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Chapter 8 - Looking ahead on methadone

From: Methadone Maintenance Treatment: Client Handbook

In this chapter:

  • How long will I be on methadone?
  • Tapering readiness
  • Methadone tapering
  • Changing your mind
  • After treatment ends

How long will I be on methadone?

This is one of the most frequently asked questions, and one of the most difficult questions to answer.

There are two different schools of thought concerning length of treatment for methadone clients. One approach looks at methadone treatment as long term, and possibly indefinite — like insulin treatment for the person with diabetes. Opioid dependence is explained as a biological disorder, and methadone is the medicine used to treat the condition.

The other approach looks at methadone as a short-term treatment. This approach sees opioid dependence as the result of the person's attempts to solve emotional problems with drugs. When the person who uses opioids learns to deal with problems in other ways, and his or her life becomes stable and happier, there is less reason to look to drugs for help. Methadone treatment is seen as allowing the person the chance to get well and get his or her life in order. Once this is accomplished, the person can then taper off methadone and progress toward a drug-free life. Short-term methadone treatment is usually one to two years.

There is truth in the ideas behind both long- and short-term treatment approaches. Opioid dependence does change the way the brain works in that it suppresses the brain's ability to produce our bodies' natural opioids, endorphins. People who withdraw from opioids, including methadone, may feel emotionally low and have trouble sleeping for months after withdrawal. It's also true that having a supportive home life, steady employment and a strong desire to be drug free can help make the period after withdrawal easier to get through, and less likely to result in a return to drug use.

You should know that those who withdraw from methadone after short-term treatment are more likely to return to drug use than those who stay in treatment. This is why many doctors and counsellors encourage clients to stay in methadone treatment for the long term.

Keep in mind that the dangers associated with injection drug use include a high risk of HIV and hepatitis C infection, increased likelihood of criminal activity and imprisonment, and the danger of death from overdose. The consequences of long-term methadone treatment, by comparison, are minimal. Long-term use of methadone has no effect on the internal organs, or on thinking. If methadone helps you to lead a normal, active and happy life, then it is well worth the inconvenience, the side-effects, and any possible stigma you may encounter from people who do not understand the nature of your treatment.

"I first started the methadone program when I was in my late 20s, now I'm 53. I never thought I'd live this long, much less be on methadone all this time. I've been on so long now, I don't even remember what my life was like before methadone."

"Once you're dependent on meth, you become an enthusiastic devotee; it's your best friend. I think that if you get the chance, you should try to quit while you're young and strong. The longer you're on methadone, the harder it is to quit. It's a highly addictive drug." — Sandy, 53, on methadone 24 years


"Everyone has their own experiences. I just want, once I am stabilized, to be tapered down. I cannot see this taking much time. I want to start living my life."

— Jill, 40, on methadone four weeks

Tapering readiness

If you think you might be ready to leave treatment, there are a number of questions you should ask yourself to help you make the decision whether or not you should begin the tapering process. Consider the following questions:

  1. Have you been abstaining from illegal drugs, such as heroin, cocaine and speed?  
  2. Do you think you are able to cope with difficult situations without using drugs?  
  3. Are you employed or in school?  
  4. Are you staying away from contact with users and illegal activities?  
  5. Have you gotten rid of your "works"/"outfit"?  
  6. Are you living in a neighborhood that doesn't have a lot of drug use, and are you comfortable there?  
  7. Are you living in a stable family relationship?  
  8. Do you have non-user friends that you spend time with?  
  9. Do you have friends or family who would be helpful during a taper?  
  10. Have you been participating in counselling that has been helpful?  
  11. Does your counsellor think you are ready to taper?  
  12. Do you think you would ask for help when you were feeling bad during a taper?  
  13. Have you stabilized on a relatively low dose of methadone?  
  14. Have you been on methadone for a long time?  
  15. Are you in good mental and physical health?  
  16. Do you want to get off methadone?  

