Thinking about using methadone but worried about the side effects? Well, firstly, know that while there are some side effects associated with the drug, it is a very well tolerated medication and most people find the side effects to be very manageable. Secondly, a lot of misinformation surrounds methadone, so some of what you may have heard may be untrue. Learn more about the side effects of methadone and learn if it might be a form of addiction treatment that will work for you.

Methadone is one of the most intensely researched medications ever developed and it has been in very wide use for over 50 years.

Doctors have a very good understanding of what side effects people on methadone will and will not experience, yet despite this wealth of knowledge, a lot of people still don’t have their facts straight on this pretty controversial, but effective, medication.

Methadone Is Dangerous, but Also Very Safe

Methadone is a very potent opiate and its use has been linked to many overdose deaths. If you take methadone other than as prescribed or if you mix methadone with other recreational or even prescription drugs you are putting yourself in grave danger. However, if you use methadone strictly as directed, methadone will do you little harm.

Studies on people who have been using methadone for decades have shown that the medication does no damage to any of the body’s organs or major systems, even when used chronically.¹

Methadone Side Effects

Side effects are more commonly experienced at the beginning of treatment and during periods of dose adjustment. Once you get stabilized on an effective dose, side effects will often diminish.

People using methadone may experience some or all of these more common side effects:

• Sedation – Methadone, like all opiates, can make you feel a little bit sleepy. This sedation tends to lessen as you get more accustomed to using the medication over time. You may feel excessively sleepy when your daily dosage is too high.
• Sweating – Many people experience increased sweating while on methadone, and for some people, this is a side effect that does not dissipate in time and must be managed by other means, such as by the use of light and breathable clothing.
• Constipation – This is one of the most commonly experienced side effects of methadone. This is best managed by natural means, such as by increasing the fiber in your diet or by increasing your activity level.
• Changes in Sex Drive – Some people find that methadone interferes with sex drive (some people find that it increases sex drive). If your medication is reducing your sex drive, it’s best to talk to your doctor about the problem.²
• Itchiness and Flushing
• Weight Gain – A few extra pounds are a common side effect of methadone. It may not be the drug, however, that is causing the weight gain, and it may just be a return to greater health and the restoration of a healthy appetite that leads to weight gain on methadone.

Other possible side effects include dizziness, headache, nausea or vomiting and respiratory depression.³

There are a substantial number of more rare or very rare side effects that are also possible. In general, people are able to tolerate methadone well and the side effects of this medication tend to be greatly less severe than the side effects of abusing recreational opiates – in fact,  the most common side effect experienced by people on methadone compared to people abusing recreational opiates is improved health and well being!

Image Copyright: Emanuele Rosso

The 5 secrets to finding success with Suboxone: What you need to know about Suboxone addiction treatment for heroin or pain pills.

Suboxone treatment - how can you make sure it works for you?

Suboxone and the Need for Addiction Treatment

Quitting opioids? Then you’re probably at least considering Suboxone... and why not, after all, Suboxone and methadone increase your odds of long-term recovery while also reducing withdrawal discomfort.¹

So if considering Suboxone, you might wonder why you also need to bother with addiction treatment – if a daily pill takes away your cravings and withdrawal symptoms… what’s left to worry about?

But the truth is, by combining medication with psychosocial therapies you greatly increase your odds of lasting success.

Without addressing your addictive tendencies and without learning compensatory strategies to manage the brain changes associated with addiction, you’ll likely relapse once off Suboxone – or if you stay on Suboxone over the long-term, you’ll just get addicted to something else (cocaine, alcohol, etc.)

Read on to learn more about:

• Why you need counseling as well as medication – and what you can expect to learn from counseling and other behavioral therapies
• Why you don’t just ‘trade addictions’ when initiating Suboxone therapy
• The long-term risks associated with cold-turkey opioid detox
• How to get the most out of your Suboxone therapy
• Your eligibility for Suboxone

If Suboxone alone could do the job, you wouldn’t likely see the manufacturer (Reckitt Benckiser) recommending Suboxone as only one part of a complete treatment plan that should also include counseling and behavioral therapy.²

6 Essential Benefits of Addiction Treatment

Why medication alone isn't enough...

Medications can reduce cravings and withdrawal symptoms to a manageable level. They help you stabilize and focus and they greatly increase your odds of lasting change - but as powerful as medications like Suboxone are, they're not a magic cure; you'll still need to work very hard.

Addiction causes brain changes that lead to compulsion and poor impulse control.³ These brain changes are lasting or permanent and they cause functional changes to the way you think and feel. Fortunately, by learning coping strategies, such as those taught in an addiction treatment program, you can learn to manage your impulses and minimize your risks.

Whether you get intensive rehab care or join an intensive outpatient group, most addiction treatment programs are designed to help you make difficult changes and to provide you with certain necessary skills - here's a list of 6 essential benefits of participation:⁴

1. Sustaining Motivation

It’s normal to feel somewhat ambivalent about major life change and to find that motivation waxes and wanes over time.

• But when a temporary motivation dip can lead to relapse and lasting consequences, it’s important to prepare for down-turns and make certain that your long-term goals drive your day-to-day behaviors.

Motivational enhancement therapies help you overcome drug ambivalence, identify personally relevant goals (what’s important to you – not anyone else) - and teach skills that keep you focused on your long-term objectives.

2. Increase Relapse Prevention Skills

Long-term goals are only as useful as your ability to manage immediate impulses and cravings. Therefore, virtually all addiction treatment programs teach relapse preventions skills, such as:

• Looking back at past relapses - identifying behavior patterns associated with relapse.
  
• Identifying the people, places and things that you associate with using/drinking.
• Learning to identify warning signs of imminent relapse (such as overconfidence, isolation, deception, etc.)
• Learning relapse prevention coping strategies, such as distraction techniques, mindfulness and scheduling.
• Writing a recovery plan for high-risk situations.

3. Replacing Negative Activities with Constructive Habits

If you take Suboxone but continue to engage in all the same negative or risky behaviors of active addiction you are likely to fall back to getting high.

1. Your environment, behaviors and thoughts all influence your ability to maintain recovery. 
   
2. You need to identify negative habits and make a plan to replace these with more productive activities.

For example, you are more likely to maintain recovery by getting out of the house and working/volunteering/going to school than you are by hanging around all day with old drug-using friends.

4. Improve Frustration Tolerance and Problem Solving Ability

By letting small problems build into overwhelming obstacles you increase the amount of frustration in your life. In the past you turned to drugs or alcohol as a way to cope with frustration, what will you turn to now?

By learning better problem solving skills and by learning to handle frustration and other negative emotions you increase your chances of lasting recovery.

5. Build and Sustain Healthy and Supportive Relationships

Most people in active addiction behave in ways that diminish the trust and solidity of important relationships. In addiction treatment you may receive couples or family counseling to help repair past damage and to rebuild healthier systems that support recovery.

You’ll also develop new sober friendships to replace the relationships you lose when changing your lifestyle.

6. Improve Your Community Functioning

Through addiction treatment programs you gain access to volunteer, educational and vocational programs that get you out into the community in a positive way.

Suboxone: 5 Secrets to Success

Research shows that opioid substitution therapy (methadone and Suboxone) is superior to all other forms of detoxification on outcomes such as decreasing drug use and sticking with treatment, but still, not everyone finds what they need from Suboxone therapy.¹ Here are some steps you can take to improve your odds of success. 

