Get Off Methadone and Subutex for Good

Brutal Truths About Methadone Maintenance Therapy

Tapering Off Methadone and Subutex

Addiction is a complex condition that affects an individual’s whole life. The circumstances that lead to addiction are unique and can range from childhood trauma to experiencing a severe accident or injury.

Substance abuse treatments are not one-size-fits-all. Opioid addiction, for example, is one of the most challenging addictions. Many people who stop using opioids take methadone or buprenorphine, commonly known as Subutex, to replace the opioid and lessen withdrawal symptoms. Methadone and Subutex, however, also have a risk of abuse and dependence. Therefore, to become completely free from opioids, you must taper off both methadone and Subutex. Typically, the first step is tapering off methadone onto buprenorphine and then tapering off buprenorphine to being substance-free.

Stabilizing Challenging Patients

Some addiction treatment facilities specialize in using methadone tapering and buprenorphine tapering to stabilize the patient before transferring them to a long-term treatment facility. Stabilization can include lowering methadone levels to what typical rehab centers will accept. It can also mean shifting the patient from methadone to Subutex, the branded name for buprenorphine.

Often, stabilization requires patients to eliminate all medications used in maintenance therapy, which can mean methadone and Subutex tapering. Effective rehabilitation programs offer multiple services to encourage success within the treatment curriculum.

Stabilizing requires teaching the patient what to expect as medication-assisted treatment of tapering occurs. A stabilized patient will receive control back over their life and see their recovery journey with open eyes.

Learn About Methadone

What is Methadone?

Methadone is a prescription opioid medication used to treat moderate to severe pain. It treats addiction by helping people gradually wean off some substances without excessive withdrawal symptoms.2 When treating symptoms of a substance use disorder, a doctor must prescribe methadone. A clinic administers the methadone daily to monitor the process. Methadone can be highly addictive on its own, so it is not typically prescribed for at-home usage.

