It’s time to clear up the confusion about tapering methadone. Listening to all the different advice on this topic can make your head spin, and even worse, leave you still feeling uncertain of how best to do it! In an effort to bring clarity to this matter, I’ve compiled a crystal clear, easy to follow methadone tapering success guide.
I’m going to set the record straight and shed much-needed light on a topic that is, quite frankly, not common knowledge. Here are the best tips for getting off methadone, pitfalls to avoid and ways to minimize symptoms.
Table of Contents
- 1 Why you should Listen to me
- 2 What NOT to do
- 3 Success Leaves Clues
- 4 How Long should I be Tapering Methadone for?
- 5 My Advice on Tapering Methadone
- 6 Common Physical Consequences of Tapering Methadone
- 7 Common Psychological Consequences of Tapering Methadone
- 8 Best ways to Reduce these Symptoms
- 9 The Power of Identity
Why you should Listen to me
You should listen to me for many reasons, but mainly due to the following:
- I was addicted to heroin and pills and successfully quit.
- I used methadone to finally end my addiction.
- I went on to become a Substance Abuse Counselor at an Opiate Treatment Program where 90% of the patients were on methadone.
- I helped many of these patients get off by devising strategic methadone tapering schedules.
- I can teach you what the people who got off successfully did, and how you can duplicate their results by modeling them.
What NOT to do
Before moving on to tapering methadone success tips, I feel that it’s essential to first review what not to do. After working with so many patients on methadone, I noticed patterns in the ones that failed at tapering. I also observed patterns in the ones who succeeded.
Here are some of the commonalities in patients who did not succeed while tapering methadone:
- Their main motivation was “I just gotta get off this stuff”.
- They were still using illicit opiates, or only clean for a few months before starting their taper.
- Most still had easy access to their dealers if needed.
- Few of them were working some kind of recovery program.
- The majority tried to taper methadone too fast. Whether the reasons were financial, having to come to a clinic so much, side-effects, family pressure etc.
- Almost none had changed the way they thought. They still linked pleasure to using opiates (TIP – you need to link PAIN to using opiates).
- Most were unemployed, not enrolled in school.
Note: Unfortunately, for most of these patients their time in methadone treatment was merely a vacation from heroin. To be successful getting off methadone, there are certain guidelines that should be met.
Success Leaves Clues
Modeling is the process of adopting the language, beliefs, strategies, and behaviors of another person in order to achieve the results they have gotten, which we too desire. For example, let me tell you a story about a girl named Marla.
She had been trying to lose weight for years, and despite multiple diets, was still unhappy with her health and body image. One Saturday while shopping at the mall, she saw a new diet book that looked promising. The book was written by a woman who had been overweight and lost 50 pounds in six months. Marla decided to give it a shot, thinking to herself, “what have I got to lose?”
The book contained the exact diet plan the author used. It also contained her strategies, rituals, beliefs and behaviors regarding health and weight loss. Marla copied everything the author did. She ate the meals recommended, and she started to think and behave like the author did in regards to dieting. At the end of six months, Marla lost 46 pounds and totally changed her life! This is the essence of modeling. Do what someone else has done to get the results they have achieved.
I suggest you harness the power of modeling by studying people who tapered methadone successfully without returning to active opiate addiction.
Here are some commonalities of the patients that I witnessed tapering methadone and staying clean throughout the process:
- Most had never gone above 100 mg of methadone medication.
- They were usually in Methadone Maintenance Treatment (MMT) for 1-6 years.
- Most had jobs they were happy with or were in school.
- Almost all of them had been clean for over one year.
- Most of them had a strong support system – e.g. family support, 12-step support, friend support.
- All of them linked pain to using illicit opiates. In my opinion the single most important factor.
- Almost all of them tapered slow. They never rushed it and accepted that they would be in treatment for a long time.
- They maintained regular attendance and for the most part made it to scheduled counseling sessions, which is a vital part of the process.
- They had hobbies, interests, and structure in their life and didn’t get bored easily. Boredom often causes a relapse.
How Long should I be Tapering Methadone for?
The length of the methadone tapering schedule should take into consideration many criteria, the main two being:
- The amount of methadone you are currently taking, and how long you’ve been on that dose.
- How long you’ve been on methadone for.
Slow tapers have been shown to be more successful than rapid tapers.
According to the presenting doctors at a conference call put on by the Center for Disease Control and Prevention, the following methadone tapering guideline was used as an example:
- Decrease by increments of 10% of your daily dose every 1-2 weeks until you reach 1/3 of the original dose. At that point begin tapering methadone at half the previous rate.
Note: This is generally a good method to use, however, many other methadone tapering schedules will also provide good results.
According to the book Methadone Maintenance: A Counselor’s Guide to Treatment, the following criteria should also be followed:
- Don’t go faster than 5 mg per week.
