Methadone: The last few milligrams

[jloops]

SWIM once had a question, and this was it...

I keep reading all these posts on the internet saying jumping off methadone at 5 mg is as bad as 50, that jumping off at 1 mg is hell, etc. (I'm talking about a slow taper here.) To me, none of this makes any sense.How on earth could this be?Admittedly, there are posters that claim they did it relatively painlessly...

I'm wondering what your experiences/experiences of friends were with jumping off the methadone, and what kind of difference you see at different doses.

It just doesn't compute with me that jumping off at 5 mg and 50 mg, or even 5 mg versus 15 mg, wouldn't be a big difference...

And I REALLY can't believe the people who say that "jumping off"(!) at 1 mg was painful. I read one guy who said he was on 1.75 mg for 3 years!!!!!!!!! He claimed that trying to quit that last 1.75 (who the heck measured that for him?!?) made him go through withdrawal after being stable on that dose for years! (Can you imagine paying full clinic prices for 1 mg for years?)

I just don't get this, and it's very discouraging. It makes me feel as if tapering is for naught, but I can't see how these posters can be right. The only thing I can think is that they've done a fast taper (in which case they were really jumping off at a much higher stable dose in a sense), or they are just... crazy?

Any insight into withdrawal and dose, and comparisons to other opiate kicks is welcome, because the rest of the web is leaving me very confused on this...

Reputation Comments on this post:

good idea for thread.plese don't underestimate how hare it is to get off low doses though.It's still hell,swim knows

[Helene]

Swim has heard this before too. However she also doubts that jumping at 1mg is anywhere near as bad as jumping at 50mg. But she has known people who have been stuck on <1mg of methadone for years. But what you are asking about is the physiological withdrawal, right? And how can you ever separate that from the psychological addiction? You can't. These people's "intense withdrawal symptoms" could be caused by their psychological addiction, as opposed to their physical one. Don't underestimate the power of the mind, it can create withdrawal symptoms from nothing if it so choses.

There is however some truth in all this. As you get to lower doses of methadone, some people report to noticing the reductions much more. I think the reason for this is the percentage of methadone you are cutting - if you are on 100mg and drop to 80mg (a drop of 20mg) you are only dropping a fifth of your total dose, 20%. Where-as if you are on 2mg, and drop to 1mg, (a drop of only 1mg in itself) you are in effect dropping half, that is to say 50% of your total dose. When put that way it is possible to understand why some people report noticing the drops much more on lower doses. However, some other people say that they find reducing from lower doses much easier than reducing from higher doses... So it's really individual to each person, I think.

Whilst I'm thinking about it, I'll mention something that swim found helped in her methadone reduction attempt a few years ago. When she got down to the lower milligrams, under 5mg, swim switched over from methadone liquid to methadone tablets. These tablets are available in 5mg and 1mg strengths. So for the lower amounts, they are much, much easier to continue your reduction with, for the simple fact that it is much easier to shave a certain amount off each tablet every day than to piss about measuring tiny amounts of methadone linctus - one drop over or under and you're 1mg over or under your intended dose. Too small an error margin.

Some doctors are a little reluctant to prescribe methadone tablets, due to the fact that they have a higher potential for IV abuse (I know this seem contrary to common sense, as you would have thought a liquid would be easier to hit up, but there's stuff in methadone linctus to try and deter people from injecting it.) So have a chat with your doc if you're getting to the final stages of a methadone taper and finding measuring such small dose increments tricky, explain the situation to him and hopefully the option of switching over to tablets could be available to you.

H

Reputation Comments on this post:

excellent clarification,as always!Gives excellent insight,different views&advice.ur amazing!

[LiquidHandcuffs]

Jloops,

Swim is currently on his 8th day of jumping "cold turkey" from 65mgs/6months.

Honestly, as hard as it may be to wrap swiy's mind around (was for swim), the reality of it all is that it truly is "all in the mind."

Swim had spent countless hours digging up "horror stories" about other peoples experiences, and he has since come to learn that it did nothing but psych him out quite a bit.

Believe it or not, Swim's experience has (thus far) been ridiculously mild with regards to those "tales from the crypt" stories strewn about Google.