00:00 What is Methadone and how is it used to treat opioid addiction? 00:10 How does Methadone help someone stop using opioids? 00:15 Methadone allows people to feel normal and not experience withdrawal symptoms from abruptly 00:20 stopping the use of opioids. 00:22 It has a low potential to cause the euphoric effects of other opioids. 00:28 Without having the negative effects of recreational doses of opioids, the person is able to concentrate 00:33 on getting the other aspects of their life in order. 00:37 Over time they are able to reduce, and then eliminate, the methadone to prevent the extreme 00:41 withdrawal symptoms that so often cause people to fail. 00:45 How does Methadone work in the body? 00:49 Methadone is a synthetic opioid used to treat opioid withdrawal and increasingly chronic 00:54 pain. 00:56 Methadone binds to the same “Mu” opioid receptors as heroin and other opioids, but 01:01 causes less euphoria and respiratory depression. 01:11 With Methadone already filling the receptors, there are fewer places for another opioid 01:15 to bind. 01:17 This effect blocks the “high” of any opioids taken after the Methadone, and is used to 01:21 limit the appeal for someone to relapse and take another opioid. 01:27 Unlike all other strong opioids Methadone is also a NMDA receptor antagonist like ketamine. 01:35 It is believed that the NMDA action of Methadone is what decreases much of the craving for 01:40 opioids, tolerance, and withdrawal symptoms. 01:44 I won’t go into it in this video, but in my opinion the most promising treatment for 01:50 addiction is another NMDA agonist, Ibogaine. 01:56 Ibogaine is believed to reset the brain's neurotransmitters that cause addiction. 02:01 How long has Methadone Replacement Therapy been in use? 02:07 Methadone was discovered in Germany in 1937. 02:12 In 1964 Methadone was first used to treat opioid addiction in the United States. 02:17 Today there are over 1396 Methadone Maintenance Programs in the the United States serving 02:23 254,000 patients a year. 02:27 How long does Methadone last and how often do I have to take it? 02:33 Methadone has a highly variable half-life of between 15 to 60 hours, and an average 02:40 half-life of 22 hours. 02:44 Methadone dosing varies significantly from patient to patient depending on metabolism 02:48 and other factors. 02:50 There are cases of people with fast metabolisms eliminating Methadone in as few as 4 hours, 02:56 and those with slow metabolisms taking as long as 130 hours. 03:00 It is this long half-life that allows people to dose only once a day at a local clinic. 03:09 How long do I need to be on Methadone Replacement Therapy? 03:14 Methadone replacement therapy is typically a long term option. 03:19 For Methadone Substitution Programs, 12 months is considered the minimum for a successful 03:24 outcome, although some people find it beneficial to stay on them for years. 03:30 20% of those who start a Methadone maintenance program will find themselves still participating 03:36 10 years later. 03:39 Is Methadone Replacement Therapy just swapping one drug for another? 03:44 Many people mistakenly believe that Methadone and other Opioid Replacement Therapy medications 03:48 are only replacing one drug for another. 03:51 This is a lack of understanding of how opioids work in the brain. 03:55 This isn’t a lack of character or willpower that makes people into addicts. 04:00 Opioids take control of the brain's reward system, the neurotransmitter dopamine. 04:05 Dopamine is normally used to reward the person doing things necessary for survival like eating, 04:11 sleeping, and procreation. 04:15 Opioids, and most other addictive drugs, hijack this reward mechanism and use it to force 04:21 them to use more of the drug. 04:25 If you would like to know more about how addiction is formed in the brain, then watch my video 04:30 “How Does Opioid Addiction Work?” by selecting the card in the top right of the screen. 04:38 Anyone thinking opioid abuse is an issue of willpower would quickly realize their mistake, 04:42 if they ever used an opioid for an extended period of time. 04:46 Let’s try to answer a few common questions about Methadone and Methadone Replacement 04:51 Therapy before making the decision to go to rehab or ask your doctor about it. 04:59 How long does Methadone withdrawal last when stopped abruptly? 05:04 A major downside to opioids with long half-life’s like Methadone is the long period of time 05:08 it takes to get out of your system and for the withdrawal symptoms to stop. 05:13 If Methadone is not slowly tapered down, withdrawal symptoms will start about 30 hours after the 05:18 last dose, last about 3 to 6 weeks, and gradually start improving after day 10. 05:26 The higher the dose the longer the tapering period needed to prevent withdrawal symptoms. 05:32 Some people need years to properly taper themselves off of Methadone. 05:37 How often do I need to visit the clinic for medication? 05:41 Methadone treatment usually requires visiting a local clinic once a day to receive the medication. 05:48 Over time some patients are allowed to take home small doses of medicine. 05:54 Being in Methadone treatment can chain someone to the local area of their treatment, because 05:58 they can’t go to just any clinic. 06:01 This makes it difficult to travel to visit friends or family, travel for work, or travel 06:06 for vacation. 06:09 The need to return daily to the clinic can also cause stress from the process of getting 06:13 there, or from the thought of not being able to make it there. 06:18 Do Methadone Replacement Programs kick you out if you relapse? 06:23 Many Methadone programs have a zero tolerance policy to participants who relapse and use 06:27 heroin or other opioids again. 06:30 I think this is a terrible policy that doesn’t help anyone. 06:35 Someone relapsing needs more help, not less. 06:37 There are also cases of people being denied medication because of an issue with their 06:42 insurance, or because they didn’t have the money to pay for the current weeks treatment. 06:47 Make sure you check into the Methadone clinic before accepting treatment there. 06:52 Find out about the rules, and how they would treat you in these situations. 06:55 A good clinic will work with you on payments, and not just cut you off. 07:00 Can you get “High” taking Methadone? 07:04 There seems to be a lot of debate about whether or not Methadone can get someone “high”. 07:09 Methadone is less euphoric than other opioids, but if the dose is raised too quickly it can 07:14 cause euphoria like heroin, morphine, and other opioids. 07:19 The key to Methadone treatment is a consistent dose, that is sized just right for the individual. 07:25 In the beginning of Methadone treatment, while the correct dose is being determined, you 07:29 may feel some euphoria, but it will quickly go away. 07:34 It needs to be a large enough dose to prevent cravings and withdrawal symptoms,but small 07:39 enough to prevent euphoria. 07:42 If you take the exact same dose consistently over a relatively short period of time, the 07:47 feelings of euphoria will diminish to nothing. 07:57 Is Methadone Safe? 08:00 Methadone is generally safe when taken are directed by a doctor, but can be much more 08:05 dangerous than other opioids when abused. 08:10 With other opioids the negative effects, such as respiratory depression, last the same time 08:15 as the effects they are seeking like the “high”. 08:18 Immediately after taking an opioid like heroin is when the user is at the highest risk of 08:22 overdose. 08:24 The “high” and the danger are tied together. 08:28 This is dangerously not the case with Methadone. 08:31 The pain killing effect and the “high” will typically only last for 4 to 6 hours 08:34 after taking Methadone, but the other effects like respiratory depression will last for 08:39 several days. 08:42 If someone is dosing based on how they feel, they could easily take too much and die from 08:47 respiratory depression. 08:50 This increase in negative effects is called stacking. 08:54 This makes it vitally important to take the same dose consistently. 08:59 This video provided information about using Methadone as part of an Opioid Substitution 09:04 Program. 09:06 In addition to using Methadone for opioid substitution, there is another newer medication 09:10 called Suboxone. 09:12 I think Suboxone is a much safer medication that should always be used instead of Methadone, 09:17 unless there is a specific medical reason. 09:19 There is a link to a video on Suboxone in the cards in the top right corner of the screen 09:24 or in the video description below. 09:29 SubLike. 09:33 If you found the content helpful please give this video a “Like”. 09:37 If you want to see more, please support this channel by selecting the “Subscribe” button. 09:43 If you know someone suffering from addiction, please “Share” this video with them to 09:50 help. 09:51 EndScreen. 09:53 Here are some other popular videos about the Opioid Epidemic.

