but one thing I do remember is that the researcher must have an awareness of certain factors that can effect results (there is specific terminology for this, but I don’t remember it).

One factor is the sample size. My sample size is relatively low, and if this were a professional study, it might be considered inadequate too. But locating several posts that are specific to what I’m looking for is a bit of a challenge. Either way, I believe for our purposes here, the quantity of posts collected will be sufficient to complete this analysis.

Other factors include, but not limited to, duration and how long the person has been clean. If I was able to conduct this study through interviews, I would probably talk to people that have been off methadone for a specific amount of time, but again I think for our purposes here, which is simply to compare and contrast the level of discomfort between these two methods, I think I’ll have everything that I need to evaluate my hypothesis and draw an accurate conclusion. Since I have an existing opinion on this subject, I am going to be very mindful of bias and make sure this is an objective study.

Hypothesis

Part 1: Hypothesis

I am predicting people that successfully detoxed from methadone cold turkey will report significantly less comfortable experiences than people that detoxed from methadone by tapering.

Experiences

Part 2: Gathering data

Using Google and search queries, I will retrieve posts from forums and message boards at random. I will pull the same quantity of sample data from both sides and then paste the entire post or excerpt depending on the length. I will also provide links to all sources used.

Cold turkey experiences:

Cold Turkey Post #1: “I wanted to be the Mother that my already scared children deserved. I can say they gave me the strenght i needed, it was the love and saddness i had for my children that boosted me and gave me the strenght i needed. I had to make myself move, i had to make myself get up and do dishes laundry averything, even going pee was hard, but i did it. Mind over matter.”
Source: Topix post
Score: 1: Extremely unpleasant

Cold Turkey Post #2: “like was already said, methadone withdrawals suck! i came off of it cold turkey at a rather high dose (120mg/day) and those w/d’s were worse than any OC, H, or bupe w/d’s i had ever been through.. i lasted 10 days in ‘done w/d’s and was still sick as fuck and had to stop it somehow”
Source: Bluelight post
Score: 1: Extremely unpleasant

Cold Turkey Post #3: “Today I’m still very week, very agitated, and somewhat depressed. I was lucky enough to have phenergan for the nausea the first few days. On my 2nd day off methadone I confess to my family that I had taken the methadone and ran out. My mother freaked and convicted me to go to the ER so I did. The dr gave me 15 Percocet’s. I took these as prescribed and they helped take the edge off. I then followed up with a dr who refused to give me any narcotics (thank god). He put me on visteril (anti histamine for anxiety) and it helped. He also excused me from work for an other week. I return this Monday and I’m a little scared but know I can do it. For anyone out there who is withdrawing…please stick it out…you can beat this.”
Source: Topix post
Score: 2: Generally unpleasant

Cold Turkey Post #4: “Methadone cold turkey 3 weeks 1 day And I am STILL feeling ********py….I’m reaching my mental capacity…Family and gf is still supporting me but I honestly don’t know how much more I can take…Still sweaty palms, anxiety, complete lack of motivation or energy, depression, any advice? support???”
Source: Drugs.com post
Score: 1: Extremely unpleasant

Cold Turkey Post #5: “Im a zombie. Mentally exhausted from the lack of sleep. I do work a physical job, and maintaining it as of late has been very difficult. Iv been up for almost 4 days straight. Cant sleep a wink. I was hoping that somebody might chip in some advice for me, as the sleep insomnia and the pain in my legs is driving me to the edge of insanity.”
Source: Drugs.com post
Score: 1: Extremely unpleasant

Cold Turkey Post #6: “I have been in a methadone program for about 4 years. I was at 140mg for most of it but tapered down to 100mg before being forced to leave the clinic due to financial issues. Also I left cause I was sick of the liquid handcuffs. It has been 8 days and I have mostly felt fine. Energy has been a little low but I have been going out during the day even got a haircut. I am confused…why did I get to escape from the horror stories that most people have? I did not even get the usual burning arms and legs no stomach BS. Eating like a horse….So I sit here at the end of day 8 only feeling better. I have a wickid case of insomnia and some weird zapping feeling in my head but I am fine otherwise.”
Source: Opiophile forum
Score: 4: Little discomfort

Taper experiences

Taper experience #1: “Yes many people, myself included, have stopped methadone by detoxing slowly. It’s not painful but you may experience minor discomfort at times. For me, I often felt like I had a bad allergy and at times some anxiety.”
Source: Topix post
Score: 4: Little discomfort

Taper experience #2: “As I got low. like 20mg. I slowed it DOWN, cuz it seemed every time I lowered I got sick, sick. I kept telling myself it was just I was catching things from the babies. Soooo I hit 10mg and I was still like I got this… well, well, well… I then needed forums like this.. just looking for anything to say I will be okay…However I heard horrible stories. And it is bad, but it is doable.. it has to be mind over matter.. “
Source: Topix post
Score: 2: Generally unpleasant

Taper experience #3: “I am at 32mg i have tapered from 130mg and i am going CRAZY. I have these fits of rage and anger i am so depressed i just cry all day…i barely have the energy to get off the couch to take care of my son. I also can’t sleep and have massive anxiety i take Klonapin and it does not do much.”
Source: Medhelp post
Score: 1: Extremely unpleasant

Taper experience #4: “I do think the bottom end of a taper is in general the worst part. One happy story is that I have a friend who quit from an 85mg/90mg a day script by tapering down over 18 months. He claims it was painless, using a little lofexidine when he jumped from 5mg/day at the end. I don’t think this would ever have worked for cat as he’s too impatient for this method, and I guess it’s a case of matching the speed of taper to your own psychology.”
Source: Drugs-forum post
Score: 5: No discomfort