Beyond getting addiction treatment you can also improve your odds of success with Suboxone by:⁵

1. Committing to comprehensive treatment (some combination of medication and counseling/behavioral therapies) for an adequate and appropriate length of time. There are no quick fixes to addiction, and though you may choose to skip counseling and taper off Suboxone quickly, this approach increases your risks of relapse.
2. Getting your family and other supportive loved-ones involved in your treatment process.
3. Spending some time once stabilized on Suboxone also dealing with other physical or mental health disorders requiring treatment. Unmanaged illness increases your relapse risk. 
4. Committing to a program that uses drug testing. Drug screening gets you help fast after a slip-up and provides you with extra motivation to remain abstinent.
5. Avoiding other drugs and alcohol - It’s too easy to simply transfer your addiction.

Aren’t You Just Switching Addictions?

No, though you will remain physically opioid-dependent, most people who initiate Suboxone therapy see a significant decline in behaviors typically associated with addiction, such as:⁶

• Reduced or eliminated physical withdrawal symptoms (on short-term opioids, you might experience a daily cycle of intoxication/withdrawal).
• An end to compulsive or out of control use.
• An end to drug seeking behaviors (this allows you the time and energy needed to start rebuilding your life).
• Reduced or eliminate opiate cravings. 

Shouldn't You Feel Some Pain?

1. Detox pains don’t help people avoid relapse.
2. Extreme withdrawal symptoms can predispose you to mental declines down the road.

Some people wonder if using Suboxone to avoid/delay and minimize opiate withdrawal symptoms is akin to running from the consequences of your actions – sort of like cheating.

• Don’t you need to suffer a bit through withdrawal so you won’t fall back into old habits – doesn’t the memory of all that pain help you stay on the straight and narrow?

OK, here the thing about addiction and brain diseases – things that sound good and make sense aren’t necessarily true or effective. While the idea of negative reinforcement makes intuitive sense, there is overwhelming evidence against its effectiveness as a deterrent – and you can see how poorly unassisted detox worked by looking at the relapse rates of those put through cold-turkey detoxes at federal hospitals through the mid part of last century – close to 100% relapse rates.⁷

So withdrawal discomfort does not help people maintain abstinence. The forces that lead to relapse emerge out of addiction-caused changes to brain structure and to diminished impulse control, memory and planning. Discomfort isn’t teaching, it’s just unpleasant.

So there’s no real benefit to enduring opioid withdrawal discomfort, but according to research presented this month (November 2013) difficult opioid withdrawal symptoms may cause long-term harm.

Researchers at Georgetown University Medical Center studied the brains of animals either maintained on morphine or maintained on morphine and then forced into withdrawal.⁸

The Results

They found that animals forced through opiate withdrawal had higher levels of neurotoxic cytokines and less of neuroprotective proteins, like CCL5. Cytokines cause brain inflammation and impaired thinking and are linked to conditions like Alzheimer’s and Parkinson’s.

• Based on their findings, the researchers conclude that cold-turkey withdrawal may be a causative factor in mental decline.

Take-Home

1. Cold-turkey withdrawal is unpleasant.
2. It does not help you maintain abstinence. It is actually associated with significantly higher relapse rates.
3. Withdrawal may be toxic to the brain and may contribute to mental declines.

Are You Eligible to Take Suboxone?

Suboxone combined with counseling and behavioral therapies offers you an excellent chance at building long-term recovery, but are you eligible to take this medication?

Suboxone might be right for you if:

• You are opioid dependent
• You are willing and able to follow dosing directions and other instructions
• You are able to understand an informed consent document and willing to sign
• You have no serious psychiatric illness that might compromise your ability to comply with treatment directives
• You are not allergic to buprenorphine or naloxone
• You have no serious liver dysfunction, paralytic ileus or acute respiratory distress
• You are not pregnant (though pregnant women may be able to take other substitution opiates, like methadone or Subutex)

The following factors may affect eligibility:

• The concurrent abuse of other drugs or alcohol, particularly a severe dependence on sedating drugs like benzodiazepines and alcohol
• Chronic pain

No more preventable deaths! If you or someone you love takes opioids you need to know how to prevent and respond to overdoses.

If you or someone you love uses or abuses opioids, being informed and prepared could be a lifesaver in the eventuality of an overdose.

Every day, more than 115 Americans die after overdosing on opioids. Even more tragically, opioid overdose deaths are preventable!

Read on to learn:

• When you’re most at risk of overdose
• How to prevent overdose
• Warning signs of overdose
• What to do during an overdose
• About naloxone (where to get it – why you need it)

What Is an Opioid Overdose?

Opioids cause euphoria, block pain – and slow breathing.

If you take too much at once, breathing can slow or stop. An overdose can be non-fatal, characterized by a loss of consciousness and depressed breathing, or lethal, characterized by a stoppage of respiration and/or cardiac arrest.

How Common Are Opioid Overdoses?

If you or someone you love abuses opioids, you need to be smart (to prevent common overdose) and prepared (to save a life).

Opioid overdoses are frighteningly common. Opioid abusers are between 6 and 20 times more likely to die than non opioid using peers of a similar age and according to the CDC, drug overdoses now cause more accidental deaths than anything else in America, including motor vehicle accidents.¹

Three in four injection heroin users report having witnessed at least one overdose.²

How Long Does Overdose Take?

Overdose death can occur within minutes of dosing, but it more commonly takes a period of hours after use, during which time the person is unresponsive and often snoring very loudly.³

Anecdotal reports suggest that when heroin is taken by injection, an overdose hit can lead to loss of consciousness within seconds – leaving a person insufficient time to even call 911 if alone.⁴

Overdose Risks

You are at greatest risk of opioid overdose when:

1. You use opioids after a break or when you relapse after a period of abstinence.
2. You take opioids with another drug, especially with another CNS depressant, like benzodiazepines.
3. Using heroin of uncertain purity.
4. Using alone.

Avoid Opioid Overdose (or at least minimize risks)

With quit attempts and even a few days of abstinence your tolerance can decrease dramatically; your previous 'normal' dose could result in overdose, respiratory depression and even death.

Consider how even short periods of abstinence erode your tolerance:⁵

• After 2 or 3 days of abstinence your tolerance is down by a quarter or more.
• After a week of abstinence you’ve lost 50 to 75% your tolerance.
• After a month you’re like a first time user again (no tolerance).
  

If you intend on quitting for good, you can reduce your risks of relapse and relapse-overdose by using an opiate substitution medication like buprenorphine or methadone.

Remember, people are at very high risk of overdose after release from detoxification programs, drug rehabs or correctional facilities (or anywhere with enforced abstinence).

Other Tolerance Reducing Factors

You may also have a lower tolerance when:

• Using in unfamiliar surroundings or with people you don’t know well
• When ill, tired or dehydrated
• After losing weight

2. Avoiding Poly Drug Use

Most fatal drug overdoses occur after poly-drug use. If you use opioids – don’t mix them with other drugs (or alcohol).⁶

Using opioids along with other CNS depressants, like benzodiazepines or alcohol, increases the risks of respiratory depression and fatal overdose – when you take opioids along with a couple of Ativans or Xanax, a dose that you could normally handle without difficulty could be enough to cause fatal overdose.

Paradoxically, using opioids with stimulants like cocaine can also increase your overdose risks, likely from cardiac factors. In one study, researchers found that injecting cocaine and heroin together increased the overdose risk by 260%.

