Tapering Off Methadone and Suboxone
Tapering off Methadone and Suboxone
Addiction is a complex condition that affects an individual's whole life. The circumstances that lead to addiction are all unique and can range from childhood trauma to experiencing a severe accident or injury. Approximately 20 million people in the United States have a substance use disorder, and because the circumstances of substance abuse are unique to each individual, treatment and recovery is as well.1
Substance abuse treatments are not one-size-fits-all. Opioid addiction, for example, is one of the most challenging addictions to address. Many people who stop using opioids take methadone or Suboxone to replace the opioid and lessen withdrawal symptoms. Methadone and Suboxone, however, also have a risk of abuse and dependence. Therefore, to become completely free from opioids, you will have to taper off both methadone and Suboxone. Typically, the first step is tapering off methadone onto Suboxone and then tapering off Suboxone to be substance-free.
Stabilizing Challenging Patients
Some addiction treatment facilities specialize in using methadone tapering and suboxone tapering to stabilize the patient before transferring them to a long-term treatment facility. Stabilization can include tapering methadone dosages down to levels that typical rehab centers will accept. It can also mean shifting the patient from methadone to Suboxone.
Often stabilization requires patients to eliminate all medications used in maintenance therapy, which can mean methadone and Suboxone 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.
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 too many withdrawal symptoms.2 When to treat symptoms of a substance use disorder, a doctor must prescribe methadone. A clinic administered the methadone daily to monitor the process. Methadone can be highly addictive on its own, so for that reason, it is not typically prescribed for at-home usage.
What are the Side Effects of Methadone?
As with all drugs, there are potential side effects that you might experience as a result of use. Some of the possible side effects of methadone are:
- Constipation
- Dry mouth
- Difficulty urinating
- Difficulty falling asleep or staying asleep
- Flushing
- Headache
- Itchy skin
- Mood changes
- Restlessness
- Sore tongue
- Stomach pain
- Sweating
- Vision problems
- Weight gain
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 persons' overall treatment plan and is combined with therapy or counseling. Methadone works in substance abuse treatment because it blocks the feeling of high that you might get from substances such as:
- 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. That is where methadone comes in, helping with the transition from the substance without too many withdrawal symptoms, thereby reducing the risk of relapse.
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. A visit to see my keyworker, who had been giving me my script, confirmed that methadone was highly addictive and not easy just to stop taking, and I would need a "detoxification."3
Is Methadone Maintenance Therapy Effective?
With decades of use as a treatment for opioid addiction, methadone maintenance therapy (MMT) has proven effective.4 For example, 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.
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. In two years, my script my methadone script had doubled. I couldn\'t go on like this.6
Donna started methadone detox and never looked back. She saved her marriage, daughter, and self-respect with a methadone detox.
Suboxone
What is Suboxone?
Suboxone is a combination medication. Suboxone includes both buprenorphine and naloxone.6 Buprenorphine is an opioid typically used to combat opioid disorder, and naloxone is a medication used to reverse the effects of an opioid overdose. Suboxone discourages misuse because when taken as instructed, you will feel the effects of buprenorphine, helping you manage your withdrawal symptoms. However, if abused by crushing it up and being injected, you would experience very unpleasant withdrawal symptoms. For that reason, Suboxone 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 Suboxone?
Suboxone is considered a safer alternative to methadone. It is also considered a safe replacement for harmful opioids such as heroin. However, Suboxone is still comprised of an opioid and therefore also carries a risk of addiction. Along with the side effects that you may experience from taking Suboxone, you can also become dependent on Suboxone and risk developing a substance use disorder. Additionally, quitting suboxone cold-turkey can result in withdrawal symptoms that put you at the risk of a relapse.
What are the Side Effects of Suboxone?
Side effects of Suboxone include:7
- Constipation
- Drowsiness
- Headache
- Insomnia
- Mouth numbness
- Mouth pain
- Redness of the mouth
- Trouble concentrating
- 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
What are the Side Effects of Suboxone?
