Are Fentanyl Users Successful with Methadone?

LauraW's daughter has asked to move back in. She's starting on methadone and is making good progress in cooperation with her probation officer. What should she keep in mind?
 

"Hello again Laurie and everyone. I thought I would add an update.

I’ve been making a conscious effort to allow my daughter to figure out what will work for her recovery. She continues to be cooperative with her probation officer, and she’s participating regularly with counseling. She likes to cook, so I’ve been rewarding her with little gift cards for the grocery store, and she really likes that.

I’m listening for wishes and dips, and they’re getting easier to recognize.

Last night, while visiting, my daughter told me that she’s decided to go with a methadone treatment program. Her probation officer is all for it, even set up the intake appointment, and has been very positive and encouraging. The only problem right now is that my daughter’s boyfriend is also an opiate user, and is not seeking recovery, so the P.O. strongly advised my daughter to move out.

She’s asked to move back home with me and my husband (her Dad). I tried to remember what I’ve been reading about responding rather than reacting impulsively. I told her that she would be welcome, but I would like to wait until she’s fully signed up/ actively committed to the methadone treatment. I can’t help wondering if I said the right thing.

I’ve been looking for info here on the AIR site to get a good idea of how methadone works, what are the success rates among fentanyl users, etc.

I’m trying to be cautiously optimistic. Any and all feedback is most welcome.

Thank you again for this excellent resource,
Laura W"

Thank you for writing in again, LauraW. Congratulations to you and your husband for all of your good work! So glad you've been so active on the site and with CRAFT.

Your daughter decided on her own to start a methadone program. Her probation officer is very encouraging of this decision.

Methadone is the heavy lifter among meds for opioid use

Methadone is the heavy lifter among medications for opioid use (see the Medication Assisted Treatment tag —MAT is now called Medication for Opioid Use Disorder or MOUD).

Methadone is the heavy lifter among medications for opioid use; it's an active opioid that eliminates the urge and stops painful opioid withdrawals. The “success” of methadone, in terms of reducing/stopping use and preventing overdose, is well established. Clients commit less crime and are more likely to work. Methadone is a very old medication in the arsenal. As for its success with Fentanyl users, the prescriber can continually increase the dose, until your daughter is comfortable and no longer craving even these very strong opioids.

Methadone also has its problems. Because methadone is carefully controlled, your daughter will need to travel daily to a Methadone Clinic to be dosed. If she stays opioid abstinent, she will eventually be rewarded with medication take homes, typically starting over weekends. Methadone has a long half-life, which means its withdrawals last longer than other opioids. It can be long and hard to get completely free of methadone.

Many choose to stay on methadone for years, sometimes even for life. Others see methadone as more short-term, a bridge lasting maybe six to 12 months. Once the client is at a more stable and healthy place, a year or so of non-active use behind them, and a hopefully strong emotional recovery in place, the client and clinic agree to start slowly dropping the dose over a long period of time.

Overdose remains a possibility with methadone

Beware — overdose remains a possibility while on methadone. Methadone takes up the body’s opioid receptors, so the use of an additional opioid on top of the methadone doesn’t bring on the normal euphoria and rush. You feel nothing at all. The frustration discourages the person from trying to use at all (this is the reason antagonist or opioid blockers like Naltrexone work). There is always the chance, however, that this frustration will cause the person to increase the amount they use to beat the methadone — which can be done, and leads to overdose.

Complications when the couple uses together

It's hard to get and stay in recovery when living with an intimate partner who also uses. See our tab, “couples".  If they are struggling with the drugs together, it will definitely help for your daughter to live in a drug-free environment, e.g. your home.

I definitely see the probation officer’s point. He/she probably, though, didn’t ask how you or your husband felt about the idea.

Having your daughter home is a big undertaking for the family. We have written a lot about having your Loved One home, including setting up a temporary space, with a daybed and locker, rather than granting them a permanent space in the house.

Be agile and prepared — agree together on next steps if they slip

You need to be agile. Should your daughter relapse on opioids, or other substances you've agreed together are off limits, your safe house can quickly become a hideout-and-use-den.

Put in place common-sense rules about living together as adults, and agree ahead of time what will happen should she start using again (for example, more intensive treatment, sober housing alternatives). While not binding, this talk about the future is an opportunity to signal to her that you can interact as adults and partners, and not as parents to a child.

We're rooting for your daughter. She's been making good decisions. Getting started on methadone is fast, as are its immediate, protective effects. She may actually enjoy a possible high from the methadone as her system adjusts for the first couple days.

You have come to the right place, if I may say. We have written a lot about having children home, especially so during COVID. The 'home/homeless' tab provides guidance on all sorts of situations having to do with housing.

CRAFT is a skillset that helps manage addiction, and support recovery, in your family. But it also focuses on you, with the understanding that you and your husband will also take care of yourselves and protect your marriage, as one critically important leg of the stool.

Self-care, as always, remains key!

You and your husband have been learning and applying CRAFT thoughtfully. It's a challenge and takes quite a lot of energy to shift your reactions and responses. We commend you for this.

Please keep in mind how important self-care is and consider revisiting Key Observations #20 which invites you to list the self-care strategies that appeal to you.

You could print it out so that your husband can also make his list.

Do the two of you need to carve out a bit more time for each other? Would a date-night (where you agree to avoid certain subjects that might drag you back into a place of worry) feel good? Or committing to do more of any activity that you both enjoy?

If your daughter is home, or headed home, you two will be the pillars she'll be leaning on each day. If you're feeling balanced, and rooted in solid ground, you'll be in the best possible position to encourage her, while still having energy left for yourselves.

Rooting for you all. xo