What are the Side Effects of Methadone?

As with all drugs, there are potential side effects that that might come with use. Some of the possible side effects of methadone are:

  • Constipation
  • Dry mouth
  • Difficulty urinating
  • Flushing
  • Headache
  • Itchy skin
  • Mood changes
  • Restlessness
  • Sore tongue
  • Stomach pain
  • Sweating
  • Vision problems
  • Weight gain
  • Bloating issues
  • Fatigue
  • Depressive symptoms
  • Difficulty falling asleep or staying asleep
  • Lower testosterone levels for males

What is Methadone Maintenance Treatment?

When methadone is used in the treatment of opioid addiction, it is called methadone maintenance therapy. MMT seeks to maintain the long-term sobriety of the patient. This type of treatment is usually only one part of a person’s overall treatment plan and is combined with therapy or counseling. Methadone works in substance abuse treatment because it blocks the high:

  • Heroin
  • Oxycodone
  • Morphine
  • Codeine

Methadone also helps prevent withdrawal symptoms that occur when someone stops using a substance such as heroin or other opioids. Withdrawal symptoms, such as sweating, vomiting, diarrhea, insomnia, and muscle pain, are extremely unpleasant and can make it hard to stop using illicit substances. Methadone eases the transition from the substance without too many withdrawal symptoms, thereby reducing the risk of relapse. Methadone maintenance clients typically have to line up at a clinic for dosing, and MMT requires daily visits to that clinic. Doses must be kept up with, meaning the patient should attend clinic sessions even if sick or on vacation.

Colin's Story

By the mid-’90’s I started to think about the effect methadone was having on me. I didn’t seem to have any freedom in my life. It seemed like I was married to it; it was running my life for me. I tried to just stop on my own, but it made me feel like shit; I was really ill.

Is Methadone Maintenance Therapy Effective?

With decades of use as a treatment for opioid addiction, methadone maintenance therapy (MMT) has proven effective.4 Individuals in MMT had 33% fewer opioid-positive drug tests than those not in MMT. Individuals in MMT were also 4.44 times more likely to remain in their treatment programs.

Is Methadone Maintenance Therapy Safe?

When used as prescribed, methadone is safe and effective. During methadone maintenance therapy, the dosage prescribed reduces withdrawal symptoms and cravings without creating a “high” feeling.

However, because methadone is an opioid, it can still cause dangerous side-effects if you take more than the prescribed amount. Severe or life-threatening breathing problems may occur at high doses and if taken with other substances. Additionally, when methadone is misused and not taken as prescribed, there is an overdose risk. Although methadone is effective from cross opiate addiction, it is not effective in building an energetic, purposeful life.

