[jloops]

I posted this basic question in the "Featured Drugs", but maybe this is a better place. I didn't get many replies there, so...

A friend is looking to get off of 40 mg of methadone. He's been on it for several years, daily, and doesn't goof around or anything with other drugs, etc. He's just got a physical dependence and has decided he doesn't want to keep taking a drug which he doesn't think he needs anymore.

We want to find a good way to get this done. He doesn't want to taper off of it over 6+ months, and switching to suboxone (at least as an outpatient) was not feasible. (He couldn't wait long enough to take the stuff, and, yes, he is committed, he already dropped from 80 mg rapidly just to get here.)


So, there's a couple of rehabs we looked at, but one of them claims to have you out after 10 days by switching you on to buprenorphine after a few days off the methadone and then tapering it down over 5-7 days -- but they only taper you to 2 mg (or 1 mg), and, apparently, you leave at that point. It seems to me that that would leave a lot of withdrawal to go through. Just how bad is the withdrawal off of 2 mg of buprenorphine? Can someone put it in terms of oxycodone/morphine/hydrocodone withdrawal for me?

Another rehab says they will switch you to a short-acting opioid (unspecified, and unwilling to specify) and taper you over a period of 21-30 days.

A final one I just spoke with has this method: on an outpatient basis, they require you to stay in the area and not drive for 8-10 days (for the methadone version of their accelerated detox -- which is slowed down to accommodate methadone users) and have a support person with you at all times.

Then, they give you moderate (i.e., pretty damn serious apparently, lots of sleeping, but not fully knocking you out all day) sedatives for day 1-7 and you spend your time at home (or in a hotel). (You show up to the clinic every day for the pills.) Finally, now that you've reduced your dependence to the level of a tramadol user (or at least gotten a lot closer to that level), they REALLY sedate you quite well (but not under general anesthesia like an ultra-rapid detox) and break out a dose of naltrexone which pushes you the rest of the three-quarters through the tunnel.

Does anyone here think that 10 days is enough? And that putting you out the door on 2 mg is going to leave me in withdrawals that won't be dangerous? What kind of withdrawal would you expect? More like kicking an 80 mg. oxycodone habit, or still like kicking a 40 mg. methadone habit?!

What exactly ARE withdrawals from 2 mg of buprenorphine like?!?!? And, if above 2 mg the ceiling effect takes place, why on earth would cold turkey off of 8 mg be worse than cold turkey off of 2 mg?

Is it just those other ("odd", or, at least, unique) effects of buprenorphine, like the kappa antagonism, that are being withdrawn from that add to the nastiness, but the mu opioid receptor withdrawal is capped out at 2 mg and no worse once you get to 8 mg? I.e., mu opioid agonist withdrawal wouldn't begin until you taper under 2 mg, but kappa opioid antagonist would begin as soon as you went below your usual dose (for a long-term bupe user)? Is this right?

Or what about the program that just tapers you down on another short-acting opiate once switching you onto it from the methadone. To me, that seems damned foolproof!




Or can my friend just taper off of 40 mg. in 3 months or something like that without actually enduring anything that would resemble acute opiate withdrawal?

Any help you can offer is welcome.

Another question is this: if someone tapered to 10-15 mg. methadone, couldn't they just switch to buprenorphine WITHOUT waiting to be extremely sick?

I.e., just take the buprenorphine when you notice that you've not taken your methadone yet today? I still can't understand why buprenorphine engenders withdrawal in people who have a dependence which is LOWER than the 30 mg. of methadone which buprenorphine is SUPPOSEDLY equivalent to!


Has anyone done this medical detox from methadone? Has anyone done a medical detox for methadone?

Or has anyone here KNOWN someone who has done a medical detox for methadone?[/B]

Or does anyone have anything to say about using buprenorphine for a 10-21 day detox off of methadone?

Or of using a detox which employs a taper from another (short-acting) opioid?

Or does anyone know a detox that just really knocks you the F out for a few weeks with Seconal or something and lets you sleep through it more or less? (We're not really considering ultra-rapid detox, but if anyone has something positive to share about its use for methadone or a big habit with another drug, I'd be glad to hear it.)


Thank you all very much for any advice/thoughts/opinions/musings you have on this!!!!!!!!!!!!!!!!!!!!!! Please, any information you have -- any and all, especially specifics and places that knock you way out or have had success with methadone detoxes, please, please let me know!

