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Methadone Detox: Do You Have The Right Plan?
Methadone can be one of the most difficult drugs to detox from. Why? It’s mostly due to the fact that Methadone has a longer half life than most other opiates. Ergo, it takes your body longer to completely be free from methadone because it occupies your brain’s opiate receptors for a longer period of time. There’s a far more technical explanation for this but that would bore you… and me.
We have thousands of people who have used Withdrawal Ease for methadone detox. However, in order to get the best results, there are some different strategies that need to be employed. In the spirit of articles such as “How to Detox From Opiates” and “How to Detox From Suboxone”, I think those on Methadone deserve a unique detox approach. For many of you on Methadone, it has been a long, long road and it doesn’t get any easier when you finally decide that it’s time to stop. Or rather, start the “process of stopping.”
As with most of my other posts and “How To’s..”, my sources range from clinical literature, secondary research, and talking to people who are currently on methadone and who have been through methadone detox. Finally, I group all of my feedback from those that have successfully used Withdrawal Ease to help them detox more comfortably and highlight some of the best practices from those folks. From there I form a methodology for detox.
Of course many of the same disclaimers apply:
I’m not a doctor nor am I a licensed addictionologist or therapist. I have gathered a great deal of useful intelligence from those people who have detoxed or are in the process of detoxing from methadone. Please consult your doctor before doing any of this.
It’s also important to note that if you use benzos (Xanax, Clonazepam etc.) to potentiate (make the “high” stronger) your methadone dose then you should detox in a controlled environment under medical supervision. Benzos can cause seizures if detoxed improperly.
I believe we’ve gathered some very valuable insight into how to best use the tools that we have along with tapering to make the detox experience a bit easier for methadone users. I hope that this helps.
As I mentioned, the half life of Methadone is a real doozy. Short of Suboxone, Methadone takes a long time to completely dissipate from the bloodstream. As you may know, the half-life is important because it is a factor in the length of your detox and subsequent withdrawal symptoms.
*Methadone’s half-life is 18-80 hours which is a very wide variance with the higher amount being significantly longer than Vicodin or Percocet (**4-6 hours and 3-4.5 hours respectively). This will give you an appreciation for one of the reasons why Methadone sometimes takes longer to detox and therefore feel like your old self again.
And just to be clear: Detox/detoxification is the body’s way of expelling a foreign or harmful presence and regaining homeostasis.
Withdrawal is a temporary pathology that includes generally unpleasant physical and mental symptoms as a result of detox.
Those were not definitions out of the Journal of The American Medical Association. They are just how I think of them. The point is that both are influenced by the long half life of methadone. This is why tapering is so critical with Methadone! You must taper when coming off of a high dose of Methadone — period.
You can help yourself if you taper in a coordinated fashion and on-schedule based on a planned tapering calendar. Is it a bit nerdy to keep a calendar? Of course it is, but it will literally mean the difference between being miserable or being functional for your acute detox period. If you have not read our article called “The Art of Tapering”, please take a look at some point to get some tips on the nuances of tapering correctly. Don’t worry about the calendar in The Art of Tapering. We’ll go over an example of what a typical methadone taper program might look like in this article.
Of course, if you have been taking methadone for 10-20 years, it’s certainly a big decision and one that you should certainly make with your doctor. The last thing we want to do is to encourage someone to detox from Methadone only to unwittingly cause them more pain. Most folks on methadone do not take it temporarily so make sure that you’ve got the A-OK from your doctor, pain management specialist or whomever is managing your care. Notice how I didn’t mention the clinic itself! Certainly, if you no longer want to be on methadone — or you no longer think you need it — then you have the right to be off of it. It’s a FREE country. But make sure it’s in your best clinical interest based on a doctor’s input to do so before detoxing.
Ok, that’s pretty clear I hope.
The Detox – Intro to Our Methodology: The 5% Rule!
There’s a lot of different pet theories in the clinical literature, on clinical websites, manufacturer websites, package inserts, drug directories, wikis etc. on how much one should taper per week. Some say reduce your intake from a stable dose by 5mg per week and other say it should be 20mg per week. It’s very confusing and that’s because every person has a different physical makeup and history. So it goes without saying that any taper schedule should just be about YOU.
There are a few other recommendations that make more sense to me due to their personalized nature. Ironically, one strategy that I like is from Mallinckrodt, the current maker of a form of methadone. They suggest the following:
“It is generally suggested that dose reductions should be less than 10% of the established tolerance or maintenance dose, and that 10 to 14-day intervals should elapse between dose reductions.” (source: http://pharmaceuticals.mallinckrodt.com)
However, I believe that starting out at a lower percentage and reducing the time between tapering your doses is more conservative and less likely to cause discomfort. Fourteen days between intervals seems like a long time, so we start out recommending week-long intervals.
This strategy for tapering your dose seems to make much more sense than setting an arbitrary “one-size-fits-all” taper. A percentage of the original tolerated maintenance dose provides an equal platform for all.