Half Life Considerations

Some pills have a very long half life – they can stay active in your system for more than a whole day. So though you might think the pills you took yesterday are no longer a factor – this isn’t always the case. In some cases, benzodiazepines taken more than a day before can still increase the respiratory depressing effects of opioids.

Consider the half lives of some common drugs:

• Valium: 20 to 40 hours
• Rohypnol: 25 hours
• Methadone: 15 to 32 hours
• Rivotril: 20 to 60 hours

So as a general, rule if you’ve taken any pills in the last couple of days or if you’ve been drinking, use a smaller opioid dose than normal to start with – because you can always take more, but you can’t go back to take less.

3. Uncertain Purity

Heroin purity can vary dramatically. If you’re not sure about the strength of a batch, try a small test dose first to gauge strength. Always prepare your own dose, so you know exactly how much you are taking.

Be careful also if using a different pill than you usually take. Potency can vary dramatically.

4. Don't Use Alone

Roughly half of all heroin overdose deaths occur when a person chooses to use alone and no one is present to resuscitate, call 911, or administer naloxone (narcan).⁷

If you choose to use alone, reduce the risks by:

• Halving your dose into two administrations instead of one larger hit – in some cases you might not need the second half…and in some cases this delay might just save your life.
• Using a ‘safer’ mode of administration – if you normally inject, snort instead.
• Use in a place where you remain still visible to others.
• Talk to a friend on the phone while you get high or arrange for friends to call and check in on you at a certain time after using.
• If you use alone, don’t lock the door to your room

Make a Plan

If you choose to use with others (which is smarter) increase the odds of an effective overdose response by developing an OD plan to turn to in the event of a crisis.

Lifesaving Naloxone

If you or someone you love uses opioids, you should have naloxone on hand to potentially save a life in the event of an overdose.

Opioid overdose is especially tragic when you consider that virtually all such deaths are 100% preventable with the administration of the opiate antagonist naloxone.⁸

• Naloxone is a cheap and easy to administer medication that stops opioid overdose in its tracks. It’s safe and easily administered as a spray into the nostril or as an injection into the upper arm muscles. It’s been saving lives for years in hospital emergency rooms and there’s no reason why you shouldn’t get yourself an overdose kit to keep on hand, just in case.
• Naloxone works to reverse overdose from any opioid drug, so in addition to heroin, it’s also useful for prescription opioid like OxyContin and others.
  
• The medication only lasts for 30 to 90 minutes, so it’s important to seek emergency medical care, even if the medication seems to have temporarily reversed the overdose.
• In many states, people at risk to witness an opioid overdose (such as heroin users, family and friends) can be prescribed this medication, so talk to your doctor about a prescription. Or, to find an overdose prevention program near you (where you can get naloxone) check out our nationwide listings of opioid treatment programs.
  

Overdose Signs

Warning signs of opioid overdose include:

• The person is unresponsive and can’t be woken up. Try rubbing your knuckles on their chest bone (a sternum rub) for 10 seconds.
• The person is awake but can’t talk
• The person’s body is very limp
• Deep snoring or shallow raspy sounding breathing (don’t ignore unusual sleeping sounds)
• Breathing is very slow (less than one breath every 5 seconds) or not present
• Lips and fingernails are blue or gray
• Vomiting
• Clammy, sweaty skin 

Remember, if someone seems to be getting too high, don’t leave them alone. Most people who die from opioid overdose don’t die right away.⁹

Responding to Overdose

In the event that someone becomes unresponsive after using heroin, after calling 911 you can also:

• Try to wake them up
• Check to make sure the airway is clear and open. If there is anything in the person’s mouth, get it out and then extend the neck forward to open the airway as much as possible.
• Check for breathing and pulse. Do rescue breathing (2 quick breaths every 5 seconds) or CPR as needed.
• Loosen any restrictive clothing that might impair breathing
• Put the person in the recovery person - lying on their side with one knee draped forward (so vomit does not block airway)
• Keep the person warm
• Do not give any fluids. Do not put the person in a cold bath or shower (you increase the risk of drowning).
• Stay with the person until help arrives and then inform first responders of the situation – what and how much was used-when was it taken.
  

In many states, good Samaritan laws protect people who call 911 to report drug overdoses and those suffering overdoses from criminal prosecution.

Image Copyright: Mannaz

When pregnant women are struggling with opioid addiction, typical forms of treating the addiction come into play. Pregnant women may be in fear of methadone treatment, but does it cause a negative effect?

When pregnant women are struggling with opioid addiction, typical forms of treating the addiction come into play. Pregnant women may be in fear of methadone treatment, but does it cause a negative effect?

The following are answers to common questions about opioid addiction and treatment for pregnant women:

"Are opioids safe to use while pregnant?"

If you use opioids while you are pregnant, you can expose your unborn child to considerable harm. This is especially true if you are abusing these drugs.

If you have been using an opioid for a legitimate medical purpose as directed by a qualified physician, you should immediately notify your doctor that you are pregnant. Your doctor can help you decide what course of action is best for you and your baby.

"How will my opioid addiction affect my baby?"

Opioid abuse and addiction can put your baby at risk for a wide range of serious problems, including improper development of the brain or spine, heart defects, preterm delivery, and stillbirth. Also, your baby could be born addicted to opioids, which will cause the child to experience painful withdrawal symptoms. This experience may be referred to as neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS).

"Can I get treatment for opioid addiction while I’m pregnant?"

Yes, you can definitely receive treatment for opioid addiction while you are pregnant. When you receive treatment at a center that understands the unique needs of pregnant women, you take an important step on the path towards a much brighter future for yourself and your child.

"How will withdrawal symptoms affect my pregnancy?"

Withdrawal can have a negative impact on your health and the health of your baby. For this reason, organizations such as the American College of Obstetricians and Gynecologists (ACOG) recommend medication-assisted treatment for pregnant women who have become addicted to opioids. This form of treatment allows you to end your opioid use without experiencing the pain of withdrawal.

"Will detoxing while pregnant affect my baby?"

As noted in the previous answer, groups including the American College of Obstetricians and Gynecologists (ACOG) advise that the stress of detox can pose significant challenges to pregnant women and their unborn children. Thus, medication-assisted treatment, which allows you to stop using opioids without going through detox or withdrawal, may be a better option.

"Is methadone safe for pregnant women?"

Decades of research have demonstrated that, when used as directed within the context of a licensed medication-assisted treatment center, methadone treatment is both safe and beneficial for pregnant women and their unborn children. Benefits of appropriate methadone use during pregnancy include decreased risk of NAS or NOWS, increased gestational age, and higher birth weight.

"Is naloxone dangerous to use while pregnant?"

Studies have documented the safety of medications such as Suboxone, which contains buprenorphine and naloxone, when used by pregnant women as part of a medication-assisted treatment program at a licensed treatment center. If you choose to receive care at a comprehensive treatment center, you’ll work with your treatment team to determine which medication is best for you.

"What opioid addiction medications are OK to use while pregnant?"

Methadone, buprenorphine, and naloxone are among the opioid addiction treatment medications that have proved to be safe for use by pregnant women in the context of a reputable medication-assisted treatment program.

Your risk of overdose is higher during the first 2 weeks on methadone than it was before you started. Learn how to stay safe until you get stabilized.

No two people react the same way to methadone, it’s impossible to predict in advance what dosage you’ll need for optimum results and it takes about 5 days on any dose for bloodstream levels to stabilize – and until they do, methadone levels in your body increase by the hour.

Methadone saves lives, but it’s a potent drug with a narrow margin of error. If you abuse opioids then switching to methadone reduces your risks of fatal overdose. However, during the first induction phase, methadone treatment actually raises your risk of accidental death.