[Debpurpletiger]

I just replied to the other post, hun.....Hope it help you out - deb

[newyorkgal]

I don't even think they use seconal anymore. I havent even heard of them being used since '80s.... They won't knock you out. They will expect you to be relatively alert, to attend groups and such... ALso, no to your question about tapering to 15 then taking sub right away. No matter what the dose of meth, you must wait to you score a 26 on a COWS worksheet before taking sub, usually around 72 hours. There's no way around that. I've never done the weismann rapid detox but from the few I know who have, I don't think it's good for methadone. I know a girl who almost died, or felt like it and couldnt move out of the bed for 6 weeks after Weismann at which time she went right back on methadone. 2 mgs. is a high dose to walk away from. Sub is alot more powerful than we realize because you don't really feel it. I believe I messaged your other thread with my opinion on what you should do after going to a detox and leaving at 2 mg. What you are looking for you arent going to find, I'm afraid. Nothing is that easy.

[jloops]

Originally Posted by newyorkgal

I don't even think they use seconal anymore. I havent even heard of them being used since '80s.... They won't knock you out. They will expect you to be relatively alert, to attend groups and such... ALso, no to your question about tapering to 15 then taking sub right away. No matter what the dose of meth, you must wait to you score a 26 on a COWS worksheet before taking sub, usually around 72 hours. There's no way around that. I've never done the weismann rapid detox but from the few I know who have, I don't think it's good for methadone. I know a girl who almost died, or felt like it and couldnt move out of the bed for 6 weeks after Weismann at which time she went right back on methadone. 2 mgs. is a high dose to walk away from. Sub is alot more powerful than we realize because you don't really feel it. I believe I messaged your other thread with my opinion on what you should do after going to a detox and leaving at 2 mg. What you are looking for you arent going to find, I'm afraid. Nothing is that easy.

Yeah, you're probably right, but I just wish there was someone who used used Valium/phenobarbital liberally during the period. After all, Valium or similar is the main ingredient of any home "cold turkey" detox!

I actually did talk to the local hospital, and they give you Neurontin (which helps stop seizures and supposedly helps a lot with opiate withdrawal) and phenobarbital (which also prevents seizures), along with some non-narcotic painkiller and probably other "supportive" (i.e., really weak!) meds.

That detox sounds great -- the only thing that's missing is a 10 day taper off the methadone!

I wonder if maybe getting down to at least 20 mg and then checking into that place would be my best bet.

They say they only keep you there for 5-7 days for methadone detox.

Is that long enough? How long does a cold turkey methadone detox last?

[Debpurpletiger]

Quitting Cold Turkey off Methadone is NOT a fun experience. The W/D process itself comes on slowly as Methadone stays in your system a long time...but when the full W/D hit - - it's NOT fun to go thru: Upset stomach, diarrhea, chills/hot cold sweats, restless legs, sneezing, runny nose, severe anxiety and it comes in "waves" so for a little while you might feel "ok" but then suddenly you're right back in the heart of the W/D.

[jloops]

Originally Posted by Debpurpletiger

Quitting Cold Turkey off Methadone is NOT a fun experience. The W/D process itself comes on slowly as Methadone stays in your system a long time...but when the full W/D hit - - it's NOT fun to go thru: Upset stomach, diarrhea, chills/hot cold sweats, restless legs, sneezing, runny nose, severe anxiety and it comes in "waves" so for a little while you might feel "ok" but then suddenly you're right back in the heart of the W/D.

Oh you're right, surely... I guess I should avoid a medical detox that doesn't involve buprenorphine or a taper?

Do you think that even the place that puts you out the door after "detoxing" by taking buprenorphine every single day (including the day you leave) is going to actually spare me much of this experience?

And, I know what you're saying, nygal, about them not using heavy sedatives usually... Groups and such, honestly, I can't see that working well for me, which is what the one place that has a 3 week buprenorphine taper expects you to do during that relatively rapid tapering period... I dunno, but I have a hard time seeing that working out...

I just need to safely withdraw, I don't need a new religion.

