My Loved One is Going to Taper off Methadone – What Should I Expect?
AiR member Layagirl wrote in with two questions:
"My son has been on methadone since May, 2015. His high dose was 88 mg and he began a slow taper in May of 2 mg/week about a month ago. What are the possible physical and emotional effects he may experience as he tapers? Thank you for the information."
"One more question. What would be your experts' opinion as to the optimal taper down from 88 mg? Thank you!"
Your son has been stable on methadone and is now tapering off. Coming off of methadone is a choice some Loved Ones make because they feel ready and because they dislike being tied to a strong drug and to the clinic life.
I am not a medical or methadone expert. If you do an internet search for “taper from methadone” you will find sites where former opiate users on methadone discuss their experience tapering, with some giving their advice on how to taper (e.g. a drop in dosage should not exceed more than 10-15% every two weeks).
For an official protocol, here is one from the Department of Defense/VA:
Methadone has one of the longest half lives of any opioid (up to 60 hours); this is the time period it takes the body to eliminate half of the drug. This means it stays in your system longer and can cause a longer protracted withdrawal process than other opioids.
From my own experience with methadone and that of others I have known personally, I want to make two points.
The first is that dropping in dosage from higher amounts is much less difficult than when you get down towards the bottom: say 10 mg or less. The reason, again in my opinion, is that each drop below 10 mg represents a more significant portion of the amount you are dropping from: so a 5 mg drop from 10mg is a 50% drop. Compare this with a drop by 5mg from 50mg (5 into 50 is only 10%).
Your son should check on how the clinic plans to address this last step of the taper. He should have control over how fast it goes. He may start feeling the effects of withdrawal during this last period, regardless of how slow he goes. It will help if he is prepared for some discomfort and can formulate a plan for “lying low” should he not feel well.
The final drop from 2mg to 0 is a 200% drop. That’s huge. Many people, including myself, felt this last taper the most acutely.
Withdrawal from methadone is long, so the period after 0mg can be uncomfortable for weeks, perhaps a month: low energy, joint pain, real trouble sleeping, depression, flu symptoms, no appetite, what I call 'restless body' (where you can’t stay still without feeling a deep itch throughout your body). People are different in how they respond to medications and to withdrawal. You’ll read accounts by some when you look at chat sites whose withdrawal period was shorter or less severe.
You only have to think of yourself to recognize how hard weeks of such symptoms can be. You have obligations like work and you are dragging yourself around, exhausted from weeks of discomfort and lack of sleep. If you are not strong emotionally and in recovery mode, you are going to find your head screaming for relief, for a way to get through your day. The urge to use, to simply get your energy back, is great. It’s a time of great vulnerability. The treatment world does a poor job of recognizing this period. Relapse to opiates is blamed on “not being on methadone” and the studies bear this out: drug-free = higher relapse. But few recognize this vulnerability and provide adequate support to get through it.
Here are two posts we wrote about this period and the protections you can help your son put in place so that he succeeds with complete withdrawal.
I'm Concerned About My Son's Nodding
Let us know how it is going. Be well.
This is a follow-up to some questions I have asked in the last month. My son is tapering his methadone from 88mg to 38mg. Based on information you and his counselor provided regarding the speed of his taper and how he was feeling physically and emotionally, he stopped the taper about three weeks ago. His mood swings have leveled off a little, but his stomach pain in the mornings has not improved (and insomnia continues as well). My question is whether this lower dose (38mgs) may not be holding him 24 hours any longer and that is why his stomach is so bloated and painful in the mornings. He takes his dose between 10 and 11 a.m. Within 30 minutes, he used to feel better. Now it is taking about 2 hours. Again, could this be due to the lower dose not being as effective? Thank you for your opinion.
Hello Layagirl: I am not qualified to answer your question. I’ve sent your question to several who are and am waiting for a response.
I have never heard of bloating and pain in the stomach as a side effect of withdrawing from opiates. Opiates, including methadone, do cause constipation, so that when you reduce the opiates, you get diarrhea. Is your son’s discomfort a result of that? I can’t say. I suggest he sees a doctor to rule out anything else.
The insomnia is a common side effect. This is hard to tolerate as it reduces energy and can exacerbate low moods. This is why a person needs a strong recovery program when tapering off an opiate. It takes courage to hang in there and not respond to what your mind knows to be the instant solution: reaching for a drug to make it all stop.
Your son is reaching the point in his taper where he could b-line to suboxone. Perhaps he contacts a suboxone clinic and asks. I understand it’s not his ultimate goal, but if the methadone taper becomes too unbearable, it’s an escape plan that keeps him from returning to the methadone. He then stabilizes on the suboxone and when ready, starts titrating from it.
More to follow when I’ve heard back from those I’ve asked to comment.
Please tell your son I am thinking of him.
Dominique
Hello Layagirl:
A colleague of mine, Dr. Tom Lincoln, has sent in this more complete answer, regarding your son’s symptoms. I hope this helps.
“I echo Dominique’s thoughts on insomnia, energy, low moods, recovery program, and possible Suboxone (buprenorphine).
Digestive system symptoms are commonly seen with opioid withdrawal including when a lowered dose of methadone is wearing off sooner. Most commonly felt are abdominal cramps (pain), diarrhea, nausea, and/or vomiting. Bloating is not usually what most people describe, but the meaning of the word or the sensation of nausea could vary from person to person. Given that the symptoms are recurring at the time when the methadone levels would be lowest, it sounds likely that these are withdrawal symptoms. The fact that it takes longer to feel better at the lower dose would also fit with this pattern.
The switch from methadone to Suboxone is usually tolerable in this dose range, but does include withdrawal symptom periods around the switch.”