Don't get scared off by manageable risks; just be careful, understand how it works and use it with respect. Read on to learn more about:

• The dangers of the induction period.
• Why methadone is so dangerous in the first 2 weeks (and much less dangerous after that).
• Warning signs of dangerous over-medication (knowing what to look for can save a life).

What Are the Dangers?

Methadone is an addiction treatment lifesaver, but you're at elevated risk of overdose until you get stabilized on a steady dose. Consider the following sobering statistics:¹

• In one study, researchers found that people were 7 times more likely to die during the first 2 weeks of treatment than they were while still abusing street opioids.
• In another study, researchers found that people were 98 times more likely to die during the first 2 weeks of methadone treatment than in the period after the first 2 weeks.
• People have been known to overdose during induction with starting doses as low as 30 mg per day.

So once stabilized on methadone the risk of accidental death drops substantially, however, during the first weeks of treatment, accidental overdose risks actually increase.

Three variables that may increase your risks of overdose are:

1. Higher starting doses and quicker dosage raises.
2. Using other drugs or alcohol during the initial methadone induction phase.
3. Poor health, especially cardiac, neurological  or respiratory problems, or genetic factors that result in abnormal methadone metabolism.

Deaths are most likely during the first 3 to 10 days of treatment. People who overdose commonly do so at home, while asleep.

Why Are the First Weeks so Dangerous?

1. Methadone has a very long half life, typically between 24 and 36 hours. This means that after 24 hours, you still have half (or more) of yesterday’s methadone in your bloodstream.
2. So if you took 30 mg on your first day, you would still have 15 mg or more in your bloodstream when you took 30 mg again the next day, bumping your total up to 45 mg. The next day, you would have 30 mg + 15 mg from the day before and + 7.5 mg from the first day…
3. Because the half life is typically more than 24 hours, the amount of methadone in your bloodstream will continue to increase for 5 to 7 days, even when you take the same dose every day. After a week, blood plasma levels can be up to 7 times higher than they were on the first day, even when taking the same dose every day.
4. After 5 to 7 days, your plasma levels stabilize and you achieve a steady state. At this point, continuing to take the same dose once a day will no longer cause progressive increases in blood plasma levels.

So, for example, if you notice that you’re feeling a little over-medicated after your second daily dose, continuing to take the same dose on the following days could put you at overdose risk. Or, if you found that the first day’s dose provided a full 24 hours of withdrawal symptoms relief, this would also indicate a dangerously-high starting point.

Warning Signs of Over-Medication

During the induction phase, be on the lookout for signs of dangerous over-medication, and if possible, ask a loved one or housemate to also stay vigilant for any of the following warning signs. Although over-medication can feel pleasant, due to methadone’s long half life and the way it causes rising blood plasma levels for days until stabilization, what feels pleasant at one minute can turn deadly in the following days (or even later as you sleep).

Warning signs of over-medication include:²

• Feeling high or drugged
• Feeling unsteady
• Nodding off
• Unusual snoring
• Being hard to wake up from sleep
• Slow breathing or difficult breathing
• Pinpoint pupils
• Itching and scratching
• Low blood pressure
• Slowed heartbeat
• Mental confusion
• An unusual feeling of extra energy and the ability to stay awake for longer than usual without needing sleep.

Don’t Let a Loved-One Sleep It Off

Most methadone-induction overdose deaths occur at home after the victim first went to sleep. Loved ones need to know that methadone over-medication is a medical emergency that demands immediate intervention.

• Don’t let a person you love try to sleep-off methadone over-medication.
• Remember that blood plasma levels will continue to rise during the night and that by morning it could be too late.

Don’t Mislead for a Higher Dose

No one wants to feel withdrawal symptoms, so there’s a temptation, when starting with methadone, to under-report withdrawal symptoms relief to get a higher daily dose.³

1. Zeroing in the correct dosage is tricky and dangerous. If you lie about how methadone makes you feel you put yourself at higher risk of over-medication and fatal overdose.
2. Remember, methadone levels build slowly in your body and you can’t easily predict how higher doses will affect you. The little dosage bump that you try to get could be the bump that puts you over a dangerous edge.

Do You Need a Higher Dose?

Methadone dosage-needs are very individualized and what works for one person might not work for another, even if these people seem to have very similar characteristics.

If, after a week on a steady daily dose you experience signs of under-medication, then you likely need a dose increase. Signs of under-medication include drug cravings, insomnia, anxiety and depression, irritability, nausea and vomiting, diarrhea, cramping and other common opioid withdrawal symptoms.

Maybe Your Dose Is OK - You Just Need to Give it Time

• If you feel OK at 3 or 4 hours after your daily dose but sick later in the day or over night, then you probably just need more time for methadone to accumulate in your body, rather than a higher daily dose.

Avoiding Overdose (Don't Top-Up)

To avoid overdose during the induction period:

• Keep increases low and slow.
• Your provider should assess you daily for any warning signs of over-medication.
• Stay vigilant for signs of over-medication.
  
• Avoid topping up with other opioids or other medications, drugs or alcohol.
  

So for safety, when starting with methadone, you have to start low and go slow. Though many people eventually find optimal therapeutic effects at between 80 and 120 mg per day (after several weeks or months of induction) federal regulations prohibit first day doses of more than 30 mg (plus 10 mg more if necessary) and in many situations, doctors will advise starting-doses that are lower than 30 -  40 mg per day.⁴

Unfortunately, this means that for the first days or weeks you likely won’t get all-day relief from withdrawal symptoms and drug cravings; you typically feel a little better peaking at 3 to 8 hours after your daily dose and then levels start to drop down at about 12 hours after dosing. if you feel good at 3 to 8 hours after dosing, this is a sign that your daily dose is about right).

1. As levels drop down, you will experience increased withdrawal symptoms, though with some methadone in your bloodstream, these should be tolerable.
2. As methadone levels drop and as you experience increased withdrawal symptoms and drug cravings, you may feel tempted to top up with additional opioids, or with alcohol or benzodiazepines.
3. Do not do this! Using other drugs or alcohol with methadone increases the overdose risks at any time. When you do this during the induction phase, the risk of accidental death goes up substantially. In one study, researchers found that 92% of methadone overdose deaths involved methadone and another drug (benzodiazepines are particularly lethal when mixed with methadone).⁵

Take Home Message

• Methadone is dangerous during the induction phase, but once you get past the first couple of weeks overdose risks drop substantially.
  
• Although you may feel under-medicated at first, methadone levels in the bloodstream can multiply 7-fold over a week on the same daily dose, so it’s very important to begin cautiously with low starting doses and slow dosage increases.
  
• You may not get all-day withdrawal symptoms relief during the first week or two of methadone induction. This is normal, and the methadone in your bloodstream should be sufficient to make withdrawal symptoms tolerable. The first 2 weeks of methadone are a high risk period for overdose and you elevate your risks substantially by using supplementary opioids, benzodiazepines or other substances on top of your methadone.

Start tapering before you’re ready and your odds of success aren’t great. Take this 16 question self test and find out if you're ready to start reducing your daily dose.

Ready for a challenge?

Most people on methadone hope to taper off and stop using at some point. Unfortunately, your odds of relapse jump once you start reducing your daily dose.

Long duration research studies show that a majority of people trying to taper off methadone either relapse back to opiate abuse or discontinue their tapering attempts. 