According to the Center for Disease Control and Prevention (CDC), methadone is responsible for 5,000 overdose deaths a year.5 Possibly due to the boom in opioid addiction in the recent past, the number of deaths resulting from methadone overdoses has risen each year. Unfortunately, six times as many individuals died from methadone overdoses in 2009 than in 1999.

Donna's Story

They put me on a methadone script. I was on methadone for about two years. It stopped the rattles, but in my head, I still needed to ‘smoke the foil.’ I had never passed a clean test, so they kept putting up my script

Donna started methadone detox and never looked back. She saved her marriage, daughter, and self-respect with a methadone detox.

Learn About Buprenorphine and Subutex

What is Buprenorphine and Subutex?

Buprenorphine is an opioid typically used to combat opioid disorder, and Subutex is a brand name of buprenorphine.7Subutex discourages misuse because, when taken as instructed, the drug’s effects will help manage your withdrawal symptoms. However, if abused by crushing it up and being injected, you would experience very unpleasant withdrawal symptoms. For that reason, Subutex can typically be administered at home and does not require as strict rules surrounding receiving your dosage in a clinic daily.

What are the Risks of Subutex?

Buprenorphine is considered a safer alternative to methadone. It is also considered a safe replacement for harmful opioids such as heroin. However, it is still comprised of an opioid and therefore carries a risk of addiction. Along with the side effects that you may experience from taking Subutex, you can also become dependent on Subutex and risk developing a substance use disorder. Additionally, quitting Subutex cold-turkey can result in withdrawal symptoms that run the risk of relapse.

What are the Side Effects of Subutex?

  • Constipation
  • Drowsiness
  • Headache
  • Insomnia
  • Mouth numbness
  • Mouth pain
  • Vomiting

 

You should immediately seek medical attention if experiencing more serious side effects such as:

  • Fainting
  • Extreme dizziness
  • Slow or shallow breathing
  • Fast or irregular heartbeat

Subutex Withdrawal Symptoms

  • Low energy
  • Low appetite
  • Irritability
  • Insomnia
  • Anxiety
  • Depression
  • Nausea
  • Vomiting
  • Headaches
  • Muscle aches
  • Cravings
  • Difficulty concentrating
  • Digestive issues

Clyde's Story

The only person I knew who’d come off [Subutex] maintenance before was my partner, James who jumped off 4mg cold. He proceeded to rock back and forth on the couch for ten days before starting to use again.

I figured it would be easy if I did it the ‘right’ way – the way it was recommended. Slowly. The truth is, there is no one-size-fits-all, and there is no such thing as an “easy” detox from a [Subutex] maintenance program.

Tapering 101

What is Tapering?

Tapering is the gradual reduction in your dosage of medication until you can stop taking the drug. The reason for methadone tapering is that the sudden stoppage of methadone can result in unpleasant withdrawal symptoms. Withdrawal occurs when your body adapts to a particular medication and needs it to function normally. Stopping suddenly causes your body to go into withdrawal. For that reason, it is essential to lower your methadone dosage gradually. This allows the body to slowly adapt to the absence of methadone and reduces the risk of a relapse.

Transferring Patients from Methadone to Buprenorphine

Like methadone, buprenorphine is an opioid. Buprenorphine is a “partial opioid agonist,” meaning that its effects are lower than full agonists such as methadone, morphine, and heroin.

  • Suboxone
  • Zubsolv
  • Bunavail
  • Probuphine
  • Sublocade

How Do You Taper Off Methadone Before Switching to Subutex?

When switching from methadone to Subutex, the amount of time taken to taper off from one medication to the next depends on several factors. Those factors include:

  • Your current dose of methadone
  • How long you have been taking it
  • How quickly you can comfortably taper off the methadone without experiencing withdrawal symptoms

What Dosage Do You Need to Taper To?

Your doctor will direct you on how much you will taper off of methadone and at what rate. Medical professionals typically recommend reducing at a rate of no more than 5mg per week or 5-10% of your dosage per week.11 You have to be off methadone for about 72 hours before starting on buprenorphine .11 This time will ensure that you will not have a severe reaction to switching medications and won’t experience extreme withdrawal.

Methadone vs. Subutex: Why Transition?

