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THINKING OF TAPERING METHADONE Revised 9-7-2005
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If I were a doctor dedicated to his patients and you came to me about tapering I would sit down and take some real time to discuss this in detail. I would first say that it is your right to taper. If you make the decision to taper, I would abide with it and do my best to help you. PLEASE CONSULT YOUR CLINIC MD
PREGNANT?: National Institute of Drug Abuse recommendation: http://www.nida.nih.gov/ResearchReports/heroin/Heroin4.html#pregnant "...Pregnant women should not be detoxified from opiates because of the increased risk of spontaneous abortion or premature delivery; rather, treatment with methadone is strongly advised. Although infants born to mothers taking prescribed methadone may show signs of physical dependence, they can be treated easily and safely in the nursery. Research has demonstrated also that the effects of in utero exposure to methadone are relatively benign." Also Read This:http://www.worldzone.net/health/nehmo/RisksofMethadoneinPregnancy.htm DEFINETLY CONTACT CLINIC MD & OBGYN
I would explain that tapering is best done when it is patient guided. There should be no set time limit and the pace should be between me (the doctor) and you. I would strongly suggest not to jump off when you reach the lower dose amounts as this can lead to a problem with strong withdrawals which increases the potential of relapse. In fact, I would suggest going very slowly at that time.
I would suggest that you keep a log book of your feelings and any problems that arise during the taper. This should also include being careful to note the worsening or awakening of any mental illness that might have been helped by methadone maintenance. (According to Dr. Shinderman, if a person suffers from another mental illness, withdrawal is contraindicated. See Doctor Shinderman's "DEAR DR LETTER" for details. Also see Dr. Payte's Letters by clicking here and going to "downloads" and " for more information. CLICK HERE
I would encourage you to keep regular appointments during your taper and follow up appointments for at least two years.
We would discuss the facts of the 70 percent chance of relapse (Dr. Shinderman)within 18 months after a taper. Some say higher (Tapering Readiness Inventory) You can easily return to medically assisted treatment after withdrawal without needing to show opiates in your blood system for up to two years. [for previously treated patients as per Federal Regulations - Sec. 8.12 (e) (3)]
We would discuss the very high potential for an overdose for those that relapse after a taper and I wouild hand you the Harm Reduction Pamphlet: OVERDOSE Prevention & Survival
We would discuss that some relapse to other drugs including alcohol after withdrawal and how damaging that can be if you have HCV. We would also discuss PAWS (Post Acute Withdrawal Syndrome)
I would go over the latest pharmacologic information about methadone and how it works for opiate addicts and why so many need to keep taking their medication. I would encourage you to keep up with the facts as they change. I would also discuss the pro's and cons of Buprenorphine maintenance which may or may not be a good choice for you.
In addition, we would discuss the usual effects of what it means to be on the effective dose for you and if you ever really reached that point. Methadone is not for all opiate addicts but it is still the gold standard.
We would also discuss the side effects which may be of import in your decision to taper and look at ways that we could work together to help you with those effects.
I would discuss with you the advantage of a stable lifestyle before tapering. In my opinion, it might be profitable for you to attend
Methadone Anonymous meetings as often as you can during and after withdrawal.
I would maintain your take home schedule during the taper, We would discuss that the best chances for a taper involve having a stable lifestyle and what that means. We would discuss the fact that your period of stability may be too short and would decrease significantly your chances of making it for 18 months.
(IMO, the patient should be in treatment long enough to make it a better than the 1 in 4 chance. Under the new Federal Regulations, they would have earned substantial take homes if the state and clinic have allowed them properly. They should have minimal clinic contact with the life that comes from being eligible for 1 month take homes after 2 years if the clinic or state would have allowed them for you. However, if you want to taper we would still work with you the best we can)
I would ask an important question --- What is happening that you want to consider the risks of withdrawing from this life saving medication? Is there something that I could do to help you (or others) with your recovery that we have been overlooking? Is there something that we could do better for you and for others that we have overlooked? SEE THIS ARTICLE ON THE EFFICACY OF SLOW TAPERING.
In the event you decide to use the Suboxone/Subutex sub lingual treatment (Buprenorphine) for maintenance or taper when you get low enough on your tapering dose to lateral over to that program we would still like to help with your transfer and continue our relationship as stated before. For a list of doctors who provide Suboxone/Subutex Treatment click here: SUBOXONE/SUBUTEX TREATMENT - LIST OF DOCTORS (Note: Some Clinics will provide buprenorphine maintenance and taper in house. This may be far more strict than if provided through an approved outside physician. Some clinic physicians may do Buprenorphine on the side.
Buprenorphine as an option for tapering after reaching 30 mg per day may work well for you. Changes in the suggested cross over amount may be revised after studies are completed in the near future The option to maintain on Buprenorphine is available and could be an important consideration. The rules and regulations for buprenorphine are far more lenient than those for Methadone at this time. Monitoring the liver is indicated for those with Hep C.
I am sure that a qualified addictionologist would add to or change my ideas that I just put down for you.
I think that this would be the way that a good doctor, be it in a clinic or private office would try to do his or her best for you.
But, I am not a Doctor and still, I want the best for you in your recovery. George Clarke ARM SE CT Volunteer Advocate
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Also do a http://www.google.com search for: Methadone Relapse Ratio
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Revised 9-7-2005
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