Filed under: JUNKe life
A month ago I described a methadone withdrawal from heroin/morphine habit (see March post below).
While the gist of what I wrote then is true – you can painlessly withdraw using methadone – I spoke a bit prematurely about successfully accomplishing that withdrawal. Why? Well, because on the fourth day, we did a couple hits to take the edge off. Then used again the next day, and soon we found we’d basically surrendered on that withdrawal attempt. In hindsight, we were kind of pissed at ourselves. We had succeeded, gotten over the hump of acute withdrawal, and then we blew it because we weren’t willing to grit out the last little bit of discomfort. By trying to take the edge off, we blew the lid off our withdrawal completely. Of course, it didn’t help that we had a bunch of dope and clean needles still hanging around the house.
So, we quickly got our habit back, although we really tried to moderate it somewhat. We ended up using roughly 100 mgs of MS Contin three to four times daily for the past month. Some days we’d force ourselves to just do 75 mg hits, but other days we’d allow ourselves 120 mg hits. And of course, prior to that was two years of continuous using before the four days of methadone taper we did in March.
Anyhow, we do want to get our using under control. So wanted to nip this mistake before it quickly turned into being really wired really quickly. Therefore, we decided to do another methadone taper as soon as possible. It didn’t take too long before we were able to acquire more methadone powder to do another taper. We are determined that this time will be different. This time, with the mistakes of our previous taper being fresh in our minds, we were ready to do another taper and do it right. No shortcuts. No wimping out. In other words, if we must endure a little bit of discomfort, then that’s what we’re prepared to endure.
In preparation for this taper, during the last three days prior to starting it, each of us made sure we limited ourselves to just 90mg hits (1 60 mg MS Contin and 1/2 60 mg MS Contin in spoon) four times per day. Final morphine injection was 8 pm on evening of Tuesday April 17.
In total we had just 480 mg of methadone powder for taper. That’s 480 mg total for the two of us.
We split the methadone powder into 8 small capsules each with 60 mg of methadone powder. It really helps to put the powder into capsules because it is so distasteful that one risks gagging on it unless you can get it down without it getting in your throat and taste buds.
Starting the taper
Took first 60 mg methadone capsule at 8am on the morning of Wednesday April 18th. This was twelve hours after final injection at 8 pm the evening before.
After an ok sleep Tuesday night, we were feeling fairly lousy by the time when we took the first methadone dose at 8 am on Wednesday morning. Not extreme withdrawal, but enough that it was dangerous to wait much longer as we might puke up the capsule if our stomachs got much queasier.
An hour after dosing we began to feel comfortable from the first methadone dose. Not at all high, not even fully comfortable, but certainly the 60 mg dose was adequate. For most of the day on Wendesday we were fine. But of course, always ongoing in the background our withdrawal from morphine is progressing, and therefore, by the early evening – less than 12 hours since first methadone dose – it was obvious that the first dose wasn’t really carrying us very well. By 8 pm, just 12 hours into the first dose, we were experiencing hot and cold flashes, intense, short-lived heat sweats, runny nose, tight breathing, a bit of gagging, along with moderate anxiety.
Our intention was to go for 24 hours before taking the second 60mg methadone dose. However, as the first evening progressed into night we realized that we would have to dose well before 24 hours. There was no way we would go through an entire sleepless night. So, at midnight, Wednesday April 19, we took our second 60 mg methadone capsule. That was just sixteen hours after our first methadone dose. And just 28 hours after final injection.
Again, within an hour, we felt it acting to take away the withdrawal effects. Nevertheless, we didn’t get to sleep until about 3 am. And, even though we’d had two doses (total of 12o mg methadone each) in the previous 18 hours, overall that first night since starting methadone taper we didn’t sleep very well at all. We both woke up frequently with intense sweating – totally drenched, yet freezing. Both having to pee frequently as well.