[cheekysod]

dude you seem dead intent on finding an easy way out and there isnt.
why dont you give outpatient subs a go. ive used methadone for years, and managed to get myself over to subs, and tapered down to 1mg at the moment. thats been a period of 4 months. not too fast. just right for me.
and regarding the "why cant you just take the sub when you remember you havent had your methadone" this is what will happen,
you go into precipitated withdrawls trust me i done it, because subs bind better to the receptors and kick the methadone off, so you have to have empty receptors. i got really sick for 2 days at my induction, mind you i was on higher than the recommended 30 for the switch, more fool me. i wont ever do that again, and i always tell people what can happen.
good luck

[jloops]

Originally Posted by cheekysod

dude you seem dead intent on finding an easy way out and there isnt.
why dont you give outpatient subs a go. ive used methadone for years, and managed to get myself over to subs, and tapered down to 1mg at the moment. thats been a period of 4 months. not too fast. just right for me.
and regarding the "why cant you just take the sub when you remember you havent had your methadone" this is what will happen,
you go into precipitated withdrawls trust me i done it, because subs bind better to the receptors and kick the methadone off, so you have to have empty receptors. i got really sick for 2 days at my induction, mind you i was on higher than the recommended 30 for the switch, more fool me. i wont ever do that again, and i always tell people what can happen.
good luck

Thanks cheekysod.

Yeah, I know you get sick and everything if you take it early, I just don't get why it's like that? I know it boots the methadone off, but since it's an opiate, shouldn't *it* prevent the sickness?!?

Supposedly it's like 30 mg of methadone itself... so, shouldn't someone switching from 30 mg of methadone be able to just...? I know that's not the way it is, but it just makes me question the whole thing since that part doesn't make any sense...

I just want to be done with this...

[Debpurpletiger]

QUOTE: ......"which is what the one place that has a 3 week buprenorphine taper expects you to do during that relatively rapid tapering period... I dunno, but I have a hard time seeing that working out...




I honestly feel that a 21 day detox using Buprenorphine is the best bet.

[cheekysod]

its some technical thing with our receptors, if there is methadone still in them, the subs take over, and even thought subs are really strong, something happens and we get sick.
all i know is i did it wrong and got really sick.
man its the worst out of control feeling in the world, i thought id made the wrong decision to go on subs, and nearly caved in and jacked up some methadone for the next day. but thankfully someone came to my aid, and told me to stick with it.
so to be quite honest i was on way more than the recommended 30mg for the switch.
after i had the first dose of 2mg, all good, then they gave me 2 more. then i went outside and started to think, im feeling worse. then i KNEW i was feeling worse, instant acid butt, had to go bathroom 3 times, couldnt sit still, started heavy cramps in the legs. it was awful.
so alls i know is make sure you wait bro.
thats all i can tell you.

mind you by day 2 i was a lot better, and i have found it way easier to count off than methadone. i am now on 1mg. wow for me thats awesome.
good luck whatever you do.
oh and sing out if you do find some place you can sleep thru all this, we'd all love to know. heh heh.

see ya
cheeky

[newyorkgal]

Its almost funny, and I don't mean it in a bad way, J, how you are looking for a painfree way to detox. As cheeky said, when you find it, let us all know., If it were easy like that, there would be no need for these support forums. We'd just check in for a long sleep and be clean, til the next time. If you insist on doing the medical detox rather than the home detox (which I think is easier in the long run as you can taper at your own pace) I think the 21 day is your best bet also BUT you gotta have some subs at home. Walking out the detox door at 2 mgs. is not going to work. You need to taper further.

[jloops]

Originally Posted by newyorkgal

Its almost funny, and I don't mean it in a bad way, J, how you are looking for a painfree way to detox. As cheeky said, when you find it, let us all know., If it were easy like that, there would be no need for these support forums. We'd just check in for a long sleep and be clean, til the next time. If you insist on doing the medical detox rather than the home detox (which I think is easier in the long run as you can taper at your own pace) I think the 21 day is your best bet also BUT you gotta have some subs at home. Walking out the detox door at 2 mgs. is not going to work. You need to taper further.

Yeah, maybe that's the way to go.... I dunno... There's one place that apparently gives you 28 days, the first 5 days are to switch you to oxycodone and then do an induction onto buprenorphine.

The next two weeks you taper off the buprenorphine.

And the last week they say they have you spend there without any buprenorphine, so, if any withdrawals are there that a aren't something you can deal with, you'll be there.

I hope they have a bunch of benzos to hand out during that taper, but I dunno, it doesn't seem like it, but I'm going to talk to the doctor about the process.

Assuming they're willing to give out benzos liberally, that may be the best solution, as far as I can see...