Side effects of Suboxone include:7
- Constipation
- Drowsiness
- Headache
- Insomnia
- Mouth numbness
- Mouth pain
- Redness of the mouth
- Trouble concentrating
- 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
Suboxone 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 [Suboxone] 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 using 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 Suboxone maintenance program.
The experience was a nightmare for myself and people close to me.8
Tapering
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. Suddenly stopping causes your body to go into withdrawal. For that reason, it is essential to lower your methadone dosage gradually. That allows your body can slowly adapt to the absence of methadone and so that you do not put yourself at risk of relapse.
Transferring Patients from Methadone to Buprenorphine
In 2002, the FDA approved the drug buprenorphine for use in the treatment of opioid addiction.9 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.
Buprenorphine comes in several forms, such as sublingual tablets, films that melt in the mouth, and injections. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), buprenorphine is available under the following names:10
- Subutex
- Suboxone
- Zubsolv
- Bunavail
- Probuphine
- Sublocade
How Do You Taper Off Methadone Before Switching to Suboxone?
When switching from methadone to Suboxone, the amount of time it takes to taper off 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 methadone dosage to less than 30mg a day and 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 Suboxone.11 This time will ensure that you will not have a severe reaction to switching medications and won't experience extreme withdrawal.
Methadone vs. Suboxone: Why Transition?
- Suboxone tends to have fewer side effects than methadone and can be less addicting
- You take Suboxone at home much sooner than methadone, so it is more convenient
- In some instances, Suboxone 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 Suboxone safely without supervision
- There is a lower risk of overdose or sedation when taking Suboxone rather than methadone
Realistic Expectations
Tapering off of methadone to switch to Suboxone takes time and cannot be rushed. It is essential to be patient with yourself and think of your long-term goals when switching to Suboxone. It is entirely normal to experience certain withdrawal levels when tapering off of methadone. 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 Suboxone. 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 means that withdrawals 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.
Suboxone Tapering
While Suboxone is typically used as an element of addiction treatment and can assist individuals in tapering off methadone, stopping the use of Suboxone also requires a tapering schedule. Although Suboxone is not as addictive as methadone, it is still an opioid and still has the potential for dependence. Typically, suboxone 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 Suboxone because quitting cold-turkey can result in unpleasant withdrawal symptoms. As a general rule, you should gradually taper off Suboxone by reducing your dosage by no more than 10-20% every one to two weeks. Overall, tapering off of Suboxone can take anywhere from a couple of weeks to a couple of months.
Complete Detox from Methadone and Suboxone
The process of complete detoxification from the medications helps individuals become substance-free. Methadone and Suboxone replace harmful substances with a safer alternative. But, methadone and Suboxone are also addictive and can lead to dependence. For that reason, it is essential to taper off of both methadone and Suboxone gradually. Typically, this occurs by first replacing methadone with Suboxone and then tapering off of Suboxone 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 Suboxone
The most significant benefit of complete detoxification from methadone and Suboxone is freedom. By returning your body to its natural state, you are not dependent on any medication to function. While taking methadone or Suboxone 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 Suboxone indefinitely. Others dislike the notion of replacing one addiction (e.g., heroin) with another (e.g., methadone). Starting and stopping methadone or Suboxone 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.
Resources
- https://www.ncbi.nlm.nih.gov/books/NBK424859/
- https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder\
- https://thebasementproject.org.uk/addiction-recovery-stories/addiction-recovery-stories-colin/
- https://www.cdc.gov/vitalsigns/MethadoneOverdoses/
- https://www.nasmhpd.org/sites/default/files/TAC_Paper_5_508C_0.pdf
- https://thebasementproject.org.uk/addiction-recovery-stories/addiction-recovery-stories-donna/
- https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Methadone%C2%AE
- https://www.tandfonline.com/doi/abs/10.3109/10826089709039361?src=recsys
- http://www.usersnews.com.au/home/2019/7/9/clydes-story-riding-the-detox-rollercoaster
- https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/buprenorphine
- https://www.karger.com/Article/Fulltext/350373
- https://pubmed.ncbi.nlm.nih.gov/23199896/
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