- A reduction in the rate of methadone tapering should be considered when reaching 20 mg.
- Tapering should be stopped or reversed if you experience significant withdrawal symptoms.
Note: I’m also of the author’s opinion in these regards. I would always tell my patients that a general rule is “the lower you go, the slower you go”. For instance, if you start tapering methadone from 65 mg at a rate of 4 mg per week, it would probably be wise to slow the taper at around 30-40 mg.
*Most of my patients generally didn’t complain of intolerable symptoms until they reached this point, which I called the “threshold”. After reaching their threshold, I would recommend stopping their methadone tapering schedule completely until they stabilized. This would often take less than two weeks, although some never got used to the lower dose.
My Advice on Tapering Methadone
- Always listen to your body.
- Don’t rush it.
- Don’t obsess about it.
- I often saw the best results when patients decreased every 10-14 days, as this gives the body longer to adjust to the decreases.
- Go slower towards the end of the taper.
- Don’t start tapering methadone before you’re ready. I often saw patients pressured by loved ones to get off methadone due to stigma associated with it.
- Make a plan, but be flexible enough to adjust it as needed.
- Work closely with the doctor, and your counselor (if you attend a methadone clinic).
Example of a Long-Term Methadone Tapering Schedule
- A man in MMT decides he’s ready to start tapering methadone. He has been in treatment for two years, and at his present dose of 80 mg for six months. He’s been clean for one year. He drops 5 mg every 10 days until reaching 50 mg, at which point he slows to 3 mg every 14 days.
- He continues this protocol until he reaches 32 mg, at which point he starts having difficulty sleeping. The lack of energy interferes with his work so he decides to stop the taper completely until he stabilizes. After 10 days he stabilizes and begins tapering methadone 2 mg every 14 days until he reaches 10 mg, at which point he slows the taper to 1 mg per month.
- I know this may seem like a long time to some people, but the people that I saw get off and stay off methadone tended to use a protocol similar to this one. In reality, there are usually more breaks in the taper for them to stabilize before starting again.
Example of a Short-Term Methadone Tapering Schedule
- A woman in a methadone detox program has been in treatment for three months, medicating at 35 mg daily. She has been clean throughout treatment. She decides she wants to start tapering methadone. After talking to her counselor and meeting with the doctor, she starts going down 3 mg per week which takes her to the six-month mark.
- This completes her 180-day methadone detox program. I will add that only rarely did I see someone have this kind of rapid success, though it did happen.
Common Physical Consequences of Tapering Methadone
The most common symptoms are perspiration, achy muscles, insomnia, lack of appetite, restlessness, cravings, and fatigue. Many of my patients used Vitadone, a supplement specifically for people on methadone, to reduce these symptoms. Many of them said it helped with the sweating and fatigue.
Common Psychological Consequences of Tapering Methadone
Feelings of grief, loss, fear, low self-esteem, depression, and anxiety are among the most common psychological symptoms of tapering methadone. I noticed that many patients would doubt their ability to come completely off methadone, and as a result, became completely paralyzed towards making any progress.
Best ways to Reduce these Symptoms
- Start taking an Opiate Withdrawal Supplement when you get down to between 10 mg and 30 mg (whenever the symptoms become unpleasant).
- If you can afford it, I also highly recommend taking this awesome supplement, because the benefits are just too good to pass up.
- Exercise regularly to stimulate the production of endorphins, the brain’s natural painkillers.
- Qigong, an ancient Chinese form of exercise, is one of the least known but most effective ways to reduce symptoms from tapering methadone.
- Focus on eating organic, unprocessed whole foods and consume enough water – Divide your weight in pounds by two and that’s how many ounces to drink on average.
- Talk to a counselor, therapist or coach.
- Attend support groups on a regular basis.
- Have a support network of sober friends.
- Write your feelings in a journal.
- Take medications prescribed by your doctor to help while tapering off of methadone.
- Meditation, acupuncture, tai chi, yoga, and herbology can be extremely effective for methadone tapering.
The Power of Identity
I believe the main reason that success rates are higher after being in MMT for two years or longer is due to the power of identity. I witnessed first-hand how people radically changed their lives from taking therapeutic doses of methadone and staying clean over time, which often led to a change of identity.
After a long time in treatment, when they started tapering methadone they were so far removed from their old drug-using lives that the thought of illicit drug use was out of the question. These were no longer people who you would ever think were addicted to drugs in the past. In fact, if you saw them in public, you wouldn’t have any idea they were taking methadone.
If you’re thinking of getting off methadone or have already started tapering methadone, I hope you’ll use some of these principles and come back to this article for reference as needed. If someone you love is tapering methadone, I encourage you to give them all the support in the world, as this is likely one of the most difficult obstacles they will ever be faced with. Click here now to view my best home detox program.
If you have any questions on tapering methadone, please don’t hesitate to leave it in the comment box below.