But while many cannot maintain abstinence without methadone (or Suboxone) a lot of people are able to taper off and avoid relapse.

Thinking about tapering?

While no one can predict the future, researchers have identified certain life factors that indicate readiness to taper and a greater probability of long term abstinence.

If you start now... will you make it clean to ZERO?

Take the following 16 question Tapering Readiness Test and see if you’re ready (simply answering 'Yes' or 'No'). 

The more 'Yes' answers you score the better your odds of long term success; the more 'No' answers you rack-up, the greater your odds of tapering failure.

Readiness to Taper Self-Test ²

1. Have you been abstaining from illegal drugs, such as heroin, cocaine, and speed?
2. Do you think you are able to cope with difficult situations without using drugs?
3. Are you employed or in school?
4. Are you staying away from contact with users and illegal activities?
5. Have you gotten rid of your “works” / ”outfit?”
6. Are you living in a neighborhood that doesn’t have a lot of drug use, and are you comfortable there?
7. Are you living in a stable family relationship?
8. Do you have straight (nonuser) friends that you spend time with?
9. Do you have friends or family who would be helpful to you during a taper?
10. Have you been participating in counseling that has been helpful?
11. Does your counselor think you are ready to taper?
12. Do you think you would ask for help when you were feeling bad during a taper?
13. Have you stabilized on a relatively low dose of methadone?
14. Have you been on methadone for a long time?
15. Are you in good mental and physical health?
16. Do you want to get off methadone?

The Tapering Readiness Inventory was developed originally by researchers at the University of California, San Francisco.

Image Copyright: Lina Menazzi

Think you know methadone? Be careful, because a lot of what’s passed as common knowledge about this controversial medication has little basis in fact. Here are 8 common methadone myths exposed and debunked.

Deciding whether or not to use methadone as a treatment for your opiate addiction is hardly a decision to be taken lightly, and there are some significant advantages and disadvantages associated with this course of treatment, however, it is important that when evaluating your options you make your decisions based on fact and evidence, and not on myth and distorted truth.

Methadone, for a number of reasons, remains a controversial medication and a lot of what is popularly known about the medication has little basis in fact. Here are 8 things people commonly say about methadone…that just aren’t true.

8 Methadone Myths Exposed

1. Methadone Rots Your Bones

Nope, methadone does nothing to the bones. People who are on an insufficient dose of methadone, however, may experience a dull ache in the bones which is actually a symptom of opiate withdrawal. If your bones hurt, then talk to your doctor about adjusting your daily dosage.¹

Although some people may say that methadone leaches calcium from your bones this has never been demonstrated in any clinical study- and there have been a lot of clinical studies done on methadone - the more likely reason that people on methadone sometimes experience low calcium levels is a diet low in calcium in the years prior to beginning to use methadone.

2. Methadone Rots Your Teeth

This isn’t true, although there’s a reason why people believe this to be so. Methadone, like most opiates and many other medications, can cause dry mouth, and since saliva protects against dental decay, this can increase a person’s risk of cavities and gum disease.

This is easily managed, however, through attention to dental hygiene, such as regular brushing and flossing and visits to the dentist; and through drinking water regularly or chewing sugar free gum to relieve dry mouth.²

Heroin users and other opiate abusers may also begin a period of methadone treatment after a prolonged period of dental neglect that becomes more obvious once no longer masked by the analgesic effects of high doses of heroin or other opiates of abuse.

3. Methadone Affects Your Memory/Makes You Dumber

You may not be so sharp on an overly high dose of methadone (as you wouldn’t on an excessive dose of any opiate) but an accurate stabilization dose should have no impact on your memory or intelligence.

Longitudinal intelligence test studies on methadone users show that chronic use of the medication results in no intelligence declines.³

4. Methadone Lowers Immune Function

Actually, methadone is about the only opiate that doesn’t negatively affect immune function. Additionally, once stabilized on methadone and no longer engaged in compulsive daily drug seeking/taking, you are far more likely to eat well and take care of your physical and mental health than you were when still abusing opiates.

There’s just no contest here – once stabilized on methadone your overall level of health and your ability to resist illness should improve substantially.

5. Methadone Is Worse for You than Heroin

Methadone is a non toxic medication and studies have shown that people can use methadone as a maintenance treatment for addiction for decades while showing no significant adverse consequences from that use. Methadone, like any opiate, can be dangerous if used at higher than recommended dosages.

Heroin, as it is sold on the street is never 100% pure. So people using heroin expose themselves to a random mix of different cutting agents on a daily basis, and the health consequences from the injection or ingestion of these different cutting agents can be severe. There is no doubt that heroin use is more harmful to the body than methadone.

6. Methadone Causes Weight Gain

Although people commonly complain about gaining weight once on methadone there is nothing in the medication that would cause this to happen. In fact, in one study of methadone maintenance patients, although 10 % of people complained of weight gain after starting on methadone, another 5% of people complained of weight loss after starting the medication!

Researchers think that some people gain weight after using methadone as a side effect of other medications, such as anti depressants which may be prescribed concurrently, or simply as a function of eating better/having an appetite return once no longer abusing opiates.

7. You’re Still an Addict on Methadone…You’re Just Addicted to Methadone Now

Addiction is characterized by things like drug cravings, compulsive use and an inability to control how much and how often you use. Once stabilized on methadone you experience none of these hallmarks of addiction.

Stabilized on methadone you are medication dependent and you need to take your medication daily to avoid adverse symptoms, just as a diabetic or a person with high blood pressure needs medication daily. Once stabilized on methadone you are no longer an opiate addict, just a person dependent on medication.

8. Lower Doses of Methadone Are Better

While some clinics may put a low cap on maximum daily dosages, the research clearly demonstrates that people on higher daily dosages of methadone are more likely to avoid relapse, avoid fatal heroin overdoses and have better psychosocial outcomes.⁴

How much methadone a person needs each day is a very individualized matter, but there is very little benefit in getting a daily dosage that is insufficient to stave off drug cravings and withdrawal symptoms.

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Suboxone is an effective drug used in the treatment of opiate addiction. It works similarly to methadone, but unlike with methadone treatment, you do not have to travel to a methadone clinic each day to take your medication, you can instead be prescribed a month’s dosage as take-home.

Because of this, and because of some other significant advantages, many prospective patients prefer the thought of Suboxone over methadone, but not everyone who wants buprenorphine can or should take it.

Before your doctor agrees to prescribe you Suboxone, she will want to run through a checklist of possible contraindications, to make sure that you will be able to use Suboxone safely and effectively.

Suboxone May Not Appropriate for People Who:¹

• Are dependent on or abusing benzodiazepines or alcohol
• Are homicidal or suicidal
• Have a serious untreated concurrent mental illness
• Have tried maintenance treatment without success on multiple occasions
• Have tried treatment with Suboxone before, with poor success
• Have serious medical complications or medical complications that are beyond the knowledge base of the prescribing doctor
• Are not likely to follow a prescribed treatment plan
• Are not likely able to use or store Suboxone safely
• Do not understand how Suboxone treatment works
• Are pregnant
• Are taking medications that will interact with Suboxone
• Have a very poor recovery environment

If none of the above contraindications describe your situation, then you may be an appropriate candidate for office based take home treatment with Suboxone. Some people however, even those who would otherwise be appropriate candidates, cannot use Suboxone as it is not strong enough for their needs. Suboxone has a ceiling effect. After a certain daily dosage, taking additional suboxone results in no additional effects. Some people with heavy opiate habits, such as those who were using high doses of heroin daily, will not find that Suboxone is able to provide sufficient relief from withdrawal symptoms. These people will need to use methadone instead.