The more questions you can honestly answer by checking "yes," the greater the likelihood that you are ready to taper from methadone. Consider that each "no" response represents an area that you probably need to work on to increase the odds of a successful taper and recovery.*

"My next step is to come off. Meth can be very hard to get off of, even if you're on it for a short time. The truth is, the longer you're on it, the harder it is to come off. I know I can do it, but I'm scared." — Margaret, 41, on methadone 10 years

Methadone tapering

The decision to taper off methadone is best made with the support of your doctor and counsellor, friends and family. If you've been on methadone for a long time, you may have stopped seeing your counsellor. Now is a good time to seek out the services of a counsellor once again. Feelings of fear and anxiety are common to clients as they get close to the end of treatment. The risk of relapse is increased. It's important that you prepare for the challenge by setting up a safety net of support.

Learning about what to expect throughout the tapering process can also be helpful in reducing anxiety. The more you know, the less there is to be afraid of.

Methadone tapering works best when done as a slow and gradual reduction in dose, dropping 5 mg every three to 14 days. At this rate there should be very few, if any, physical symptoms during the taper.

Once the dose is lowered to around 20 mg, the tapering may be slowed down to an even more gradual reduction, to reduce or eliminate any symptoms.

Nowadays, most methadone providers will allow you to choose the rate at which your dose is reduced. This gives you more control of the process, and lets you keep withdrawal symptoms to a minimum. The entire process should be given plenty of time. Expect at least six months to a year.

Regardless of whether you have been in methadone treatment for a short or long time, on a high or low dose, the process is the same, and the degree of difficulty in withdrawing is the same. All clients withdrawing from methadone find the most difficult stage is at the end of the taper. This is when you are most likely to have to tolerate some symptoms of withdrawal.

Withdrawal from methadone comes on more slowly and may last longer than withdrawal from opioids such as heroin or OxyContin. With tapering, the withdrawal symptoms should be minimal, but you can expect some aching, insomnia and lack of appetite. These symptoms should go away within 10 to 14 days, but beyond that, you may still feel a sense of loss, sadness and sleeplessness that may go on for several months.

Relapse, or return to drug use, is all too common at this time. It's important to recognize the things that might trigger you to use again before it happens. Stay away from old haunts and old friends from your using days. Call on your non-using friends, family or counsellor if you're feeling low, or frustrated or stressed. Keep in mind that after you've been off opioids for a while, your tolerance to their effects is lowered, meaning that what used to be a normal dose is now an overdose. Watch you don't become a sad statistic. Be careful.

Changing your mind

Keep in mind that you don't have to go off methadone. You can change your mind and return to treatment at any point in the tapering process. Maybe you're not ready yet, maybe you'll be ready at a later time, maybe you'll never be ready. Staying on methadone can be the right choice for some. It's up to you. A return to treatment is not a failure. If the choice is between being on methadone, or risking a return to a dangerous drug habit, stick to the methadone — it's better for you. It's better for everybody.

After treatment ends

If you decide to go through with the taper, and you stop taking methadone, it may still take a while for your body to adjust from long-term opioid use. Some people have trouble sleeping, and may feel low. This can go on for as long as months after the end of the taper. During this period it is important to maintain and extend your support. Some find that becoming involved in support groups such as Narcotics Anonymous can help provide the extra strength to stay firm in your decision to be drug free. Individual counselling can also help.

Recovery from drug abuse is not an instant fix. It takes time; it's a process. What works for you may or may not work for someone else. The important thing is to find your own way, and get headed in the right direction.

*Tapering Readiness Inventory from Treatment of Opiate Addiction With Methadone: A Counselor Manual, U.S. Department of Health and Human Services (DHHS) SMA94-2061 

(From S. Brummett, R. Dumontet, L. Wermuth, M. Gold, J.L. Sorensen, S. Batki, R. Dennis & R. Heaphy (1986), Methadone Maintenance to Abstinence: The Tapering Network Project Manual, University of California, San Francisco).