Taper experience #5: “From everything I’ve been through, which has been considerable, the best way to get off methadone is to taper off slowly… From personal experience and from seeing others go through this, it’s really the best and most successful way. For one thing, you have to WANT to get off in order to stick with tapering. Withdrawal by tapering is not a barrel of fun but it’s not horrible either if you do it slowly and by small amounts. By “small amounts,” I’m talking .5 mg – 1 mg every couple weeks.”
Source: Steadyhealth post
Score: 3: Neutral or tolerable

Taper experience #6: “hello and congrats on your taper so far…I have been clean from methadone for 44 days. I to was at a clinic for over 2 years most of that at 70 mg. I tapered down and also didnt feel much until I hit 20..stayed there a few weeks same at 15 then 10 after staying there for a couple weeks and already feeling bad decided to just bite the bullet. The first 2 weeks were rough but I followed gnarlys advice and pushed through. You can do this just be prepared for long recovery. Start taking vitamins supplements ect. get the protein shake mix…try to build your body up as much as possible before you decided to jump. Tapering low (read some went down to 1mg) may help as far as the severity of the withdrawl (withdrawal), just keep doing what you’re doing, as gnarly said its a slow process..and YES you can be a success story.”
Source: Medhelp post
Score: 2: Generally unpleasant

Testing

Part 3: Testing hypothesis

As you can see, I recorded a “score” at the bottom of each entry. These scores represented the following scale to measure discomfort:

1: Extremely unpleasant, 2: Generally unpleasant, 3: Neutral or tolerable, 4: Little discomfort, 5: No discomfort.

When it comes to deciding how we want to detox from methadone, the only thing we really care about is how to do it with as little discomfort as possible. Therefore, I thought scoring each entry based on this scale would allow me to test my hypothesis and draw a conclusion.

Now we will look at the average score for each group:

Cold turkey average: 1.6 (Generally to Extremely unpleasant)

Tapering average: 2.8 (Generally unpleasant to Neutral or Tolerable)

The averages indicate that tapering is probably a better detox option than cold turkey, but I am going to attempt to put all of this in perspective in the next section when I draw the conclusion.

Conclusion

Part 4: Conclusion

The average score from people that quit cold turkey was 1.6, which is between generally unpleasant to extremely unpleasant. I am aware that placing each story on a scale is based my own judgement call and I tried to be as unbiased as possible. If you read these excerpts and compare and contrast the two groups, I think you would draw similar conclusions. At the very least, there is no question at all that cold turkey detox was much more unpleasant than tapering in this group.

With one exception, people in the cold turkey group had very strong words to describe how unpleasant the withdrawals from methadone were after they quit cold turkey. Quitting methadone cold turkey demands extraordinary will-power and a very strong desire (and reason) to quit methadone. One person was driven to quit methadone so she could be the mother that she believed her children needed and I’m willing to bet she got through withdrawals by constantly reminding herself about her children and the reason she is putting herself through this. As she put it, “even going (to) pee was hard”. Can you imagine that? The next person said methadone withdrawals were more difficult than any other withdrawals he had been through. Other words that people in the cold turkey group used to describe their withdrawals included: weak, agitated, depressed, lack of motivation, lack of energy, insomnia, and exhaustion. I guess you could think of it as the worst comedown you ever had from a drug, every single day, for two months straight (or more). But there will always be exceptions and outliers in any group, and there was also an individual that had been off methadone for 8 days and felt “mostly fine”. What did he do differently from the others? Probably nothing, but everyone is different, and for most people cold turkey is extremely unpleasant.

Next, we look at the experiences in the Taper group. The average score for this group was 2.8 which falls between generally unpleasant to neutral or tolerable, and closer to the latter end. Tapering from methadone is no cake walk either, but it is still most likely a better option than cold turkey. Where cold turkey demands incredibly strong will-power, tapering would require a lot of discipline since your success would depend on your faithfulness to your plan or schedule. You can’t cheat yourself by becoming inconsistent and then expect to be successful here. People that taper also need to be very honest with themselves every step of the way, and all of us addicts know that our minds can play tricks when it comes to our drug of choice. For example, if I am supposed to make the next drop in my taper today, and I told myself what the hell, I’ll take an increased dose today and drop the dose tomorrow, what difference does it make? That would be the addict in me trying to make excuses.

Some of the words and phrases that were used to describe tapering included minor discomfort, “not horrible”, and one person even said it was painless. There was also someone that tapered, but their experience was very similar to the cold turkey group with depression, lack of energy, and rage.

In general, it seems like the symptoms from cold turkey withdrawals and taper withdrawals are similar, but everything is experienced at a greater extreme with cold turkey withdrawals. And if you think about it, this makes sense. When you quit something cold turkey, you jump off at a much higher dose. Maybe it’s 20mg, 50mg, or 100mg, but either way it is much greater dose than if you tapered and your last dose was 1mg, more or less. On top of that, your body would be already adjusted to the pace of dropping doses in small decrements since you have been tapering all along. Therefore, it can be expected that you will still experience the symptoms associated with methadone withdrawals, but they will not be as pronounced as someone that subjects their bodies to an unpleasant and unexpected surprise when they quit cold turkey.

Related stuff

1. Detox Articles: Tapering
2. Taper Readiness Worksheet

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