Getting into a methadone or Suboxone treatment program and off the abuse of opiates is a monumental step to better health and a better life, but medication alone is rarely enough! Those that give themselves the best chances of a lifetime of recovery take the time of stability that medication offers and use it to take back control of their lifestyle, their finances, their relationships and social support network and many other things. Read on to find out what must be done during maintenance treatment before you can begin thinking about tapering off your medication.

Although some people may choose to use Suboxone or methadone indefinitely as a form of lifetime maintenance treatment, most people will eventually decide to discontinue their use of these medications; and when they do, they once again face an elevated risk of relapse back to opiate abuse.

In general, longer periods of methadone and Suboxone treatment are associated with better eventual outcomes, and the National Institute on Drug Abuse (NIDA) recommends that 1 year be considered a minimum period for the use of methadone treatment.

Once off methadone or Suboxone, you will likely once again experience increased drug cravings. You need to be prepared for this.

A sufficient period of Suboxone or methadone treatment lets you get your life back on track without having to worry about drug cravings and withdrawal symptoms while doing so. Over time, once you have built your strength and social support networks up, you are in a much better position to resist temptation and are more likely going to be able to stay addiction free, even without medication assistance.

Although you may not feel like you need counseling and other forms of addiction treatment while on Suboxone or methadone, this treatment assistance can prove invaluable as you work towards stability and emotional health in your daily life – putting you in a far stronger position for an eventual attempt towards ending your use of Suboxone or methadone.

Getting Ready to End Suboxone Therapy

What You Need to Accomplish While on Methadone or Suboxone before You End Treatment

Addiction is considered a bio-psycho-social disease – one that intertwines through all areas of our lives. Because of this, real weakness in any facet of life leaves us more vulnerable to relapse.

For best chances of remaining in recovery after ending treatment with Suboxone or methadone, we need to have used out time in treatment to¹:

• Restore physical health – A lot of people come out of a period of lengthy opiate addiction in less than ideal physical health. It is vital that the time on Suboxone or methadone be used to restore overall health and wellness and to receive appropriate treatment for any lingering conditions. Health workers in most methadone clinics will provide liaisons to needed health care and Suboxone prescribing doctors should provide referrals as needed.
• Restore emotional health – Because addiction and mental health disorders so often co-occur, many people requiring methadone or Suboxone treatment will also need treatment for conditions like depression or anxiety. Left untreated, these disorders greatly increase the odds of post medication use relapse.
• Overcome other addictions – Many people who initiate treatment with Suboxone or methadone have co-occurring addictions to other substances, such as cocaine or alcohol. A person who ends treatment with methadone or Suboxone while still abusing any other substances is at high risk for relapse back to opiate use.
• Repair family and other relationships damaged during the time of opiate abuse – Having a strong sober social support network can make or break a long term attempt at recovery. Unfortunately, we too often damage these relationships through the actions of addiction. Repairing important relationships takes time and effort, but it is an important aspect of the recovery process.
• Deal with any legal consequences of drug use – Ideally a person stays on methadone or Suboxone while they navigate the criminal justice system (if needed) while dealing with the consequences of actions of addiction.
• Attain financial and housing stability – A person that does not have a safe, secure and stable place to live or who lacks minimum financial stability is not a good candidate for methadone or Suboxone tapering.
• Find healthy ways to spend your free time – boredom or ‘dangerous’ leisure time activities are threats to recovery. You should not consider ending your treatment with methadone or Suboxone until you have adopted new healthy ways to fill you free time – adopting activities that do not increase temptation.

Suboxone or Methadone Treatment Takes Time

It is no small thing to remake your life so completely. To restore physical and emotional health takes time. To find a stable job and a good place to live doesn’t happen over night and to make right with family and friends what went wrong during a period of addiction can take longest of all.

It takes time and it takes effort and you need to give yourself enough time on methadone or Suboxone to accomplish what needs doing before you begin your tapering down – there is no right or set amount of time for maintenance treatment…only a right for you duration.

Take the time you need and find true stability before ending your treatment on methadone or Suboxone.

Methadone is an opiate drug that is used both in the treatment of pain, and as a treatment of opiate addiction.

As an addiction treatment medication, methadone serves as a substitute opiate – you take methadone each day instead of the opiate drug you normally abuse (heroin or OxyContin, for example).

As an opiate, methadone fills the opiate receptors in the brain and thus keeps you from feeling opiate withdrawal symptoms or drug cravings – and when you are on an appropriate daily dosage of methadone, you won’t get high either.

On methadone, you get a chance to get your life back together, without having to go through withdrawal symptoms and without having to battle through excessive drug cravings. On methadone, you don’t have to worry about getting enough money each day to get high and on methadone you’re clear-headed enough to work and to take care of yourself and those dependent on you.

Methadone is hardly a miracle drug, and there are some significant drawbacks to its use, but no other drug works better in keeping severely opiate dependent people from abusing drugs.

How Is Methadone Used?

Methadone is a long acting opiate. A single dose of methadone provides a whole day of relief from withdrawal symptoms and drug cravings.

At the start of your methadone treatment program, you will need to travel to a methadone clinic each day to receive your day’s dosage. Methadone cannot be taken home at first, as it is an easily abused drug with a street value. In time, if you follow the regulations of the methadone clinic, you can earn up to a month’s take-home supply of methadone between clinic visits.

How Long Does Methadone Treatment Take?

There is no set duration for the use of methadone as an addiction treatment medication. Some people use methadone only very briefly, as they transition off short acting opiates – as a detox aid. Other people may use methadone as a replacement and stabilizing medication for a lifetime.

• For the best chances of staying in recovery doctors recommend that you use methadone for at least 1 year
• Methadone, when used as prescribed, does no harm to any of the major organs or bodily systems, and can be used safely, indefinitely
• People who stay on methadone are less likely to relapse back to illicit drug use than people who end their use of this medication

Although some people may choose to use methadone indefinitely, most people eventually decide they want to break free. After a stabilization period and when you are ready to resist the withdrawal symptoms and drug cravings that are associated with dose reductions, you can start to taper your daily dose downward, to an eventual goal of complete cessation. The National Institute on Drugs and Addiction (NIDA) recommends at least a year of methadone treatment and stabilization prior to attempting a taper.

Methadone treatment is effective and when you take methadone as directed, it is very safe. Through more than 50 years of widespread use, methadone has been intensely studied and it is proven safe for use, even by pregnant women.

The Benefits of Methadone Treatment

Methadone is the gold standard treatment for severe opiate addiction – nothing works as well, and unlike some other forms of addiction treatment, the entry costs to a methadone treatment program are very low – a daily dose of methadone can cost just 10$ or 15$.

If you take methadone you are much less likely to also abuse opiate drugs. Some of the peripheral benefits of a drug free lifestyle include:

• A reduced risk of HIV/AIDS, Hepatitis C and other infectious diseases
• A reduced risk of criminal activity and imprisonment
• A reduced risk of death
• Improved overall health
• Improved social functioning
• A higher quality of life

The Drawbacks of Methadone Treatment

Although nothing works better at helping people stop abusing opiates, methadone is not a perfect medication and methadone addiction treatment has some disadvantages, such as:

• For the first months (or years) of treatment, you will need to take you daily dosage under supervision at a methadone clinic
• Methadone induces a powerful dependency – some people say that the withdrawal pains of methadone are worse than of heroin
• Methadone treatment is stigmatized
• Methadone is a medication with side effects, such as constipation, weight gain and others

Talk to your doctor about whether methadone is right for you and get information on other options, such as Suboxone or detox based treatment before making any decision. If you and your doctor decide on methadone, know that you are taking the most effective medication for the treatment of opiate addiction and that you have an excellent opportunity to get your life back together!