For someone who is taking 120mg per day, 5% would be 6mg
For someone who is taking 160mg per day, 5% would be 8mg
The relative drop is still the same for everyone every time one steps down. Does this make sense? The next step down should be 5% of the remaining dose! I repeat, the next step down should be 5% of the previous dose. (See below for an example of this!)
For instance: If you were on 120mg as demonstrated above and you step down 5% (6mg) to 114mg per day, then your next step down will be 5% of 114mg. A running average. If you keep stepping down 6mg per day then the percentage of your step down grows incrementally larger… you don’t want that. As you progress, your steps down will become smaller but will still remain 5% of the total dose.
I know I know, for some of you it may be hard to cut doses into such precise amounts. Remember this is just a guard rail, not an exact science. We’re trying to get you to be as disciplined as possible because we believe it matters. Do the best that you can and round up or down as needed.
Our recommendation is a conservative one and perhaps it seems a bit complicated at first but if you have read The Art of Tapering (link again), you’ll understand that this is just a starting point.
Need A Pharmacist?
It’s important to note at this point that if you do not think you can self monitor your taper accurately then you need to enlist the help of a friend or family member who can act as your “pharmacist.” This person will safeguard your meds and dispense them to you based on your agreed upon taper schedule. They will need to be lenient enough to let you adjust your time between intervals (up to 10 days between intervals) so that you are comfortable throughout the process. However, the mission remains the same: to actively lower the blood concentration of methadone in your body over a fixed period of time as comfortably as possible.
Hopefully your “Pharmacist” can keep you motivated and on schedule at the same time. If you have any doubts about this, we recommend that you play it safe and ask someone to be your “Pharmacist”. You may owe them dinner or a present at the end of all of this but it will be worth it.
An Example of What a Methadone Tapering and Detox Schedule Might Look Like Using “The 5% Rule”!
: Calculate a 5% decrease of your current, stable dose or prescribed daily dose. As an example, we’ll use 120mg per day. Remember, we are using percentages of your current dose that we assume is a comfortable (as directed) level for you. As you calculate your percentage drops, you will probably see that not all reductions will have round numbers…in these cases, please round up or down as needed.
: Get a calendar or open up your calendar on your computer and “map-out” your tapering schedule based on the “5% rule” every 7 days. As you can see, I’ve written out the complete formula for all of you math-challenged folks like me!
= 120mg of Methadone x .o5 (5%) = 6mg
120mg of Methadone — 6mg = 114mg per day for the first week of the taper
= 114mg x .05 = 5.7mg
Rounding up 5.7 = 6 (again)
So you would subtract 6mg from 114mg = 108mg of methadone daily for week #2 of your taper
Week 3 = 103mg per day
Week 4 = 98mg per day
And So On…..
If you feel as though you have withdrawal symptoms that are becoming acute or that are particularly bothersome, you can think about adding an extra day between the reductions in dose which will slow the taper down a bit. Try that for a week and see how you feel. If that still produces acute symptoms, then add another day with a max of 10 days between tapering. You need to be as comfortable and functional as possible but you also need to remember that you are engaged in a systematic process of lowering the blood concentration of methadone in your body… so keep on chugging. Detox is never going to be completely painless.
Once you get to the actual detox portion (even though the tapering has detoxed you quite a bit), you will no longer be taking methadone and hopefully the taper process has helped tremendously. You will probably have a few days of feeling lousy and of course I recommend reading our Withdrawal Survival Guide and taking our product to help with this period. I think it was essential that I address the tapering aspect of this process since it is the most complicated and nuanced of all of the drugs minus Suboxone.
If you don’t buy the product or read the Survival Guide then just remember that the discomfort and insomnia will pass shortly and if you have completed your taper, you come a long way towards making your detox a whole lot easier!
A Note To Withdrawal Ease Customers:
If you have bought our Withdrawal Ease product, we often recommend that methadone users begin taking the product a bit earlier on in the tapering process. Normally, we recommend that people start taking Withdrawal Ease about a week before they completely finish their taper. With methadone, the taper is usually longer and the length of time that one’s body has been dependent is usually longer as well. There are a lot of ingredients in Withdrawal Ease that can help with mild withdrawal symptoms that some might feel during the tapering and detox process. We usually leave it up to personal preference but starting Withdrawal Ease a couple weeks or so before you completely stop seems to be the most effective solution.
It’s also important to mention that The Withdrawal Ease Survival Guide is still an integral part of the program and should be employed when the detox begins in earnest (i.e. when you stop taking Methadone completely following your taper). It’s also good simply to follow the advice in the Guide because things like exercise and eating right are always good habits to live by.
That’s our opinion on the best way to detox from Methadone. It may not be perfect but until something better comes along, I think it’s a good way to free yourself from methadone — if that’s what you wish to do!
Thanks for reading this and I hope that it helps people who truly want to quit but do not know how. If you have any feedback on this article please email us at firstname.lastname@example.org!
* aaiPharma, Inc. Methadone hydrochloride injection prescribing information. Wilmington, NC. 2004 Feb.