We had planned to have our second dose at 8 am on the 19th. But we had taken it eight hours previously at midnight. So, starting day two we had two doses active in us – one was 24 hours old, one just 8 hours old. Because methadone can last up to 36 (even 48) hours we know that doses start to double up over time. This is a good thing to help maintain a dose sufficient to cover withdrawal.
So the second day went fairly comfortably. Our goal was to try and go 24 hours (i.e. until midnight) before taking our third dose. Remember, the background withdrawal is intensifying as time goes on. It reaches its peak between 48-96 hours after final injection. Midnight would be 52 hours after final injection.
Again, the methadone initially carried us alright on Thursday. Not full comfortable. But certainly manageable. Periodic hot sweating, then cold, then hot, then cold, with some runny nose. Very little energy. Very little appetite. Felt sort of nauseaus after eating small portions. By mid-afternoon we realized we wouldn’t get reach midnight. We reasoned that we would much prefer to feel comfort for eight hours during this point by dosing earlier, even though it would mean that the methadone taper would end eight hours earlier on the far end a few days in the future.
Our goal became 8 pm for our third dose. That would be 20 hours since previous one. However, sickness intensified during the afternoon of the second day and so we ended up dosing for the third time at 6pm. That was just 34 hours after our first dose, and 18 hours after our second. By sickness, I don’t mean horrible sickness. But, enough that it really make dosing sooner, rather than later, the preferable route. Of course, in doing so, we considered the whole time frame, and figured that we wouldn’t be cutting off our nose to save our face in the process.
We expected another restless, sweaty night on Thurday/Friday. But surprisingly we both had very solid sleeps. No sweating at all. This was a great relief. We got up at 8 am on Friday April 20th. It was now 14 hours since our third dose and 48 hours since our first dose. And we were 56 hours into our total withdrawal.
During the day Friday (today) we felt quite good. Not much appeitite. I was cold most of the time, and she was hot most of the time. Infrequent, short heat flashes with little outbreaks of overall sweating. But nothing major.
Our intention today was to try and get to midnight before taking our final, fourth 60 mg dose. A long stretch which would be 30 hours since our previous one.
But by mid-afternoon we changed that to 8 pm. And we ended up taking our final dose at 6 pm this evening.
So, that last dose came 70 hours into withdrawal. If this final 60mg methadone dose covers another 24 hours, in total we will be covered until 94 hours since final injection. That certainly covers the major intensity period.
This last 60 mg dose was 24 hours after our previous one.
So, the period between doses did increase:
- 1st to 2nd dosing was 16 hours
- 2nd to 3rd dosing was 18 hours
- 3rd to 4th dosing was 24 hours
When this final dose effectively wears off around 6pm on Saturday (tomorrow), we will have four entire days since our last injection. From previous experience, withdrawal usually lasts five full days of actual symptoms, with PAWS (post acute withdrawal sysmptoms of being bagged out and somewhat depressed lingering on for another week, if not more).
So, we’re looking at this methadone taper wearing off and then going though one final day or so of minimal withdrawal symptoms. Thankfully, we’ll certainly be well past the peak of withdrawal and just have the final stage lingering physical effects of withdrawal for a day or two. And then the PAWS effects which can last for weeks, even months.
It is worthwhile noting (really paying attention to the fact that) PAWS effects are what often end up pushing a person to use again because they feel so emotionally worn down and lousy after having physically withdrawn but they’re still experiencing the difficult period prior to their natural opiate-endorphine system getting up and running to par again.
Overall evaluation of this taper
I think four doses is the right number of doses to use in a methadone taper. However, for a more comfortable withdrawal, I think each dose could have been a bit larger. 100 mg would have been very nice – in fact, it would have been pretty much a high. So I’d say 70-80 mgs would have been about the perfect dose each time.
For a 100 mg multi hits per day morphine habit, four 70-80 mg methadone doses would be the correct dosing because it will provide appropriate level of coverage/comfort, and it will last long enough (because its half-life would be at a higher point when each dose is wearing down), so that each re-dosing would not be required quite so quickly as we needed them with just a 60 mg dose.