Opiates are potent drugs. They can produce powerful euphoria, analgesia and also respiratory depression. Taken in high doses, opiates are dangerous, and respiratory depression can lead to death.

Methadone is a full agonist opiate. Taking increasing doses of methadone leads to increasing euphoria, analgesia and respiratory depression. If you take a high dose of methadone, you are at risk of an overdose death. Thousands of Americans die each year from overdoses of methadone (most overdoses occur from methadone prescribed for analgesia, not methadone used as addiction treatment).

Suboxone contains the active ingredient buprenorphine. Buprenorphine is a partial opiate agonist with a ceiling of action. When you take buprenorphine, it fills opiate receptors in the brain, and once these receptors are filled, withdrawal symptoms are reduced or eliminated. But because it is only a partial agonist, the drug can only partially activate the opiate receptors. As a result, buprenorphine can only induce limited euphoria, analgesia and respiratory depression.

Buprenorphine has a dosage ceiling. In most cases, the maximum effects of Suboxone are achieved with the 16 to 32 mg dosage when taken sublingually (under the tongue).¹ Once you reach this ceiling, taking increasing doses of the medication results in no increasing euphoria, analgesia or respiratory depression. Methadone has no dosage ceiling, and taking increasing doses of methadone can lead to death.

Suboxone is Safer

Suboxone is a much safer medication than methadone (although methadone, when used exactly as directed, also has a very good safety profile) and this is one reason why doctors can prescribe Suboxone in lengthy take home doses.

Although Suboxone is a relatively ‘safe’ opiate, it is still a powerful medication that merits respect. People have died after abusing buprenorphine, particularly when abusing this medication with benzodiazepines.

If a person uses Suboxone or methadone as prescribed then no more is she a drug addict than is someone physically dependent on blood pressure medications! Addiction and physical dependence are not the same. Although a person on Suboxone or methadone will need to take their medication each day, they will not experience the compulsions or harms from use that are characteristic of addiction.

People using methadone or Suboxone as directed for the treatment of an opiate addiction are not drug addicts, although they still physically dependent on opiates.

To understand the difference it is important to understand the difference between Physical Dependence and Addiction.

Physical Dependence

The body naturally adapts (physical changes occur) to the use of certain drugs and medications, and the sudden cessation of use of such medications can lead to withdrawal symptoms.

Opiates cause physical dependence and so the use of medications like methadone and Suboxone will result in a state of physical dependence and upon cessation of use, a period of drug specific withdrawal symptoms.

Other medications that produce physical dependence include certain anti depressants, anti anxiety medications, beta blockers for high blood pressure and others.

Although someone using beta blockers to control high blood pressure would experience withdrawal symptoms upon the sudden cessation of use, you would hardly call a person using such a medication on a daily basis a drug addict!

Addiction

The American Academy of Addiction Medicine considers addiction to be a chronic condition that is characterized by behaviors such as a loss of control over the use of drugs or alcohol, using drugs or alcohol compulsively, craving the substance and using this substance despite obvious harms from its use. ¹

A person using methadone or Suboxone as prescribed will take just enough of their medication each day to feel normal, not high. They will not lose control over their use, not use their medication compulsively, not crave their medication and experience benefits, not harms, from their use. By all measures, the use of methadone or Suboxone as an addiction treatment does not equate to an addiction.

Break Free from Addiction with Methadone or Suboxone

Although while using methadone or Suboxone you will remain physically dependant on opiates, by switching from opiates of abuse (heroin OxyContin, etc.) to methadone or Suboxone you end your compulsive use of opiates and all the harms that are associated with such a loss of control.

Methadone and Suboxone aren’t perfect medications, and if you decide to stop using these drugs you do need face a period of opiate withdrawals, but once stabilized on wither of these medications you’ll no longer get high each day and you’ll no longer feel a desperation to use or to get the money you need to use. Once stabilized on methadone or Suboxone, you’ve broken free from addiction and from there you’ve got an excellent chance to get your life back on the right track. ²

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A list of SAMHSA recommended medications for managing the withdrawal symptoms that occur during Suboxone tapering.

While tapering, some people experience difficult withdrawal symptoms. You can reduce symptoms severity with a slow tapering regimen* but you may still experience significant discomfort. Here is a list of OTC and prescription medications you may want to consider to help alleviate the discomfort of withdrawal.

*In addition to reducing the discomfort of withdrawals, a longer-slower tapering program also increases your odds of eventual success.

Typical Suboxone withdrawal symptoms include:

• Depressed mood
• Anxiety
• Irritability
• Restlessness
• Cravings
• Insomnia
• Nausea and vomiting
• Abdominal pain and diarrhea
• Runny nose and tearing eyes
• Muscle aches and cramping
• Lower back pain
• Yawning
• Light fever
• Sweating
• Elevated blood pressure and heart rate

Medications for Suboxone Withdrawal Symptoms

The following recommendations are from a 2009 Substance Abuse and Mental Health Administration (SAMHSA) nursing publication on the use of buprenorphine (Suboxone).¹

Over the Counter Medications

For Muscle Aches

• Try 800 mgs of ibuprofen, every 6 hours as needed.

For General Pain

• Try 1000 mgs of acetaminophen (Tylenol) every 4 hours, as needed.

For Gastrointestinal Problems

• Try 30 cc of Maalox every 2 hours, as needed.

For Diarrhea

• Try 2 mgs of lopermide (Imodium) every 6 hours, as needed.

For Insomnia

• Try 50 mgs of diphenyhdramine (Benadryl) at bedtime, as needed.

Prescription Medications

If experiencing severe withdrawal symptoms while tapering, talk to your Suboxone doctor about the possibility of a prescription for one or more of the following medications.

For Abdominal Pain

• Try 40 mgs of dicyclomine every 6 hours, as needed.

For Nausea and Vomiting

• Try 25 mgs of promethazine, every 6 hours, as needed.

For Anxiety

• Try 0.1 mgs of clonidine, every 2 hours, as needed.

Reducing Withdrawal Symptoms While Tapering

You may be able to reduce withdrawal symptoms while tapering by splitting your medication into smaller doses, taken 2 or 3 times per day.

Image Copyright: Danielle Zeda

Using or thinking about using Suboxone or methadone? Work through the 15 recovery steps outlined in this article and greatly increase your odds of long-term success.

Difficult tasks aren’t necessarily complicated.

Beating opiate addiction isn't easy, but when you break it down into steps, it’s not really that complicated either.

Here’s an easy to follow guide to the recovery steps that increase your odds of success with methadone or Suboxone.