The only symptom that hasn't been quite so mild for Swim is the Insomnia.

Even though Swim may be (and certainly is!) completely exhausted, his body always seems to "fake" an ailment that results in Swim waking up (and with wide eyes at that) only to find that within minutes, there really is no "ailment" at all.

Swim suspects Norepinephrine to be the culprit, and has heard that Clonidine will ease this (Swim wishes he had some, so he recommends swiy look into it should he jump).

Reputation Comments on this post:

very good reply, rel. unique point of view

[JaWill88]

swim has also heard many people say that there doesn't seem to be much of a difference in dropping 150 or 50, 50 or 5, ect. swim does agree with above post about the percentage being much more when one gets to a really low dose. swim has noticed tapering from other opiates doesn't really work well for him either. it seems that swim is either physically dependent on the substance, or he is not. the actual dose does really not seem to matter much, although it does make some difference. this is just what swim has noticed. and swim definately agrees with the fact that the mind is a powerful thing and should by no means be underestimated. well swim has posted the thread "leaving methadone at 100mg" and can definately understand the concern of leaving methadone. swim just really wants to say good luck. swiy will get through it.

Reputation Comments on this post:

interesting idea about the dependent/not dependent being more imp. than dose... hopefully not true though!

[jloops]

You guys are great, thank you.

So, is this stuff about the last few milligrams BS -- or, rather, just psychosomatic? Leaving 5 mg behind, let alone 1 mg, cannot be worse than leaving a bag a day habit of dope behind, right?

Because I cannot conceive of being reasonably stable on 1 mg for a week or two and feeling fine, and then dropping that 1 mg and feeling it. I mean, it's crazy... right?

Or has anyone ever felt real withdrawal, not just a little hot and cold and anxious for a week, jumping from a dose of 5 mg or less?

[MarkyMayhem]

SWIM isn't one who can suffer WD well, at all.
Several years back, he jumped from 10mgs, after tapering from a 60mgs/2yr bit at the clinic. He was on 10mgs for about 3 months before jumping. In retrospect waiting 3 months on 10mgs may not have been the best idea, but that's another story for another time.
Anyway, SWIM really didn't suffer much WD at all, other than severe sleep problems which leveled off at about 4-5 hrs sleep a night for damn near a year...

[dyingtomorrow]

SWIM's doctor at one of his past methadone clinics described it like jumping off a building. At higher levels you are just fucked. As you get into the lower range, how bad it hurts starts depending on how high up you are.

From what SWIM has personally seen, how long you've been on it makes a big difference as well. SWIM jumped off at 20mgs after only being on methadone for a couple months (then doing a week long quick taper from 80 mgs to 20 mgs to nothing), and it was about 4 days of hell, but then he felt better relatively quickly after that (although he immediately relapsed after feeling good). It seems that the withdrawals linger a lot longer for those who have been on it for years, even when they get down to low levels like you are describing.

One other thing SWIM would add, once you get below the 15-20 mgs range, ideally below 10 mgs, other medications can start helping immensely. Withdrawing from 80 mgs of methadone, valium and clonodine aren't going to do that much. But when you are at a low dose of methadone, they can actually have you feeling almost completely painless, albiet tired and probably depressed. Lethargy is much better than acute pain and panic though.

[mickey_bee]

When swim previously managed to get clean doing a methadone taper over the course of 3 months, he did find that the last 10-15mg were alot harder than the first reductions.

It's pretty logical really. If swim's stable on 100mg/day, then a 10mg reduction is only lowering the dose by a mere 10%.
However, by the time swiy get's down to 20mg/day for example, a similar reduction would lower the dose by 50%.

Many people do find that the initial reductions are nothing compared to the final few mg's. However, that is NOT to say that reducing the last few mg's is as bad as a CT withdrawal from much higher doses. Instead, swim at least feels that the last few mg's in reduction are alot harder than the initial reductions in dose, mainly for the reason stated above.

Which interestingly can also be applied to life, and why as you get older a year seems a shorter and shorter amount of time.......
Slight sidenote, but interesting none the less!