Ideally, instead of the first dose on Wednesday morning with final dose on Friday evening, it would be better to go at least three complete days before the final dose.
We went 2 hours less than 2 1/2 complete days from first to last dose, i.e. 58 hours. It would be optimal to go 3 complete days, i.e. 72 hours from first to last dose.
Optimally, by waiting 12 hours before dosing, then dosing over 72 hours, and then final dose lasting a further 24 hours, the complete coverage lasts 108 hours since final injection. That completely covers the withdrawal period.
Whereas we waited 12 hours before dosing, but then completed our dosing regime in just 58 hours. Add on a further 24 hours coverage from the final dose, and our coverage lasts just 94 hours since final injection.
Our four doses of 60mg made this taper entirely possible. In all actuality, we can say we had a relatively painless withdrawal. In comparison to going cold turkey, it really was truly a breeze. Nothing even nearing suffereing.
Nevertheless, I imagine we will most definitely be uncomfortable tomorrow night. We will likely will sweat a lot, and sleep very little, and generally not feel very good at all.
Because of inadequate dosing the danger is one could easily talk themselves into doing a hit to take the edge off. Our own experience has shown us that’s not a good idea (not a good idea at all!).
Proper dosing is very important! If we’d had 80 mg doses rather than 60mg doses, then the final 14 hours of discomfort which we’ll experience (and therefore, RISK) could have been avoided altogether.
Luckily, we have learned from previous taper experience just last month that we must avoid using to take the edge off. We must grit out the final day or two of minimal discomfort and then endure the subsequent PAWS period by eating well, doing moderate exercise, and getting out and keeping occupied with positive activities.
I say “luckily” because if we hadn’t learned this, we would most likely use tomorrow night when this final methadone dose really starts to wear off. We’d tell ourselves that just one hit to take the edge off won’t be a problem. And, as a result of seeking absolute avoidance of any suffering, our ultimate likelihood of falling back into a pattern of using to take the edge off, leading to using more, leading to a habit again, would be very high.
We know we must not use at all – at least until we have completely withdrawn. Trying to make entirely comfortable the final phase of withdrawal by moderate chipping doesn’t succeed. What ends up happening is that rather than chipping away the discomfort, one actually ends up chipping away one’s chance of successfully completing their withdrawal.
So, we know now to look at our blessings. We had four 60 mg doses of methadone and they were sufficient to taper us from a habit relatively painlessly. We appreciate this fact, rather than dwell on the fact that we will still have to endure a couple final days of discomfort (which would have been avoided slightly larger methdone doses) without the relief of a hit to modify that discomfort.
In the long run, enduring 14-24 final hours of withdrawal is a small price to pay. We hack that out and we win round. We chip away at it and we lose.
We know the costs of losing. So, what’s one day of suffering versus months more (at minumum) of using, eventually having to withdraw again, and thousands and thousands of dollars saved? It’s fuck all, is what it is!
We know now how to get it done this time. So, get it done we will. How? By knowing we can’t chip away this final period of withdrawal. Accordingly, we are committed not to using during the next couple of weeks despite the fact that we’ll feel pretty lousy at times and know it would bring us instant, immediate relief.
We will completely withdraw this time. Still, we see ourselves chipping again in the future. But not until this withdrawal is fully completed and we give our systems some time to get opiate sensitive again.
Right now it is 1 am Saturday morning. It is just seven hours since the final forth 60 mg dose of methadone. It is 77 hours since my last fix of morphine. I would be sick as a very sick puppy right now if I hadn’t had these four taper doses of methadone. I had a short sweat a couple minutes ago, but generally I feel pretty good.
Well, it’s time to go to bed and get what I expect will be my only good sleep for many days. I’ll let ya know how it goes. And if it goes good, then god damn it, we’re gonna fight for people’s right to have the option of a quick methadone taper!
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