15 Steps to Success with Suboxone or Methadone

As recommended by the Substance Abuse and Mental Health Administration (SAMHSA).¹

1. Decide to stop using all illicit opiates.
   
2. Contact an addiction treatment clinic or methadone clinic, or get referred to a doctor licensed to prescribe Suboxone.
3. Get assessed and informed and decide if medication management makes sense for you, and if so, which medication fits best.
4. Work with your health team to get titrated onto your medication. (This has to be done carefully – start on methadone too quickly and due to its long half life you could overdose. Start on Suboxone too quickly and due to its antagonist effects you could go into sudden complete opiate withdrawal.)
5. Start counseling to learn coping skills and new behavioral strategies. Never rely on medication as the only leg to support recovery.
6. Get medical and dental check-ups and initiate any treatment needed to restore physical health. Opiates can mask discomfort, so it’s easy to let small injuries or ailments grow into larger problems while high and somewhat anesthetized.
7. Take a hard look at your use of alcohol and other drugs. Do you abuse other substances? Does your substance use hinder your recovery efforts? Many people find it impossible to maintain abstinence from one substance while using or abusing others.
8. Work with your health team to find an optimal daily dosage of methadone or Suboxone. Lower is not always better – you want to find a dosage that eliminates withdrawal symptoms and cravings without intoxicating or stupefying.
9. Learn about triggers and make a list of places, people and things that set you off. Start minimizing needless exposure to triggers and continue to work with a counselor/recovery group to learn effective ways to handle unavoidable triggers.
10. Substitute unhealthy behaviors with healthier replacements. Instead of watching TV all evening, switch out a show or two for an evening walk or jog...instead of hanging out aimlessly before work each day, switch to attending recovery meetings to get your day started right…
11. Make repairing damaged relationships a priority. Healthy relationships support your recovery.
12. Build a steady ‘normal’ routine for your life. Focus on balance - building a routine with blocks of time for work/school, recovery specific activities, fun activities, family time, etc.
13. Schedule regular appointments with your healthcare providers – over the mid to long-range you’ll want to check in every 1 to 3 months.
14. Once past the tough initial period, avoid dangerous overconfidence by continuing with counseling and recovery support groups.
15. Find purpose and joy in your daily life.

Research proves that medications increase your chances of maintaining recovery, but you can’t expect a pill alone to magically change your life around.

That’s why you need to combine medication with counseling, behavior change, support group attendance and a whole lot more to really have a fighting chance at building recovery that lasts.

You can change, but change takes effort!

Image Copyright: Darkmatter

Learn the advantages and disadvantages to a blind methadone taper. Would not knowing the reduction schedule ease your anxiety or would you rather stay in control, so you can plan coping strategies for temporary upswings in withdrawal symptoms?

"I'm so worried about dropping down to 20 mg...I think I feel sick already..."

Is it better to schedule dose reductions so you can prepare for withdrawal symptoms or would you rather stay ‘blind’ to the timing and taper rate to minimize anxiety before reductions?

There’s no right answer to this question, it comes down to personal preference, but some people find that a blind methadone taper reduces anxiety and expectation effects – making the detox process a little easier.

Read on to learn more about:

1. How a blind taper works
2. How expectation effects can change your withdrawal experience (like a self-fulfilling prophesy)
3. The arguments for and against a blind taper
4. Some general methadone tapering advice

What Is a Blind Taper?

Some people feel anxious before dose reductions. Unfortunately, anxiety and expectations of severe withdrawals can intensify symptoms (like a self-fulfilling prophesy).

To minimize this negative influence, some methadone users request a blind taper. In a blind taper:

1. Your doctor, pharmacist (and other clinic workers) conceal the timing and rate of dose reductions
2. Since you don’t know when to expect reductions you worry less - and by worrying less you experience milder withdrawal symptoms.¹

Blind tapers are voluntary; you still retain ultimate control – after all, it’s your body and your money:

• With a blind taper, you should retain control to end the ‘blind’ at any time (to find out your current dosage, dosage schedule and estimated tapering completion date.)
• You should never forfeit your right to learn your current dose or schedule. This is unsafe (you could need this information for a medical reason) and unethical (you have the right to know what you put in your body.)

How Expectations Can Alter Experiences

Can worries about withdrawal symptoms actually worsen your experience?

Well, expectation effects are powerful and just as placebo pills can ease symptoms, negative expectations can reduce a drug’s efficacy.

To demonstrate this effect, scientists in Munich divided a pool of subjects into three groups. All subjects were given the same potent opiate medication (remifentanil) and then subjected to heat pain while in an MRI machine.

1. Subjects in one group were told that the medication would work really well to control pain
2. Subjects in the second group were told that the medication would not control pain
3. Subjects in the third group were told that the medication would worsen pain

 The Results

• Subjects who expected significant analgesia during the heat pain experiment reported twice the pain relief as those who expected no analgesia.
• Though remifentanil is a very strong opiate (roughly 100-200 times more potent than morphine)² subjects who expected worsened pain experienced no pain relief from the medication.
• Having a positive expectancy effect increased neural activity in areas of the brain associated with endogenous pain management.
• Having a negative expectancy effect increased neural activity in the hippocampus, a brain area most commonly associated with memory.

Based on the study results, the researchers recommend factoring a patient’s medication expectations into treatment planning to optimize positive outcomes.³

Blind Dose Reductions – Pros and Cons

Blind Tapering Pros

• You may feel less anxiety preceding scheduled dose reductions (since you won’t know when they’re coming).
• Expectation effects could intensify your withdrawal symptoms (see above).
• Without having to worry about your number, you can focus your energy on developing effective coping strategies and generally getting on with life.
• You can assess your symptoms objectively – how you really feel vs. how you should feel.
  
• Certain numbers, like the 20mg threshold, can provoke significant anxiety. In a blind taper you won’t have to worry about this.
  

Blind Tapering Cons

• Instead of anxiety immediately preceding scheduled reductions, with blind dosing some people feel anxiety all the time.
  
• You can’t make plans to compensate for temporary upswings in withdrawal symptoms. If you know you’ll be feeling unwell for a couple of days after a scheduled reduction you can plan easier tasks for these days.
• You don’t get to feel the sense of accomplishment that comes with knowing you’ve ‘mastered' a dose reduction.
• By retaining control over the process you’re more likely to optimize your tapering plan – such as modifying the rate of taper – to really suit your needs.⁴

Making a Tapering Plan to Reduce Anxiety

Whether or not you choose a blind taper, to reduce anxiety, you should maximize your control over the process. When discussing options with your doctor or counselor, remember:

• Never feel pressured to start on a tapering plan – blind or not – before you’re sure you’re ready.
• Slow tapering plans are more comfortable - for example, 5 mg reductions every 3 to 14 days, slowing as you start experiencing greater symptoms at around 20 mg.⁵
• You should retain control. With a blind taper this means knowing that you can stop your taper if or when you choose to, for whatever reason.
• Before you start, learn how to change to your tapering plan. Who would you talk to? How quickly can changes be made? A good tapering plan should include contingencies for dose reduction slowing or dose increases.
• Discuss ways to temporarily manage overwhelming withdrawal symptoms, especially if it could take a few days to alter your dosing plan.

The Importance of Counseling during the Taper

Whether you choose blind reductions or not, you are more likely to succeed when you replace medication with other effective coping strategies. If you’re not already involved in psychosocial counseling or support groups, the period of tapering would be a great time (if already late) to start.⁶

• You were fine during maintenance - it’s during the tapering phase that you really need counseling again! Use counseling to learn coping strategies and stay emotionally balanced while dealing with increased cravings and withdrawal symptoms.
• In addition to physical discomfort, methadone tapering can cause an organic mood syndrome of dysphoria (the opposite of euphoria), insomnia and loss of appetite. Counseling and other supports can get you over this motivation-sapping hump.⁷

If you saw a counselor twice a month during your maintenance phase – you might want to bump that up to a weekly or twice weekly meeting during the tapering phase.

Image Copyright: Jason Michaels