  • Buprenorphine tends to have fewer side effects than methadone and can be less addicting.
  • You take Subutex at home much sooner than methadone, so it is more convenient.
  • In some instances, Subutex can be prescribed and picked up at a pharmacy, making it easier to obtain and use.
  • You don’t need the structure of MMT, and you can take Subutex safely without supervision
  • There is a lower risk of overdose or sedation when taking buprenorphine rather than methadone
00:00 welcome to webisode 12 where we will 00:03 discuss 00:03 which is better methadone or 00:06 buprenorphine 00:07 i'm eric morris an addiction 00:09 psychiatrist with over 18 years of 00:11 experience 00:12 working in opioid treatment programs 00:15 many opioid treatment programs now offer 00:18 both buprenorphine 00:20 and methadone as maintenance treatment 00:22 options 00:23 leading us to ponder which medication is 00:26 best for each patient 00:29 many patients entering opioid treatment 00:32 programs 00:33 already know which medications they 00:35 prefer 00:36 based mostly on their own experience 00:39 and those of acquaintances 00:42 while patient preference is an important 00:45 factor in deciding which 00:47 opioid agonists to use 00:50 specific patient characteristics can 00:52 lead to providers 00:54 to favor one medication over the other 00:57 our job as treatment providers 01:00 is to provide the prospective patient 01:03 a menu of evidence-based options and to 01:06 serve 01:06 as their consultant for the best choice 01:09 for them 01:11 in a 2017 study lee at all 01:15 found that depo naltrexone 01:18 is as effective as sublingual 01:21 buprenorphine 01:22 for preventing relapses and retaining 01:25 patience and treatment 01:27 naltrexone can be difficult to start in 01:30 the outpatient setting 01:32 few patients presenting to opioid 01:35 treatment programs 01:36 can endure the withdrawal process 01:38 without relapse 01:40 so naltrexone is rarely an appropriate 01:43 medication 01:44 to start in the setting depot naltrexone 01:49 by the nature of its actions is more 01:52 commonly 01:53 and more easily started at the end of 01:56 inpatient treatment patients who desire 02:00 this treatment 02:01 can be referred to such programs 02:04 methadone as a full opioid agonist 02:08 has a heavier opioid effect 02:11 as the dose increases buprenorphine 02:14 reaches a ceiling on its opioid effect 02:18 at daily dose around 16 to 24 milligrams 02:22 per day 02:23 for this reason some patients find that 02:26 they still have some opioid withdrawal 02:28 symptoms 02:29 even at maximum doses of buprenorphine 02:32 these patients may feel better on 02:35 methadone 02:36 some practitioners feel patients using 02:40 heroin 02:41 which now often contains carfentanyl 02:44 won't do well on buprenorphine as on 02:47 methadone 02:48 but thus far there's no evidence to 02:51 predict 02:52 who will or won't 02:55 respond to buprenorphine methadone is 02:58 more dangerous 02:59 than buprenorphine in patients using 03:02 sedative 03:03 medications like benzodiazepines 03:05 barbiturates 03:06 gabapentin or alcohol those drugs 03:10 aren't safe even with buprenorphine the 03:12 risk is probably 03:14 less than with methadone patients 03:17 with co-occurring alcohol or sedative 03:20 use disorders 03:22 may be at lower risk for overdose 03:26 with buprenorphine compared to methadone 03:29 methadone has more drug interactions 03:31 with 03:32 other medications than buprenorphine 03:35 particularly with mental health 03:37 medications 03:39 methadone can interact with medications 03:43 prone to causing prolongation of the qt 03:46 interval patients with pre-existing 03:49 cardiac rhythm problems 03:51 may be at higher risk with methadone 03:54 than with buprenorphine depending on the 03:57 type of problem 03:59 methadone may still be the best 04:02 medication 04:03 for these patients but extra care and 04:06 monitoring 04:07 may be advisable patients with 04:11 respiratory illness 04:13 with co2 retention are 04:16 at higher risk with methadone 04:19 than buprenorphine as are patients with 04:22 untreated sleep apnea patients with 04:25 central sleep apnea 04:27 may be at risk with both medications and 04:30 a careful risk versus 04:32 benefit analysis with documentation in 04:35 the chart 04:36 is advisable if the practitioner decides 04:38 to proceed with treatment 04:40 with either of the two agonist 04:43 medications 04:44 unfortunately studies have consistently 04:48 shown worse treatment retention 04:51 for patients maintained on buprenorphine 04:54 compared to methadone methadone is 04:58 cheaper than buprenorphine and patients 05:00 without insurance coverage 05:02 for treatment may choose methadone over 05:05 buprenorphine 05:06 for that reason we will never have 05:10 one medication that's appropriate for 05:12 every patient with opioid use disorder 05:16 thankfully we now have three 05:20 fda medications available to choose from 05:24 we want patients to remain engaged in 05:26 treatment 05:27 so it's best to check with our patients 05:30 frequently to assess their response to 05:33 their medications 05:35 we also want to make sure it's easy as 05:37 possible 05:38 for patients to switch medications if 05:42 one isn't working well 05:44 if you have further questions please 05:47 feel free to contact your state 05:49 opioid treatment authority thanks again 05:52 for watching 05:54 and keep up the good work

Realistic Expectations

Tapering off of methadone to switch to Subutex takes time and cannot be rushed. It is essential to be patient with yourself and think of your long-term goals when switching. It is entirely normal to experience certain withdrawal levels when tapering off of methadone. Methadone tapering is typically done in clinic. It often takes up to a year, and  once you are tapered below 60mg there is a high risk for relapse. Your doctor will be there to help you transition in the smoothest way possible.

Having realistic expectations and a transition plan will help you successfully switch from methadone to a buprenorphine like Subutex. Your transition plan is one that you will create together with your doctor to feel confident that you will be able to transition with the least severe withdrawal symptoms possible.

Withdrawal Concerns of Transferring from Methadone to Buprenorphine

Switching from methadone to buprenorphine requires close monitoring. It is not done quickly or easily. Before taking buprenorphine, a person must be fully clear of methadone. Moving from a more potent opioid like methadone to a weaker one like buprenorphine/Subutex means that withdrawal symptoms may occur.

Withdrawal symptoms make the process potentially painful, psychologically difficult, and medically challenging. During this time of transition between medications, it’s possible to be more prone to relapse. The resulting withdrawals and cravings, though temporary, can increase the risk of opioid abuse.

Subutex Tapering

While Subutex is typically used as an element of addiction treatment and can assist individuals in tapering off methadone, stopping the use of Subutex also requires a tapering schedule. Although Subutex is not as addictive as methadone, it is still an opioid and still has the potential for dependence. Typically, buprenorphine tapering will occur after an individual has tapered off methadone. Your tapering goal can be reducing the chance of relapse or being substance-free.

It is important to taper off of Subutex because quitting cold-turkey can result in unpleasant withdrawal symptoms. As a general rule, you should gradually taper off Subutex by reducing your dosage by no more than 10-20% every one to two weeks. Overall, tapering off of Subutex can take anywhere from a couple of weeks to a couple of months.

Complete Detox from Methadone and Buprenorphine

The process of complete detoxification from the medications helps individuals become substance-free. Methadone and buprenorphine replace harmful substances with a safer alternative. Methadone and Subutex are also addictive and can lead to dependence. It is essential to taper off of both methadone and Subutex gradually. Typically, this occurs by first replacing methadone with Subutex and then tapering off of Subutex completely. This tapering is no quick and easy process. It is crucial to create a tapering schedule with your doctor that is realistic and will alleviate withdrawal symptoms.

The Benefits of Complete Detox from Methadone and Subutex

The most significant benefit of complete detoxification from methadone and Subutex is freedom. By returning your body to its natural state, you are not dependent on any medication to function. While taking methadone or Subutex is safer and healthier than abusing opioids such as heroin, they are also addictive and can have numerous side effects. For individuals who wish to be free from opioids, a complete detox may be a smart decision.

Some take methadone or buprenorphine indefinitely. Others dislike the notion of replacing one addiction (e.g., heroin) with another (e.g., methadone). Starting and stopping methadone or buprenorphine can be tough on the body because of unpleasant withdrawal symptoms. A complete detox will help your body to resume its normal functioning and allow you to pursue non-pharmacological therapy treatments such as psychotherapy.

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